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Physician and epidemiologist
"high-quality, low cost population medicine"
I am an epidemiologist and physician trained in internal medicine and pediatrics who currently conducts implementation science research on strategies to improve the delivery of evidence-based healthcare interventions in settings of extreme poverty. My work currently is focused on the implementation and evaluation of integrated healthcare delivery interventions. The laboratory for my work in this area is rural Far Western Nepal, over thirty hours outside of the capital of Kathmandu, where most of the national healthcare resources and talent lie. There, our organization, Possible (previously known as Nyaya Health), runs a public sector district hospital and manages surrounding community health workers under a public private investment partnership agreement with the Nepali government. We are studying interventions aimed at improving institutional birth rates, the implementation of child healthcare services, surgical care delivery, the financing of public sector services, iatrogenic harm, and care coordination of chronic diseases.
Across the globe, under-five mortality in low-income countries has dropped from 90 deaths per 1000 live births to 50 today. Even with this decrease, we still have hit stubborn "implementation gaps" in impoverished communities that threaten our abilit
As a note: we took much of our inspiration for our current group prenatal care intervention from Centering, and our lead physician consultant/researcher on that program (Sheela Maru) is an OB/GYN who learned the rigorous Centering Pregnancy approach during her residency at Boston Medical Center. We actually met with Sharon Rising (midwife who founded Centering) prior to designing the group ANC and in fact during our conversation with her she herself spoke about their work around Centering Parenting for early child care. That conversation helped spawn the present idea. We couldn't apply Centering for group prenatal care precisely owing to challenges within our own context, but have used many of its principles and the literature supporting it.
Developmental disabilities are a major, growing, and neglected field in Nepal, and I am excited by your efforts. A few comments/suggestions: 1) The case needs to be made that the government must invest in individuals with developmental disabilities. You will not achieve scale without government buy-in. You should start presenting your ideas now to Child Health Division and Family Health Division in Teku and get their input into design phase. 2) The group in Banepa HRDC is impressive and has pioneered cerebral palsy care for children, both operative and non-operative management. It is worth dialoguing with them if you have not already. 3) Be very cautious with the structure and financing of the health camps you mention. Although common in Nepal and elsewhere, they have very limited utility, and substantial harm, in achieving better access to healthcare. They introduce the wrong kinds of incentives for both providers and patients. For the most part, the focus of visiting teams should be on training up local providers to deliver care on an ongoing basis.
Great ideas, and I wish you the best of luck in achieving improved access to care for children with developmental disabilities.