Four days had passed since Match Day in 2008 by the time Raj Panjabi, MD, MPH, found a free moment to check his email. He sat in a tent in his home country, Liberia, borrowing a medical relief agency’s internet access to learn he had matched at Massachusetts General Hospital (MGH). He fired off a few celebratory emails before quickly turning his attention back to his efforts to improve the gravely under-resourced health care system in Liberia.
Nearly a decade later, Panjabi is still at work in Liberia, continually striving to improve health care access, quality and affordability as both a physician in BWH’s Division of Global Health Equity and co-founder and CEO of the nonprofit Last Mile Health.
His tireless work around health equity was recognized last year with the $1 million TED Prize. On April 25, Panjabi revealed he would use the award to fund a program to train, empower and connect community health workers across the world – an expansion of work he had been doing locally in Liberia over the past several years.
Panjabi recently spoke with BWH Bulletin about his work as a physician, educator and health equity champion.
What role can community health workers play in providing care in underserved areas?
RP: So much of what impacts patient care has to do with access, quality and cost. Community health workers can help us improve all three.
In terms of access, they can provide free blood-pressure screenings in rural areas. To improve quality of care, they can distribute information about colorectal cancer screenings to minority populations. Regarding cost, a significant chunk of health care costs come from a small subset of patients using the emergency room to receive care for unmanaged conditions like congestive heart failure. Community health workers could help these patients monitor their blood pressure, pulse and weight – all key contributors to re-admittance – at home and prevent them from needing expensive emergency care.
Innovations like these are being scaled and expanded in a big way in places like Rwanda, Sierra Leone and Haiti. In Liberia, we’re now working with the government to scale a program of 4,000 paid community health workers who will be supervised by nurses and other health care professionals to provide care for a variety of chronic diseases and acute illnesses, such as malaria and pneumonia in children under 5. We are bringing health care closer to the doorstep.
Why do you see a need for more formalized education?
RP: Doctors and nurses complete certificate and degree programs that lead to a higher level of care – why can’t the same principles be applied to community health workers? One of our aspirations is to train community health workers to diagnose children with malaria using lab kits. There’s a lot that can be learned from how Brigham, MGH and Partners structure medical education that we can apply here.
How would you describe your approach as a clinical educator?
RP: I think the most profound experience comes from being at the bedside, so that’s one of the things I emphasize with trainees, fellows and even with our nonclinical staff, from technical analysts to the executive leadership. I know that sounds like a very basic point and probably obvious. But what’s ironic is that as you become more and more engaged in global health work, you are often put in roles that take you away from the bedside, which is where you have to be to understand what’s needed. It’s those very insights into patient care that guide research and advocacy.