Thanks but No Thanks

Last week I attended the inaugural symposium of the Center for Global Health of the Massachusetts General Hospital (MGH), which is also know around these parts as “Man’s Greatest Hospital” and as the bigger half of Partners HealthCare.  Partners is Massachusetts’s heavyweight of health care ($7 billion in annual revenues; 44,000 employees; 22% of all billings in eastern MA; and a $700 million building boom underway; Boston Globe 2009).  It’s also a research powerhouse ($600 million in NIH funding in 2009, NIH RePORT) and the object of a Justice Department anti-trust investigation for possible conclusion with insurers (Boston Globe 2010).

The MGH Global Health Center was launched this year with a mission of providing “leadership and support at MGH to reduce health disparities for the world’s most vulnerable and crisis-affected populations through education, research and service” (MGH Center).  It seems that having a global health center/program is popular among universities and hospitals these days.  Locally, Boston University started one this year (CGHD) and Harvard has its Institute for Global Health (HIGH), and Paul Farmer, one of the symposium speakers, said he was aware of more than 100 such academic programs.  The symposium’s title, “Broadening the Response: The Role of Academic Medical Centers in Global Health”  (MGH Symposium) led me to think there would other academic medical centers represented (there are at least five more in Boston alone), but it seemed not the case.  Dignitaries abounded though, and the morning line-up consisted of our own illustrious Senator John Kerry; Paul Farmer, Co-Founder, Partners in Health; Eric Goosby, US Global AIDS Coordinator; Walter T. Gwenigale, (now former) Minister of Health and Social Welfare, Liberia; and a handful of the Center managers.

The audience was large (about 1000), attentive (coffee and pastries preceded), and young (due to the high interest in the topic among the Boston area’s many students and postdocs).  The no-cost helped (thanks).   Senator Kerry was, well, senatorial and urged all to help the wider public realize the value of the US government’s modest spending in global health.  Dr. Farmer made the point, possibly lost on the meeting’s organizers, that all of the 100-plus academic global health programs emphasize research and training and not service, which is needed the most.  He also said, again perhaps lost on the organizers, that improving the working conditions and tools for health workers in impoverished areas was more important than training.  Dr. Goodsby spoke in governmental policy-ese, nice phrasing but lacking substance:  customer response will result in effective allocation [but the “customers” have no choice but to take what’s available], the goal is a self-correcting system [but will only happen if there are options], we have “research to innovation to measurable impact” and are moving beyond pilot studies to implementation on the national level [who and how?].   Dr. Goodsby’s parsing came in handy though when during his question period a spokesperson for a large group that stood up asked him if he will stand with them to insist that President Obama keep a campaign promise to add a certain amount (I forgot how many more billions) to AIDS treatment funding.  I guess this group feels that more money means proportionately more care despite good evidence to the opposite (my post of 4/14/10).  Dr. Goodsby did not stand but gave an extended answer.

My favorite speaker was Dr. Gwenigale who was both plain-spoken and inspiring, both as a member of the first elected administration after Liberia’s back-to-back civil wars (1989-2003, Wikipedia article) and as someone who has worked hard to improve what many would think was an impossible situation.  He mentioned a number of specifics:  increasing Liberia’s annual per capita health spend from $3 to $29 (it’s more than $6000 in Massachusetts), upping the salaries of docs from $100 to $1000 per month to reverse the brain drain (I’m guessing that Dr. Bangsberg, the MGH Center director, makes at least $1000 per day), instituting a national cap on health worker salaries to prevent the NGOs from recruiting them out of the public sector, and subsidizing health care workers who agree to work in rural areas.  In answer to a question, Dr. Gwenigale mentioned the country’s “health funding pool” through which all donors funds were administered with full accounting and transparency to the donors and that the US doesn’t contribute to the fund, preferring to give contracts to US organizations who then work in Liberia, but “it’s not coordinated with government and not good for us.”  I also noted he said that his ministry is struggling with implementing known health care practices, they know what works and what to do (maybe they don’t need the training offered by MGH).

I did not stay for the afternoon speakers which included one of my favs, Kristian Olson of the Center for the Integration of Medicine and Innovative Technology (Olson CIMIT), and another celebrity, Dr. Vanessa Bradford Kerry, the senator’s daughter and Associate Director for Education and External Affairs of the Center.  So my perspective may be biased, but based on what I heard, MGH/Partners should rethink the Center and its mission to reduce “health disparities” through research, education, and service, the first two of which seem self-serving.  Maybe a donation to Liberia’s health funding pool or increasing Partners’ participation in the Boston Health Care for the Homeless Program (BHCHP) would be a better use of the Center’s budget.


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