Partnering for Health Equity and Global Health Education

Dr. Andrew Enslen, a global health track resident at the time, spent six weeks in the spring of 2023 working with UGHE in a local district hospital, functioning as a consultant attending physician who supervised and taught 3rd-year medical students (pictured here). Working closely with these passionate and committed students was a highlight of his experience, he said.

Dr. Andrew Enslen, a global health track resident at the time, spent six weeks in the spring of 2023 working with UGHE in a local district hospital, functioning as a consultant attending physician who supervised and taught 3rd-year medical students (pictured here). Working closely with these passionate and committed students was a highlight of his experience, he said.

Partnering for Health Equity and Global Health Education

Dr. Andrew Enslen, a global health track resident at the time, spent six weeks in the spring of 2023 working with UGHE in a local district hospital, functioning as a consultant attending physician who supervised and taught 3rd-year medical students (pictured here). Working closely with these passionate and committed students was a highlight of his experience, he said.

Partnering for Health Equity and Global Health Education

This story is adapted from an article originally published by the Stanford Center for Innovation in Global Health in May 2023. This version has been edited to focus on the contributions of Department of Medicine faculty. You can read the original story here.

A shared commitment to healthcare capacity-building and fostering global health equity has brought together Stanford Medicine faculty and leaders of the University of Global Health Equity (UGHE) in Rwanda. 

UGHE launched in rural Butaro, Rwanda, in 2015, with a novel mission: “To change the way health care is delivered around the world by training the next generation of global health professionals to deliver more equitable, quality health services for all.” 

The university is partnering with globally minded medical schools, including Stanford, to provide high-quality education to its students and build healthcare capacity in Eastern Africa. 

“The brainchild of two global health visionaries, Agnes Binagwaho and the late Dr. Paul Farmer, UGHE is on track to be a premier medical school on the continent,” says Michele Barry, MD, director of the Stanford Center for Innovation in Global Health (CIGH) and Shenson Professor, who has served on UGHE’s member advisory council since 2018. Binagwaho is the retired vice chancellor of the university, former Rwandan minister of health, and health equity advocate. 

Farmer was a global health equity leader who founded the nonprofit Partners in Health, which helped launch UGHE.

Department of Medicine faculty say they’re deeply inspired by UGHE leaders’ and students’ commitment to excellence and serving their communities. “Bidirectionality,” a spirit of equal exchange and learning, is fundamental to these Stanford-UGHE collaborations, leaders agreed.

“This idea, this place, and these people are paving the way for a better world for all of us,” says Brooke Cotter, MD, Stanford clinical assistant professor of hospital medicine, who serves in a new, CIGH-supported role as director of education and collaboration between the universities.

A Bridge Between Data Scientists and the Front Lines of Health Care

Shortly after the university formed, UGHE-Stanford partnerships began to take shape — often shepherded by UGHE’s founding dean of medicine, Abebe Bekele, says Charles Prober, MD. Prober, professor of pediatrics, microbiology, and immunology and senior associate vice provost for health education at Stanford Medicine, chaired a Dean’s Advisory Committee that Bekele assembled.

“Dean Abebe can pull many people into his tent from institutions around the world,” Prober says.

When Bekele visited Stanford several years ago, Prober introduced him to Stanford colleagues including Laurence Katznelson, MD, professor of neurosurgery and endocrinology and associate dean of graduate medical education. They discussed how Stanford could help teach UGHE’s first medical students as the university developed its faculty.

Katznelson, Lars Osterberg, MD, John Kugler, MD, and Cotter developed an initiative to provide online instructional support for preclinical medical students. Stanford faculty helped lead monthly Zoom discussions with UGHE students on various clinical cases.

The program helped foster rich ties between Stanford faculty, UGHE counterparts, and students despite pandemic travel restrictions.

Stanford physician Dr. Lars Osterberg visits a patient alongside UGHE medical student Rosine during his visit in spring 2023.

Kugler, clinical professor of medicine and director of the Educators-4-Care program, says this type of teaching opened up meaningful global health engagement opportunities to physicians who cannot easily travel overseas: “The ability to provide helpful clinical education from a remote location allows for a new type of impact that we are only just beginning to tap into.”

Virtual Connections Become Tangible

The collaboration is now extending from the virtual to the in-person world, further deepening connections.

In June 2023, Osterberg, professor (teaching) of medicine and co-director of Stanford Medicine’s teaching and mentoring academy, traveled to the UGHE campus to teach and serve as an attending physician at Butaro Hospital for third-year students completing their internal medicine rotation. It was his third time doing so since 2022, working alongside the same students he’d previously taught over Zoom. Stanford Global Health Track resident Andrew Enslen, MD, also recently spent six weeks there, teaching and overseeing clinical rotations.

Stanford physician Dr. Lars Osterberg stands with several medical students, Prisca, Arnold, and Eric, whom he mentored during his time teaching and serving as an attending physician at UGHE in the spring of 2023. 

This story is adapted from an article originally published by the Stanford Center for Innovation in Global Health in May 2023. This version has been edited to focus on the contributions of Department of Medicine faculty. You can read the original story here.

A shared commitment to healthcare capacity-building and fostering global health equity has brought together Stanford Medicine faculty and leaders of the University of Global Health Equity (UGHE) in Rwanda. 

UGHE launched in rural Butaro, Rwanda, in 2015, with a novel mission: “To change the way health care is delivered around the world by training the next generation of global health professionals to deliver more equitable, quality health services for all.” The university is partnering with globally minded medical schools, including Stanford, to provide high-quality education to its students and build healthcare capacity in Eastern Africa. 

“The brainchild of two global health visionaries, Agnes Binagwaho and the late Dr. Paul Farmer, UGHE is on track to be a premier medical school on the continent,” says Michele Barry, MD, director of the Stanford Center for Innovation in Global Health (CIGH) and Shenson Professor, who has served on UGHE’s member advisory council since 2018. Binagwaho is the retired vice chancellor of the university, former Rwandan minister of health, and health equity advocate. Farmer was a global health equity leader who founded the nonprofit Partners in Health, which helped launch UGHE.

Department of Medicine faculty say they’re deeply inspired by UGHE leaders’ and students’ commitment to excellence and serving their communities. “Bidirectionality,” a spirit of equal exchange and learning, is fundamental to these Stanford-UGHE collaborations, leaders agreed.

“This idea, this place, and these people are paving the way for a better world for all of us,” says Brooke Cotter, MD, Stanford clinical assistant professor of hospital medicine, who serves in a new, CIGH-supported role as director of education and collaboration between the universities.

Stanford physician Dr. Lars Osterberg visits a patient alongside UGHE medical student Rosine during his visit in spring 2023.

A Bridge Between Data Scientists and the Front Lines of Health Care

Shortly after the university formed, UGHE-Stanford partnerships began to take shape — often shepherded by UGHE’s founding dean of medicine, Abebe Bekele, says Charles Prober, MD. Prober, professor of pediatrics, microbiology, and immunology and senior associate vice provost for health education at Stanford Medicine, chaired a Dean’s Advisory Committee that Bekele assembled.

“Dean Abebe can pull many people into his tent from institutions around the world,” Prober says.

When Bekele visited Stanford several years ago, Prober introduced him to Stanford colleagues including Laurence Katznelson, MD, professor of neurosurgery and endocrinology and associate dean of graduate medical education. They discussed how Stanford could help teach UGHE’s first medical students as the university developed its faculty.

Katznelson, Lars Osterberg, MD, John Kugler, MD, and Cotter developed an initiative to provide online instructional support for preclinical medical students. Stanford faculty helped lead monthly Zoom discussions with UGHE students on various clinical cases.

The program helped foster rich ties between Stanford faculty, UGHE counterparts, and students despite pandemic travel restrictions.

Kugler, clinical professor of medicine and director of the Educators-4-Care program, says this type of teaching opened up meaningful global health engagement opportunities to physicians who cannot easily travel overseas: “The ability to provide helpful clinical education from a remote location allows for a new type of impact that we are only just beginning to tap into.”

Stanford physician Dr. Lars Osterberg stands with several medical students, Prisca, Arnold, and Eric, whom he mentored during his time teaching and serving as an attending physician at UGHE in the spring of 2023. 

Virtual Connections Become Tangible

The collaboration is now extending from the virtual to the in-person world, further deepening connections.

In June 2023, Osterberg, professor (teaching) of medicine and co-director of Stanford Medicine’s teaching and mentoring academy, traveled to the UGHE campus to teach and serve as an attending physician at Butaro Hospital for third-year students completing their internal medicine rotation. It was his third time doing so since 2022, working alongside the same students he’d previously taught over Zoom. Stanford Global Health Track resident Andrew Enslen, MD, also recently spent six weeks there, teaching and overseeing clinical rotations.

The ability to provide helpful clinical education from a remote location allows for a new type of impact that we are only just beginning to tap into.

— John Kugler, MD, clinical professor of medicine 

Cotter, who traveled to UGHE during spring 2023 to attend on the wards and teach third-year medical students, hopes to develop a group of core faculty who can return annually to assist with rotations.

All were inspired by students’ deep commitment to serving their communities. Osterberg relates how Rwandan patients and their families often have to purchase supplies for medical procedures themselves. Medical students took the extra step of walking family members to the pharmacy to assist with this overwhelming task. Osterberg also recalls how students volunteered to remain on campus over a holiday weekend to ensure that patients were cared for.

“These students go far and beyond to get things done,” Osterberg says.

During his visit to UGHE in spring 2023, Stanford physician Dr. Lars Osterberg meets with Dr. Olana Wakoya Gichile at Butaro District Hospital, where he served as an attending physician on the internal medicine ward and taught third-year medical students.

Building Local Capacity

Beyond teaching, many Stanford faculty members have supported UGHE in building its local capacity for world-class care and instruction.

Prober helped build a mentorship program that matched UGHE faculty with medical school faculty from prestigious U.S. medical institutions. Osterberg has provided “teach the teacher” trainings for educators. Joseph Becker, MD, clinical associate professor of emergency medicine, helped develop the university’s emergency medicine curriculum.

UGHE has partnered with Stanford Surgery’s global engagement initiative, the Center for Health Education, and the Stanford Byers Center for Biodesign on technological initiatives to expand capacity for teaching, learning, and medical innovation.

“There are so many wonderful people doing great things at both UGHE and Stanford,” says Cotter, who sees her role as strengthening and expanding partnerships between the institutions. “The hope is that through coordination, we can cross-pollinate our efforts.”

Barry affirms CIGH’s commitment to building and strengthening the UGHE-Stanford collaboration: “We have much to learn from one another.”

The ability to provide helpful clinical education from a remote location allows for a new type of impact that we are only just beginning to tap into.

— John Kugler, MD, clinical professor of medicine 

Cotter, who traveled to UGHE during spring 2023 to attend on the wards and teach third-year medical students, hopes to develop a group of core faculty who can return annually to assist with rotations.

All were inspired by students’ deep commitment to serving their communities. Osterberg relates how Rwandan patients and their families often have to purchase supplies for medical procedures themselves. Medical students took the extra step of walking family members to the pharmacy to assist with this overwhelming task. Osterberg also recalls how students volunteered to remain on campus over a holiday weekend to ensure that patients were cared for.

“These students go far and beyond to get things done,” Osterberg says.

During his visit to UGHE in spring 2023, Stanford physician Dr. Lars Osterberg meets with Dr. Olana Wakoya Gichile at Butaro District Hospital, where he served as an attending physician on the internal medicine ward and taught third-year medical students.

Building Local Capacity

Beyond teaching, many Stanford faculty members have supported UGHE in building its local capacity for world-class care and instruction.

Prober helped build a mentorship program that matched UGHE faculty with medical school faculty from prestigious U.S. medical institutions. Osterberg has provided “teach the teacher” trainings for educators. Joseph Becker, MD, clinical associate professor of emergency medicine, helped develop the university’s emergency medicine curriculum.

UGHE has partnered with Stanford Surgery’s global engagement initiative, the Center for Health Education, and the Stanford Byers Center for Biodesign on technological initiatives to expand capacity for teaching, learning, and medical innovation.

“There are so many wonderful people doing great things at both UGHE and Stanford,” says Cotter, who sees her role as strengthening and expanding partnerships between the institutions. “The hope is that through coordination, we can cross-pollinate our efforts.”

Barry affirms CIGH’s commitment to building and strengthening the UGHE-Stanford collaboration: “We have much to learn from one another.”

Where Health Care Is a Luxury

Power failures are common in rural Cambodia. One that occurred during surgery required improvisation, with several mobile phones providing light.

Power failures are common in rural Cambodia. One that occurred during surgery required improvisation, with several mobile phones providing light.

Where Health Care Is a Luxury

Power failures are common in rural Cambodia. One that occurred during surgery required improvisation, with several mobile phones providing light.

Power failures are common in rural Cambodia. One that occurred during surgery required improvisation, with several mobile phones providing light.

Where Health Care Is a Luxury

Take a 24-hour flight to Phnom Penh, Cambodia. Board a bus and ride for 10 hours to the rural province of Banteay Meanchey. Help set up medical, surgical, dental, and ophthalmological outpatient clinics. See more than 100 patients a day. A week later, take it all apart and fly home. Repeat in a year.

Though he visits a different village every year, that’s the annual routine that Robert Negrin, MD, has followed for the past 10 years, except for a three-year hiatus due to the COVID-19 pandemic. “It’s wonderful to reconnect with my friends and colleagues each year,” he notes. “We have an incredible camaraderie, and we all missed each other during the pandemic gap.”

Negrin, a professor of blood and marrow transplantation medicine, volunteers in the yearly medical missions sponsored by the Cambodian Health Professionals Association of America (CHPAA). About 100 people participate, of which 30 are physicians. “We work with patients, medical students, and others in an environment where health care is a luxury if and when it is even available,” he says.

Trained as a hematologist, Negrin serves as a general medical physician in the clinic in Cambodia, referring patients to the surgery,  dental, or ophthalmology team members as needed — in a similar fashion to the subspecialty referrals that primary care physicians make at Stanford.

Medical Students Eager for Knowledge

In addition to seeing hundreds of patients on each trip, Negrin and his colleagues enjoy working with the Cambodian medical students who serve as interpreters. “They are all dying for interactions with us,” says Negrin. “They are like sponges: bright, committed, dedicated, and eager to learn about American medicine.”

In fact, some of the medical students Negrin has worked with in the past are now physicians themselves. “They are the ones who will change health care in Cambodia and go on to help take care of their own people,” he says, adding that “an improved healthcare system in Cambodia would make the need for these medical missions unnecessary.”

But right now, the need is enormous, especially in rural areas where thousands of people line up for 10 hours or more every day of the weeklong medical mission to be seen by a physician. “What is remarkable,” Negrin observes, “is that no one complains about the wait, or how hot it is, or that they didn’t get to be seen.”

Two Patients Remembered

Over the course of his 10 years as a volunteer with CHPAA, Negrin has seen thousands of patients. Although many are memorable, two stand out in his mind.

A 22-year-old woman came to the clinic looking “as white as a ghost,” he recalls. He ordered some blood tests but couldn’t make an accurate diagnosis. He raised money through GoFundMe to send her to Bangkok, Thailand, where hospital staff determined that she had leukemia. Her treatment there resulted in a four-year remission. She and her husband came to the mission site each year, even though it was often a great distance from their home. They adopted a child and became close friends with Negrin. Then, she unfortunately suffered a relapse, and though Negrin tried to get her to China for care, he was not able to do so. Sadly, she passed away.

“This was difficult for me because I had to accept the limitations in the Cambodian healthcare system and that I couldn’t do everything I knew I could have done for her,” he says. “I still think about her and am saddened by the harshness of fate that is so impacted by where you happen to have been born.”

A second memory is of a woman in her late 20s who came to see him but was embarrassed to have him examine her. With the help of a Cambodian female medical student, she allowed him to proceed. He found a lump in her breast. The woman told him that it made her feel like she wasn’t a true woman. Negrin helped collect money from CHPAA volunteers to send her to see a physician who had participated in the CHPAA program as a medical student and was now in practice in Phnom Penh. There, through their generosity, she was able to undergo surgery to remove the tumor. Later, she sent Negrin a photo of her wedding and told him that she felt like a full woman again.

Hundreds of patients from Cambodian rural villages wait for as long as 10 hours every day of the annual weeklong medical mission sponsored by the Cambodian Health Professionals Association of America. Volunteer Robert S. Negrin, MD, professor of blood and marrow transplantation medicine, comments that “no one complains about the wait, or how hot it is, or that they didn’t get to be seen.”

Take a 24-hour flight to Phnom Penh, Cambodia. Board a bus and ride for 10 hours to the rural province of Banteay Meanchey. Help set up medical, surgical, dental, and ophthalmological outpatient clinics. See more than 100 patients a day. A week later, take it all apart and fly home. Repeat in a year.

Though he visits a different village every year, that’s the annual routine that Robert Negrin, MD, has followed for the past 10 years, except for a three-year hiatus due to the COVID-19 pandemic. “It’s wonderful to reconnect with my friends and colleagues each year,” he notes. “We have an incredible camaraderie, and we all missed each other during the pandemic gap.”

Negrin, a professor of blood and marrow transplantation medicine, volunteers in the yearly medical missions sponsored by the Cambodian Health Professionals Association of America (CHPAA). About 100 people participate, of which 30 are physicians. “We work with patients, medical students, and others in an environment where health care is a luxury if and when it is even available,” he says.

Trained as a hematologist, Negrin serves as a general medical physician in the clinic in Cambodia, referring patients to the surgery,  dental, or ophthalmology team members as needed — in a similar fashion to the subspecialty referrals that primary care physicians make at Stanford.

Medical Students Eager for Knowledge

In addition to seeing hundreds of patients on each trip, Negrin and his colleagues enjoy working with the Cambodian medical students who serve as interpreters. “They are all dying for interactions with us,” says Negrin. “They are like sponges: bright, committed, dedicated, and eager to learn about American medicine.”

In fact, some of the medical students Negrin has worked with in the past are now physicians themselves. “They are the ones who will change health care in Cambodia and go on to help take care of their own people,” he says, adding that “an improved healthcare system in Cambodia would make the need for these medical missions unnecessary.”

But right now, the need is enormous, especially in rural areas where thousands of people line up for 10 hours or more every day of the weeklong medical mission to be seen by a physician. “What is remarkable,” Negrin observes, “is that no one complains about the wait, or how hot it is, or that they didn’t get to be seen.”

Hundreds of patients from Cambodian rural villages wait for as long as 10 hours every day of the annual weeklong medical mission sponsored by the Cambodian Health Professionals Association of America. Volunteer Robert S. Negrin, MD, professor of blood and marrow transplantation medicine, comments that “no one complains about the wait, or how hot it is, or that they didn’t get to be seen.”

Two Patients Remembered

Over the course of his 10 years as a volunteer with CHPAA, Negrin has seen thousands of patients. Although many are memorable, two stand out in his mind.

A 22-year-old woman came to the clinic looking “as white as a ghost,” he recalls. He ordered some blood tests but couldn’t make an accurate diagnosis. He raised money through GoFundMe to send her to Bangkok, Thailand, where hospital staff determined that she had leukemia. Her treatment there resulted in a four-year remission. She and her husband came to the mission site each year, even though it was often a great distance from their home. They adopted a child and became close friends with Negrin. Then, she unfortunately suffered a relapse, and though Negrin tried to get her to China for care, he was not able to do so. Sadly, she passed away.

“This was difficult for me because I had to accept the limitations in the Cambodian healthcare system and that I couldn’t do everything I knew I could have done for her,” he says. “I still think about her and am saddened by the harshness of fate that is so impacted by where you happen to have been born.”

A second memory is of a woman in her late 20s who came to see him but was embarrassed to have him examine her. With the help of a Cambodian female medical student, she allowed him to proceed. He found a lump in her breast. The woman told him that it made her feel like she wasn’t a true woman. Negrin helped collect money from CHPAA volunteers to send her to see a physician who had participated in the CHPAA program as a medical student and was now in practice in Phnom Penh. There, through their generosity, she was able to undergo surgery to remove the tumor. Later, she sent Negrin a photo of her wedding and told him that she felt like a full woman again.

It’s the human contact with the patients and especially the students, many of whom have become lifelong friends. And the knowledge that I’ve made a small impact on the lives of a few people. I know we are just Band-Aids in the big picture, but lately I’ve stopped asking myself why I do this.

We Are So Privileged in the U.S.

Negrin says that the hardest part of each of the trips is coming home. “We are so privileged here in the United States,” he says. “I start to question why are we ordering a CT scan for every little thing? What is the likelihood we will find anything significant? At times, the care we provide is so excessive. It’s made me reevaluate how I function as a clinician in a healthcare system that is rich in resources and the finest in the world.”

Why does Negrin keep going back? “It’s the human contact with the patients and especially the students, many of whom have become lifelong friends,” he says. “And the knowledge that I’ve made a small impact on the lives of a few people. I know we are just Band-Aids in the big picture, but lately I’ve stopped asking myself why I do this.” 

Volunteers from the Cambodian Health Professionals Association of America medical mission, with Robert S. Negrin, MD, professor of blood and marrow transplantation medicine (seated on red stool) and Cambodian medical students who serve as interpreters (wearing yellow shirts).

It’s the human contact with the patients and especially the students, many of whom have become lifelong friends. And the knowledge that I’ve made a small impact on the lives of a few people. I know we are just Band-Aids in the big picture, but lately I’ve stopped asking myself why I do this.

We Are So Privileged in the U.S.

Negrin says that the hardest part of each of the trips is coming home. “We are so privileged here in the United States,” he says. “I start to question why are we ordering a CT scan for every little thing? What is the likelihood we will find anything significant? At times, the care we provide is so excessive. It’s made me reevaluate how I function as a clinician in a healthcare system that is rich in resources and the finest in the world.”

Why does Negrin keep going back? “It’s the human contact with the patients and especially the students, many of whom have become lifelong friends,” he says. “And the knowledge that I’ve made a small impact on the lives of a few people. I know we are just Band-Aids in the big picture, but lately I’ve stopped asking myself why I do this.” 

Volunteers from the Cambodian Health Professionals Association of America medical mission, with Robert S. Negrin, MD, professor of blood and marrow transplantation medicine (seated on red stool) and Cambodian medical students who serve as interpreters (wearing yellow shirts).