NIH Featured Story: Gene F. Kwan, MD, MPH

Better heart health through education: Q&A with Gene F. Kwan, MD, MPH

March/April 2024 | Volume 23 Number 2

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.

Original Post

DoM Faculty Appointments and Promotions – May 2024

Congratulations to the following Chobanian & Avedisian School of Medicine faculty on their recent appointment or promotion.

Associate Professor

Christopher Heaphy, PhD, Medicine/Hematology & Medical Oncology, focuses on cancer biomarker discovery and validation with the aim to utilize novel tissue-based biomarkers to improve individualized prevention, detection and treatment strategies. In particular, he specializes in abnormal telomere biology as it relates to cancer initiation and tumor progression. His seminal study published in Science demonstrated the association between inactivating somatic mutations in two chromatin remodeling genes, ATRX and DAXX, and the activation of the Alternative Lengthening of Telomeres (ALT) phenotype, a telomerase-independent telomere maintenance mechanism. His laboratory also is working to elucidate the underlying mechanisms of cancer initiation and progression, as well as to understand how the interactions between the cancer and its tissue microenvironment may facilitate this process.

Zoe Weinstein, MD, MS, Medicine/GIM, specializes in two models of addiction care: Office Based Addiction Treatment (OBAT) and Addiction Consult Services. Her retrospective study of Boston Medical Center’s (BMC) OBAT program resulted in one of the largest and longest evaluations of treatment duration for patients on buprenorphine, which now has been cited 180 times. She currently is conducting a mixed methods prospective cohort study on the impact of COVID-19 on BMC’s OBAT population and has been invited to be first author on a manuscript, in development, on a NIDA clinical trials study on predictors of retention in addiction treatment. Dr. Weinstein helped establish and grow one of the leading Addiction Consult Services in the U.S., which serves as a national model, attracting trainees as well as attendings from around the country to learn from its work. From 2019-23 she served on the board of directors for the Association for Multidisciplinary Education and Research in Substance Use and Addiction, the leading national interdisciplinary organization in the field of addiction.

Clinical Associate Professor

Sohera Syeda, MD, Medicine/Pulmonology, Allergy, Sleep & Critical Care Medicine, specializes in COPD readmission prevention. Based at VA Boston Healthcare, she created the VA Boston COPD readmission reduction program. She is director of the pulmonary diseases module of the medical student PISCEs course, associate director of the pulmonary, sleep and critical care fellowship program and VA site director for the pulmonary and critical care medicine fellowship. In addition, Dr. Syeda is director of VA Boston’s Coordinated Care and Case Management Program for High-Risk Veterans with Heart Failure and Chronic Obstructive Pulmonary Disease and director of VA Bedford’s Enclave Pulmonary Clinic.

Hollis D. Day, MD, MS, MHPE, Delivers Distinguished Professor in Geriatrics Keynote Lecture

Hollis D. Day, MD, MS, MHPE, associate professor of medicine, delivered the Distinguished Professor in Geriatrics (DPG) keynote lecture at the annual Society of General Internal Medicine (SGIM) meeting held recently in Boston. Day, who also is chief of geriatrics at Boston Medical Center (BMC), discussed the future of geriatrics and if it is a dying specialty. Her answer was an emphatic no. She proposed ways for geriatricians and general internists to become more actively engaged in the research, education and clinical care of the older adult.

Invited professors are general internists and/or geriatricians with nationally recognized expertise in education, research, and/or clinical care related to the care of older adults. The DPG program facilitates career development of SGIM members in academic fields directly related to older patients.

Day recently was accepted into the premier leadership program for women in academic health sciences in the country, the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) program. Established in 1995, ELAM offers an intensive one-year fellowship of leadership training with extensive coaching, networking and mentoring opportunities aimed at expanding the national pool of qualified women candidates for leadership in academic medicine, dentistry, public health and pharmacy.

Day’s research interests include integrating geriatrics into the internal medicine curriculum at the student, resident and faculty development level; interdisciplinary team teaching; and inter-professional communication. Her clinical focus areas include dementia and delirium in geriatric patients and cognitive assessment in the primary care geriatric setting.

She is a member of the American Geriatrics Society, the Society of General Internal Medicine, and the American College of Physicians.

Day earned a bachelor’s degree in English from Johns Hopkins University, a master’s degree in anatomy from the University of Maryland and medical degree from the Medical College of Virginia. She also completed a master’s degree in health professions education from the University of Illinois, Chicago. She completed her residency in internal medicine at the University of Pittsburgh Medical Center and fellowships in general internal medicine and geriatrics at the Hospital of the University of Pennsylvania.

She came to BU/BMC from the University of Pittsburgh Medical Center (UPMC) where she specialized in geriatrics, and the University of Pittsburgh School of Medicine (UPSM) where she was advisory dean, associate professor of medicine and the medical director of the Advanced Clinical Education Center. While in Pittsburgh, she led the efforts to integrate geriatrics throughout the medical school curriculum at UPSM and was a Founding Program Director for the geriatrics track in UPMC’s internal medicine residency program.

The Society of General Internal Medicine (SGIM) is a global association of over 3,300 leading academic general internists dedicated to enhancing medical education, improving healthcare access, eliminating disparities, and advancing comprehensive, coordinated, and cost-effective care for adults through innovative education, research, and clinical practice.

Original Post 

DoM Faculty Appointments and Promotions – April 2024

Congratulations to the following Chobanian & Avedisian School of Medicine faculty on their recent appointment or promotion!

Associate Professor

Maureen Dubreuil, MD, MSc, Medicine/Rheumatology, specializes in spondyloarthritis, including the pharmacoepidemiology of spondyloarthritis. Her work has shown protective effects of medications on disease outcomes and comorbidities. She recently led a national project to develop referral recommendations for adults who may have spondyloarthritis. She serves as director of research training for the section of rheumatology and as faculty for the rheumatology fellowship program.

S. Reza Jafarzadeh, DVM, MPVM, PhD, Medicine/Rheumatology, specializes in the development of novel Bayesian methods and the application of causal inference methods in rheumatic diseases, critical care and infectious diseases. He applies innovative statistical methods to solve challenging research questions and has established a national reputation in the development of Bayesian methods in the evaluation of diagnostic tests and prevalence estimation in the absence of a reference standard. He developed a novel Bayesian approach that was more accurate than the CDC’s method to estimate the prevalence of arthritis in the U.S.