Making Human Resources the Priority in Global Healthcare Development
Dr. Michelle Morse fights for the infrastructure to support crucial training in surgical care in places like Haiti
Dr. Michelle Morse is a powerful influence in building a high-quality medical workforce in Haiti. She is a hospitalist at Brigham and Women’s Hospital, and a clinical instructor and affiliate in the Department of Global Health and Social Medicine at Harvard Medical School. As deputy chief medical officer at Partners in Health, she works tirelessly to support clinical services and medical education systems at University Hospital in Mirebalais. She is also founding co-director of EqualHealth, a nonprofit dedicated to providing quality medical and nursing education in Haiti.
I caught up with Dr. Morse between speaking engagements and her direct training work to ask her a few pertinent questions about what needs to happen next in global health to bring about the kind of parity she’s been fighting for so vigilantly.
Lisa: Hi Dr. Morse. First off, you do an amazing amount of work to help train the medical community in Haiti. What have you seen are the biggest challenges to doing that, and to providing high-quality care in developing countries?
Michelle: Hi Lisa. What I have seen as one of the most challenging things is figuring how to ensure provision of surgical care in resource poor settings. Working in Port-au-Prince, Haiti, after the earthquake, so much of what we saw were surgical emergencies. And to build quality surgical care, the number one priority is to have the right human resources, which isn’t easy. One of the biggest problems is that there are no clear human resources health targets from the WHO; for example, how many OBGYNs countries need per population, or how many anesthesiologists are necessary for providing good surgical care. Part of the problem determining those targets for human resource services is that we don’t have the infrastructure set up to train people in surgical care. My vision for global health is to use that understanding of the essential need for well-trained human resources to advocate for training programs that train health professionals to provide the surgical care necessary. Any other needs, from reliable medications to finding spaces to administer healthcare, should follow from there.
Lisa: You are an amazing advocate for high-quality medical education in poor countries. What are some of the ways you see the organizations you work with –Partners in Health or EqualHealth — and organizations like Physicians for Peace best fostering that education?
Michelle: I’ll give you the example of what we do at EqualHealth. I helped found the organization as a connector to share resources from well-experienced teaching hospitals in the U.S. with up-and-coming teaching hospitals in Haiti. The most important thing is to directly connect individual faculty members to get them engaged in building training systems, often outside the political quagmire of the institutions themselves. We’ve been doing that for the last five years. I find that’s a great way to go, to partner NGOs directly with public hospitals in poor countries to get them engaged. We look for faculty members in the U.S. who are interested, and show them the need in places like Haiti. The partnership starts on a foundation of equity, where the U.S.-based faculty member has skills, and the hospital in Haiti says, ‘this is where we need you to help.’ That creates a dialogue on how we can use U.S. expertise directly toward building care delivery.
Lisa: That sounds like an amazing plan. The question is, what is the best way to recruit those U.S. faculty members?
Michelle: For recruiting, that’s where having the right communications strategy comes in. If you’re looking for partners that engage in global health based on the principles of equity and individual contribution and driven by the actual needs on the ground, you are looking for a specific subset of faculty members. You have to go to places where progressive faculty members and nurses go, and that might not be the typical global health conferences, which are often focused on U.S.-driven research versus actually building health systems and training programs in countries that need them. You have to be very thoughtful about choosing partners that believe in this country-led approach. I hope over time that all global health will be handled in this way, but for right now there is no standard with how academic institutions engage in global health, no clear principles, ethics or moral guidance in how they engage. I wrote an article about it. https://www.devex.com/news/how-to-end-a-neocolonialist-approach-to-global-health-training-84742
Lisa: Great, agreed. And then, once we have partners we’ve found who are willing to be ethical, and we’ve partnered them with institutions on the ground, what’s the best way to build practical training programs?
Michelle: We have to take as our model the high-quality residency training programs in the U.S. if we want to build a healthcare workforce globally and if we want to meet surgical healthcare needs globally. We have to invest in local human resources. What I would love is for our surgical colleagues to step back and think about making a shift from short-term “mission” trips, which do not transform or change things, and instead contribute toward building knowledge and skills of those who are left with the everyday work when the doctors from the mission trips are gone. We don’t have a specific model yet for longitudinal training that allows local doctors to lead the education of the next generation of care, but we have to understand that doctors in this country didn’t learn to be doctors through lectures. We have amazing mentors and faculty members who lead rounds with us. The big challenge is creating and developing, in an iterative and organic way, a model to provide mentors for every person who is part of the surgical process, from anesthesiology to scrub nurses.
Lisa: I absolutely agree, and that is what we’re looking for also, that model. One of the things we’re looking at is technology to fill that gap between when doctors can be there, in country, for training, and after they leave. What is your feeling about that use of technology?
Michelle: I absolutely believe that technology has huge transformative potential, and is one of the major solutions to the health challenges and communication challenges in developing countries. One of the biggest barriers is that often the majority of places we’d want to use technology for remote lectures and consultations don’t have the infrastructure, reliable electricity or fast Internet to accommodate it. But I see that as a huge reason to advocate for the building of such infrastructure. Access to information and communication is becoming a global right. Without reliable electricity and Internet, you are completely cut off from places that are 50 years ahead in clinical care. In teaching hospitals in 2016, if we’re not talking about that as a major injustice and something that has to change on a major scale, we will be in the same place in 10–15 years. We have to use the word ‘Justice.’ We have to use strong language to get folks to engage in that fight and to invest in infrastructure.
“I absolutely believe that technology has huge transformative potential, and is one of the major solutions to the health challenges and communication challenges in developing countries.”
Lisa: Speaking of that word, of ‘Justice,’ I love what Partners in Health says about your mission, which is both “medical and moral.” Can you speak to that a bit, the idea of a global health organization being an ‘antidote to despair’? How do you navigate the morality piece, making sure to avoid the sort of colonialism accusations that can arise when going to aid poor countries?
Michelle: Partners in Health has always been a leader in fighting for health as a human right. We helped to inspire a lot of other organizations to use that language, to use language around ‘justice,’ ‘equity,’ ‘health as a human right.’ The more we use that language, the more successful we will be at ensuring access of care to everyone, at galvanizing the bureaucrats and the leaders of healthcare to make the structural changes we need. I believe we can achieve health equity. We have the technology to do it; there’s really just an implementation gap that’s preventing it. We have to structure access to healthcare to allow it to reach the poorest, the most vulnerable and the sickest in places like Haiti, but also in the U.S.
Lisa: Thank you so much, Michelle, for your time and your tireless work in global health.
Michelle: Thank you Lisa!
