Better heart health through education: Q&A with Gene F. Kwan, MD, MPH
May/June 2024 | Volume 23 Number 3
Photo courtesy of Gene F. Kwan Dr. Gene F. Kwan, shown here attending to a patient in Haiti, has also worked in Rwanda, Malawi, Liberia, and India.
Dr. Gene F. Kwan, a cardiologist and global health researcher, is an assistant professor at Boston University’s Chobanian & Avedisian School of Medicine. Since 2008 he’s worked in rural Rwanda and Haiti collaborating with each country’s ministry of health as well as with the organizations Partners In Health and Zanmi Lasante. He’s worked on projects in Malawi, Liberia, and India. He’s presented research and featured as a speaker at several American Heart Association conferences. He serves as a non-communicable diseases advisor for Partners In Health and is co-author of “The Partners In Health Guide to Chronic Care Integration for Endemic Non-Communicable Diseases.”
Why did you choose medicine and public health?
Being a doctor started with wanting to help people on an individual level—my mother was a nurse and I saw how important it was for her to make that contribution to other people's lives. I didn't really think about public health until I was in medical school and had experiences in other countries. Then I was able to see firsthand how medical care was delivered and, more specifically, how medical training was executed. It made me feel very fortunate for the education I had. I saw there weren’t the same opportunities for people in other parts of the world—or other parts of the country—just by virtue of the randomness of where people are born. There's inequity there. Through my work and research, I want to improve access to care not only by helping patients but also by helping providers.
What’s special about Partners In Health?
A lot of it is said in the first word of the name—"partners.” They very much collaborate with other organizations, other people, and even policymakers to help them and to understand what barriers and challenges they're facing. Partners In Health also has a tremendous interest in research and scientific discovery. Through its collaborations, it has tried to build the research skills of the clinicians and the health administrators. Partners In Health has even addressed social barriers that impact health, for example, by teaching people how to become carpenters or help with agricultural and improve farm yields. The organization focuses on rural areas of the countries in which it works. Such areas lend themselves to innovative ideas about improving access to care for patients who are most in need.
Did you work with Paul Farmer?
One of the last things he told me was “Don't forget Haiti.” Haiti is a very challenging place, particularly now, and it's easy to get disheartened about lack of progress or false starts or the barriers. But there are patients there who need help. There are providers and other partners there who are going above and beyond every day to make sure that patients get the care they need. We need to continue to collaborate in places where it’s difficult.
Tell us about your NIH-funded projects.
Oftentimes, as we've seen in Haiti as well as in Rwanda, there are a lot of patients admitted to the hospital with heart failure because the quality of care they initially received was limited. Some of that is due to the training and education of the clinicians… but in other cases, it’s because patients themselves face barriers.
My study funded by the National Heart, Lung, and Blood Institute (NHLBI),
Identifying facilitators and barriers to heart failure care in Haiti to adapt a community-based intervention, aimed to understand the barriers patients face. Many patients were not returning to the clinic after a first diagnosis with heart failure, so we wanted to understand why and how we might change that. Patients take two days off from work, walk to a far-away clinic, wait in a really crowded waiting room, and then they get to see a clinician for 10 minutes. That whole experience can be disheartening! Partners In Health designed robust community health worker interventions and networks to improve care for patients. We've also been able to deliver education to patients, so they understand heart failure and how this chronic condition requires continuous medication to keep the symptoms controlled.
Our Fogarty-funded study,
Simulator-Based simplified Focused Cardiac Ultrasound (sFoCUS) Training in Haiti, used simulators to train for cardiac ultrasound. There are about 10-15 cardiologists in all of Haiti, a country of 10 million people, and a lot (if not all) of them are working in the capital. So our resident trainees in the rural areas just don't have access to the same kind of cardiology training. There are simulators (mannequins) that help trainees learn the skill of obtaining and interpreting cardiac ultrasound images. Our program implemented this simulator training in rural areas. Keep in mind we applied for this before COVID, so our work was very timely!
Why do you emphasize implementation science?
In global health, a lot of the science is taking evidence that works in other contexts and trying to implement it in a new context with its unique barriers, constraints, challenges, and awareness levels. Implementation science helps us understand how to overcome all of these. A particular context may help an intervention be successful, so we need to understand contextual factors that create success. If you're going to disseminate or scale up in other places, you need to understand what inputs would be needed to be able to get things to work. Without studying the implementation of these interventions, a successful intervention can fail in a new context. There's a whole other science to understanding how to get interventions to the 95% of the world where it's particularly challenging.
What is important for other global health researchers to know?
One of my main messages to mentees is “be a very good listener first and foremost.” We need to listen to what our collaborators on the ground are telling us and often they also know what the solutions are. A researcher’s role is to help implement possible solutions and then study whether they're successful or not. My number two lesson for mentees is “be invited back.” You're not going to have long-term collaborations if you're not invited back! A lot of that boils down to being a good partner as opposed to coming in with preconceived ideas of what may or may not work. So always listen… and be invited back.
Global health is hard by nature and research is also very hard—putting those two together is extremely challenging so it takes grit and determination and resilience. There'll be many setbacks along the way. If you keep in mind that people throughout the world aren't getting the care they need and you can make some contribution to that—if you keep that as your long-term goal—it will help you get through the setbacks.
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Updated June 11, 2024
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