The January 12 earthquake in Haiti triggered one of the largest humanitarian responses in history. Although some 316,000 people perished in the quake, many thousands were saved by the rescue and relief efforts of international and local teams. More than $2 billion was spent on humanitarian relief, and another $10 billion was pledged for recovery aid. But almost two years after the earthquake, recovery and reconstruction have been slow to take root. Much of Port-au-Prince remains in ruins: some estimate that little more than a third of the rubble has been removed from Haiti’s capital city. How should we evaluate the international humanitarian and recovery aid efforts? Why has reconstruction stalled? What examples of previous disaster recovery efforts, if any, offer models relevant to Haiti’s current challenges? What are the long-term implications of the earthquake for the Haitian health system? Scholars in Medicine pursuing the aid effectiveness topic will consider these and other questions.
Associated Faculty & Staff: Paul Farmer, Abbey Gardner, Jehane Sedky, Katherine Gilbert
Students interested in this opportunity can contact Dr. Farmer's assistant Jonathan Weigel, jonathan_weigel@hms.harvard.edu.

“Health system strengthening” has become entrenched in the jargon of global public health and medicine. Every health care worker knows that durable health systems are the best way to deliver care efficiently and equitably around the world. In international health policy, there is often a one-size-fits-all approach, wherein children are often considered “little adults” without specific consideration to their different needs and clinical presentations. What are the key components of health system strengthening, and how can they be harmonized to meet the needs of vulnerable persons, specifically children? What does health system strengthening now promise beyond similar efforts in the past, such as the primary health care movement of the 1970s or the focus on child survival of the 1980s? What examples, if any, demonstrate models for building and scaling up effective health systems that include high-quality pediatric services? Rwanda has been cited as one example of a country in sub-Saharan Africa that has made great strides in strengthening its health system, including reducing child mortality by 50% and achieving exemplary coverage rates for all basic child vaccinations, and several newer vaccinations. Is this a fair analysis? If so, what in particular does Rwanda’s example offer to other developing countries (Haiti, for example) seeking to improve children’s access to high-quality care? Scholars in medicine will consider these questions, among others.
Associated Faculty & Staff: Paul Farmer, Agnes Binagwaho, Peter Drobac, Corrado Cancedda
Students with questions about this project can contact Dr. Farmer's assistant Jonathan Weigel, jonathan_weigel@hms.harvard.edu.

Some 75% of case fatalities from cancer occur in developing countries; experts estimate that by 2030, 70% of new cancers will occur in the developing world. Some write off cancer as untreatable in resource-poor settings—as they did for AIDS and MDRTB and many noncommunicable diseases. But models of effective cancer care in impoverished communities exist, and there is growing consensus about the feasibility—if not the imperative—of treating cancer in developing countries. How can health systems in resource-poor settings be strengthened to provide timely cancer diagnosis and quality care? Alternatively, how can cancer care be used as a wedge to push a more ambitious equity agenda, namely health system strengthening? What cancers can be effectively treated despite the shortage of oncologists in the developing world? How can training programs redress the lack of oncologists in developing countries? These and other questions will motivate the studies of scholars in medicine who choose this topic.
Associated faculty: Paul Farmer, Felicia Knaul, Larry Shulman, Sara Stulac, Gene Bukhman
Students with questions about this opportunity may contact Dr. Farmer's assistant Jon Niconchuk, jonathan_niconchuk@hms.harvard.edu.

Food insecurity leads to significant morbidity and mortality around the world every year. How does food insecurity interact with diseases of poverty, such as malaria, AIDS, tuberculosis, and cholera? Malnutrition has a simple and effective treatment: food. But still hundreds of millions of people—many of them children, almost all of them poor—suffer from chronic malnutrition around the world; chronic malnutrition is directly or indirectly associated with the deaths of 5 million children under five every year. Why is the international aid apparatus unable to provide adequate food to all who need it? What are the principal barriers to delivering food aid today? How does population growth affect our ability to stem the global pandemic of malnutrition? What is the role of new technologies, such as genetically-modified organisms and ready-to-use therapeutic foods, in decreasing the number of chronically malnourished people in the world?
Associated faculty & staff: Paul Farmer, Salmaan Keshavjee, Joan VanWassenhove
If you have questions about the project, contact Paul Farmer's assistant Jon Niconchuk, jonathan_niconchuk@hms.harvard.edu.

“Accompaniment” is a broad and elastic term with many applications in medicine and global health. On one hand, it is a basic principle of patient-centered care: doctors and nurses and community health workers must accompany patients—especially the poorest and sickest patients—on the road to recovery and good health. Directly observed therapy has been shown to improve clinical outcomes in the treatment of chronic diseases like cancer, HIV, and hypertension; it is, in essence, a form of accompaniment. But accompaniment also has a broader meaning relevant to global health: all health interventions could follow an accompaniment model. Global health practitioners and policymakers could accompany their intended beneficiaries by linking training, research, and service; by shoring up health systems and building infrastructures of transparency and accountability; by encouraging local procurement. Scholars of medicine who choose this topic will ask a number of essential questions about the accompaniment approach: How could the principles of accompaniment guide new rules of the road for foreign assistance and global health? What are the key modalities of an accompaniment approach? What examples in the history of global health provide support for, or evidence against, an accompaniment approach?
Associated Faculty & Staff: Paul Farmer, Nancy Dorsinville, Evan Lyon
If you have questions about the project, please contact Dr. Farmer's assistant Jon Niconchuk, jonathan_niconchuk@hms.harvard.edu.

The Scholars in Medicine cholera project offers students the opportunity to participate in research on the ongoing cholera epidemic in Haiti. After the first cases were documented in October of 2010, the Haitian cholera epidemic has become the largest the world has seen in recent history: over 7,000 deaths and over half a million cases have been reported. Today, cholera is well on its way to becoming endemic in Haiti. There are many pressing questions that scholars in medicine could pursue: what conditions in post-earthquake Haiti enabled such rapid spread of this waterborne pathogen? Why has one of the largest humanitarian aid efforts in history failed to slow cholera? What is the role of oral cholera vaccine in epidemic settings? What does the Haitian cholera epidemic have to tell us about global cholera prevention and control? Faculty in the Department of Global Health and Social Medicine are engaging these and other questions, and welcome the participation of scholars in medicine.
Associated faculty: Paul Farmer, Louise Ivers
If you have questions about this project, please contact Jon Niconchuk, jonathan_niconchuk@hms.harvard.edu.

This project will consider the challenges of building health systems from the ground up. What are the nuts and bolts of building clinics and hospitals in resource-poor settings like Haiti and Rwanda? How can such facilities be integrated into district-level health systems so they help provide care efficiently, equitably, and sustainably? Scholars who choose this topic will grapple with questions of scale and cost and the tradeoffs health providers face when choosing how and where to deploy resources. Moreover, how can governments and international organizations coordinate and harmonize public and private health initiatives. Haiti, sometimes called the “Republic of NGOs,” highlights the challenges and the benefits of significant nonstate investment and involvement in health care delivery. What lessons can be gleaned from efforts to coordinate foreign aid providers in Haiti before and after the earthquake?
Associated Faculty & Staff: Paul Farmer, Ted Constan, Claire Pierre
If you have questions about this project, please contact Dr. Farmer's assistant Jon Niconchuk, jonathan_niconchuk@hms.harvard.edu.