1. The Mutual Benefits of International Twinning Partnerships HIV/AIDS Twinning Center www.TwinningAgainstAIDS.org Dr. Joseph Masci ICASA 2011Satellite Session “Institutional Twinning Partnerships as a Mechanism for Health Systems Strengthening and Sustainable Development of Human Resources for Health” Addis Ababa, Ethiopia, 5 December 2011

2. Debra Berhan-Elmhurst Partnership Funded through U.S. Centers for Disease Control and Prevention (CDC) Sponsored by the American International Health Alliance 2007-present HIV/AIDS Twinning Center ~ www.TwinningAgainstAIDS.org

3. Debre Berhan Referral Hospital Debre Berhan

4. Debre Berhan Referral Hospital Located 130 km to the north of the Ethiopian capital of Addis Ababa One of 17 government hospitals in the Amhara National Regional State of Ethiopia Provides a comprehensive health care service to nearly 2.4 million people encompassing the catchment area in the northern shoa zone of the Amhara region A referral designation to 2 rural hospitals and 10 health centers Teaching hospital and one of the first hospitals to start an ART program Adults: ever enrolled 4062; ever started on ARV 2254 currently on ARV 1353 Children: ever enrolled 310; ever started on ARV 148, currently on ARV 83

5. Elmhurst Hospital Center New York, New York

6. Elmhurst Hospital Center One of 11 NYC municipal hospitals run by the Health and Hospitals Corporation Located in the most culturally diverse neighborhood in the US Provides medical care to an ethnically diverse, largely poor, and medically underserved patient population, and prisoner population 80% are underinsured, uninsured, or on Medicaid Approximately 11% are undocumented immigrants Multidisciplinary HIV treatment program encompasses prevention and education services, voluntary HIV counseling and testing, the direct provision of medical and psychosocial care to approximately 1300 HIV infected adults and 60 children, coordination of care among the hospital’s specialty services Teaching hospital of the Mount Sinai School of Medicine

7. Partnership Summary and Goals Initial partnership exchange in July 2007; 13 exchanges to date To enhance the medical and psychosocial care of HIV patients to prevent complications and improve quality of life To strengthen all medical and nonmedical hospital services at DBH, Mehal Meda and Enat Hospitals To strengthen patient involvement in quality of care at DBH, Mehal Meda and Enat hospital To enhance the professional knowledge and training opportunities for the Ethiopian partners’ staff Standardize and build the capacity of nurses at DBH, Mehal Meda, Enat Hospitals, Debre Berhan University, Debre Berhan Health Science College and Nursing College

8. Improvements in Clinical Practice Training of physicians in use of antiretroviral therapy Creation of infection prevention manual for DB Hospital Training of opthalmology staff in intravitreal injections Donation of colposcope for DB physicians to assess patients for cervical cancer Donation of 7 computers with accessories Opening and dedication of Learning Resource Donation of 11 heaters Training of nurses and physicians in quality improvement activities Outposting of U.S. physician Assessment of social service needs Key Achievements & Outcomes HIV/AIDS Twinning Center www.TwinningAgainstAIDS.org

9. Enhancing the medical and psychosocial care of HIV patients to prevent complications and improve quality of life. Focus areas have been treatment adherence palliative care patient education counseling and testing home care patient support groups and pen pal program between Ethiopian and US patients Key Achievements & Outcomes HIV/AIDS Twinning Center www.TwinningAgainstAIDS.org

10. Biomedical Engineering Department

11. Facilities Underway The New Emergency Medicine Ward New Learning and Resource Center

12. Our Russian Partnership: 2004- 2009 Orenburg

13. The Value of Twinning Understand the context and environment in which people work by direct observation and discussion Identify mutual goals based on real-life, on-the-ground analysis Develop sustained interpersonal and professional relationships and break down barriers and defenses which may block achieving the goals. HIV/AIDS Twinning Center ~ www.TwinningAgainstAIDS.org

14. Understanding systems and traditions Targeted exchange visits with defined purposes and appropriate staff (physicians, nurses, social workers, pharmacists, etc) allow for in-depth examination of specific processes, contexts. Establishing rapport Non-judgemental, problem-solving approach Identifying objectives Narrow and well-defined goals emerge from targeted exchanges Defining success Early understanding of how strategies may or may not be transferable allows for realistic goals and means of quantification Challenges & Role of Twinning HIV/AIDS Twinning Center www.TwinningAgainstAIDS.org

15. Direct comparison of facilities, staffing and procedures has resulted in greater insight into our system of care at a NYC public hospital For example, rapid HIV testing strategies have been improved Collaborative consulting between staff in various disciplines (eg, medicine, nursing, social service, pharmacy) during focused exchanges to Debre Berhan has fostered closer communication and better understanding among these disciplines at Elmhurst Hospital Center. This phenomenon has better enabled us to reconfigure as an accountable care organization. Direct observation of processes in a resource-deprived setting has given US partners a greater appreciation of developed systems of care at the US partners’ hospital. This has led to increased job satisfaction. Professional satisfaction has grown very substantially as a result of our twinning partnerships in Ethiopia and in Russia. Staff, most of whom have worked in HIV/AIDS care for their entire careers have developed a new-found sense of purpose in their work at home and abroad. Impact of Twinning on US partner HIV/AIDS Twinning Center www.TwinningAgainstAIDS.org

16. The twinning partnership between Elmhurst and Debre Berhan has helped to facilitate: At Debre Berhan Infection control policies and oversight mechanism New approaches to efficiencies in care Intensive training of nurses Creation of learning center At Elmhurst Enhanced role of nurses and pharmacists as educators Renewed focus on performance improvement strategies Greater appreciation of the role of public hospitals Greater understanding of the mission of public hospitals Conclusion HIV/AIDS Twinning Center www.TwinningAgainstAIDS.org

17. Thank you HIV/AIDS Twinning Center ~ www.TwinningAgainstAIDS.org

18. Contact Information for Joseph Masci, M.D. Mascij@NYCHHC.org Elmhurst Hospital Center Mount Sinai School of Medicine HIV/AIDS Twinning Center www.TwinningAgainstAIDS.org