TMC PULSE

t m c » p u l s e | n o v e m b e r 2 0 1 5 18 18 To combat the so-called "brain drain," Baylor and BIPAI teamed up with the University of Botswana to found a medical school. Major Bradshaw, M.D., formerly dean of student affairs and education and senior vice president at Baylor, served as the founding dean and lived in Botswana for three and a half years. Bradshaw described a strict curriculum to prepare students for working independently early on in their careers. "They graduate from medical school, they do an internship and then they're assigned by themselves to a remote village," he said. "They have to be able to deal with whatever comes through their door." For the first year, Bradshaw was the sole medical school faculty member. By the time he left, the school had 26 faculty members. The first class of the Botswana School of Medicine gradu- ated in October 2014. This need for doctors inspires the work of another TMC initiative: the Global Women's Health program operated by Texas Children's Hospital and the Baylor Department of Obstetrics and Gynecology. The program is based in Malawi, where there were 12 OB-GYNs for a country of over 13 million people when it was founded in 2012. The Global Women's Health program aims to change that by training Malawian doctors in their own country. "They will then train the coming generations and at some point, they won't need us," said Michael Belfort, M.D., Ph.D., obstetrician and gynecologist-in-chief at Texas Children's and chair of the department of obstetrics and gyne- cology at Baylor. "That's the goal." There are currently 12 residents in training, which means when all are fully trained, the num- ber of OB-GYNs in the country will double. "[The residents] are already thinking about how they can give back to the program and keep it going," said Susan Raine, M.D., vice chair of Global Health Initiatives at Texas Children's and an associate professor in the department of obstetrics and gynecology at Baylor. "In five or 10 years, we hope they want us to be there, but we don't want to be needed." In July, the program initiated the Global Women's Health Fellowship. In Malawi, the fel- lows learn and provide care in ways they never will here in the United States. Obstetric fistula, for example, is a condi- tion caused by prolonged or unattended labor that results in incontinence. While it is almost unheard of in the U.S., it is commonplace in many parts of the world. "In all of my training in this country, I saw it twice," said Raine. "In Malawi, our doctors will do maybe eight of these surgeries a week. Even though we don't see it here much, it still enhances the skill sets of our trainees coming back to practice here." The Global Women's Health program also works to increase the resources available to doc- tors in Malawi. A current objective is to establish a laparoscopic surgery program. "One of our goals is to create an environment where doctors want to stay in Malawi because they have those tools," Raine said. "Right now, they haven't had the ability to gain and maintain the equipment. People can donate, but if it breaks and there's no one to fix it, the program stops." Rebecca Richards-Kortum, Ph.D., Rice University's Malcolm Gillis University Professor and professor of bioengineering, made a similar observation. "If you had a big checkbook and could just buy all the same devices we use in Houston, you would find those devices stop function- ing because they break or you don't have the resources to use them safely and effectively," she said. "You need to design for the environment where you actually need to use the technology." Designing for low-resource environments is a cornerstone of Richards-Kortum's work as director of the Rice 360˚: Institute for Global Health Technologies. Since 2007, Rice 360˚has been working in Malawi to engineer innovative solutions to health problems, with an empha- sis on pediatric technology. Working with the Queen Elizabeth Central Hospital in Blantyre, Rice 360˚ developed a continuous positive airway pressure (CPAP) device to help prema- ture infants in respiratory distress. Traditional CPAP machines cost close to $6,000 and require infrastructure not available in Malawi. The prototype Rice 360˚ built cost $160. "We worked with physicians at Texas Children's Hospital to show that it did deliver the right amount of flow and pressure, and we carried out a clinical evaluation of it at Queen Elizabeth Central Hospital," Richards-Kortum said. "We were able to show that for the prema- ture babies with respiratory distress, survival improved from 24 to 65 percent." The device is now being used at 28 hospi- tals in Malawi, as well as hospitals in Tanzania, Zambia, South Africa and a number of other African and Southeast Asian countries. Rice also offers a minor in global health technology. Students work in teams to tackle a design challenge with the goal of developing a prototype by the end of the semester to take back to Malawi. "Often when you hear about global health disparities in the news, it's hard to understand Left: An ambulance is prepared to transport complicated cases from a Ugandan village. Right: A lab worker in a clinical center of excellence at Mulago Hospital, Uganda.

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