Empowering cardiovascular education and care in Haiti.
Haiti has a major deficit of healthcare professionals. In 2019, there were 3,354 physicians for more than 11 million people. Most physicians in Haiti are general practitioners. There are about 8-10 medical schools in Haiti, the majority of which are in Port-au- Prince. After medical school, students don’t have many choices in terms of training due to the lack of training hospitals (there are about 6 training hospital, but 2 of them provide training only in OBGYN, and Family medicine). 50% of those teaching hospitals are in the capital. The limited number of healthcare providers and the concentration of health centers in Port-au- Prince results in limited access to healthcare for most of the population. To address the growing cardiovascular epidemic in Haiti and the limited number of specialists, standardized and equitable access to education should be a goal for leaders in the country to improve patient care. The Development of a standardized curriculum, growing international network of professionals, and virtual learning can help to address the gaps and disparities in medical education in Haiti. This is what a group of Haitian cardiologists in training or practician cardiologists have decided to achieve by having a non-profit organization; ICARD-HAITI; which started to provide and implement a standardized cardiovascular disease curriculum through a Global Medical Education Network organization. Via a virtual curriculum, for the first time ever, all IM, EM, and FM residents in Haiti were able to have access to a uniform and equally accessible educational resource created and delivered by a global network of experts, and professionals, many of whom have personal ties to Haiti. What was this pilot project about?
The pioneer is of the idea of implementing this virtual cardiology training in Haiti is Dr. Norrisa Haynes, a senior cardiology fellow at the University of Pennsylvania (UPenn) who attended Yale University for her undergraduate studies where she received a Bachelor of Science (BS) in Molecular and Cellular Biology. She went on to complete her medical school and internal medicine training at Columbia University College of Physicians and Surgeons. During medical school, she received a Master of Public Health (MPH) from Harvard University. After residency, she worked for Partners in Health (PIH) in Haiti for 2 years at Hôpital Universitaire de Mirebalais (HUM) as a junior attending. During those two years, she also worked as a Harvard Medical School instructor and Brigham hospitalist. After spending 2 years in Haiti, she started cardiology fellowship at UPenn. She is interested in imaging and is currently obtaining a Master of Science in Health Policy. Dr. Haynes is a member of the ACC/AHA joint guidelines committee and is a member of the ACC FIT Women in Cardiology group (WIC). Dr. Haynes also serves on the board of the Association of Black Cardiologists (ABC). She is the first author of the manuscript published in June 2021 in the British Medical Journal with the title Implementation of a virtual international cardiology curriculum to address the deficit of cardiovascular education in Haiti: a pilot study.
When asked about her reasons of working on the project, she reports “my time in Haiti was life changing. I was struck by the beautiful culture, rich and admirable history, and warm hospitality. There is so much beauty in Haiti, however, the social, economic, and health disparities were glaring. My time in Haiti reaffirmed my desire to pursue a career in cardiology given the high prevalence, morbidity and mortality associated with CVD in the country. Nearly 50% of adult suffer from hypertension. The
prevalence of diabetes and stroke are also very high. I am passionate about health equity and justice not only in the United States but also internationally. There is much work that needs to be done to achieve health equity in Haiti. Observing the global disparity in medical care and medical education has motivated our team to start an organization called Global Medical Education Inc which has the mission of addressing the global disparity in medical education and patient care globally.”
This initiative started to address a need for improved specialized patient care and cardiovascular education. About 1/3 of all deaths in Haiti are due to cardiovascular disease (CVD). Haiti also has the second highest incidence of peripartum cardiomyopathy in the world but has fewer than 20 cardiologists for a population of nearly 12 million people. There are no cardiology fellowship programs in Haiti. To obtain specialized training, physicians must leave the country and pursue training elsewhere. Thus, the responsibility to care for patients with CVD falls on internists and general practitioners (GPs), who often do not have access to optimal cardiovascular education. Her team started the ICARDs-Haiti curriculum (International Cardiology
Curriculum Accessible by Remote Distance Learning) and wrote a peer-reviewed published article to show that grassroots, international, collaborative, and virtual educational initiative could provide effective and
equitable access to education to providers in low-income countries with the goal of improving patient care. Essentially, the paper showed that participant performance analysis revealed that 80% of the curriculum demonstrated a positive trend in knowledge acquisition postintervention. Based on the end of the year evaluation. In addition, 94% of participants reported that the curriculum was educational and relevant to medical practice in Haiti and 100% reported that the curriculum was good to excellent.
Additionally, the curriculum and digital platform were cited as an effective means of maintaining trainee education during the COVID-19 pandemic. The review concluded by showing that the application of the Analysis, Design, Development, Implementation and Evaluation instructional framework (ADDIE) enabled a methodical and iterative approach to the development and implementation of an international curriculum and partnership among Haitian, American and French health professionals in the design, development and implementation of the curriculum helped to ensure that the curriculum was applicable to providers in low resource settings such as Haiti.
The Global Med Ed network team is composed mainly internists trained in Haiti who have detected a deficit in medical training and particularly at the level of cardiology in Haiti and have decided to focus on tele-education as an initial and palliative measure. After the success of this pilot project, the team has already started with an implementation to national level, in all medical residency programs domestic and family medicine nationwide. Each training program in Haiti faces its own challenges and the team
work closely with chief residents, program directors that allows them to know the problems and gaps faced by residents in their learning and provide them with a content adapted to their reality. The final goal is to reproduce the same example in other specialties that are not provided in Haiti. For a successful national implementation, a real collaboration with MSPP via the department of Training and Development in Sciences of Health (DFPSS) as well as all the residency and training leaders are crucial. The challenges are tremendous, but knowledge is power. With other support, the team hope to deliver a tremendous support to the cardiovascular system in Haiti.
Garly R. Saint Croix, MD
Interventional Cardiovascular Disease Fellow
Columbia University Division of Cardiology at
Mount Sinai Medical Center of Florida