SC Connecticut News

Rheumatic and musculoskeletal diseases are a leading cause of disability worldwide, according to studies. Yet few global and community health programs address these complex conditions, says Evelyn Hsieh, MD, PhD, associate professor of medicine (rheumatology, allergy and immunology).

To help address this gap in global rheumatologic care, in 2023 Hsieh led the creation of the Yale Rheumatology Program in Global and Community Health. The program connects faculty, fellows, and others in the Yale Section of Rheumatology, Allergy and Immunology who are interested in global and community health. It strives to promote research, capacity building, education, and partnership on issues of priority amid resource disparities.

“I saw the program as a way to add cohesion to the great work being done across the section,” Hsieh said. “Bringing this work together under an organized platform allows people to collaborate and build ideas off each other.”

The program provides a network for faculty and trainees striving to better understand how diverse geographies, ethnicities, genetic factors, environmental variability or health system disparities uniquely influence the epidemiology and outcomes of rheumatologic and musculoskeletal diseases. Hsieh stresses that equity, sustainability, and innovation underpin the program's various initiatives.

Facilitating Collaboration

The Yale Rheumatology Program in Global and Community Health offers periodic research-in-progress meetings for those engaged in clinical and translational research. At one such meeting, clinical fellow Mario Felix, MD spoke about his work on social determinants of health and lupus. Another participant resident Diego Cabrera, MD discussed musculoskeletal outcomes among women aging with HIV in Peru.

“It’s important for people to have a way to share their research and also learn more about what others are doing both locally and globally,” Hsieh said.

Through various global health research training programs hosted by the initiative scholars from Peru and China were welcomed in 2023. Plans are underway to host scholars from Uganda during the 2024–2025 academic year while sending Yale scholars abroad.

“Through these exchanges trainees fellows faculty have opportunities to build relationships acquire practical skills collaborate on mutually meaningful projects,” Hsieh said.

Addressing Workforce Disparities

Supported by a grant from the International League of Associations for Rheumatology (ILAR), the program offered a virtual educational series for Rwandan internal medicine residents in 2023 led by Joshua Bilsborrow MD MHS collaborating with University Rwanda College Medicine Health Sciences.

Bilsborrow noted Rwanda’s shortage of rheumatologists resources treat rheumatic diseases effectively. In 2024 Bilsborrow Hsieh collaborated on second ILAR grant led by Ugandan colleague Mark Kaddumukasa MD PhD Makerere University College Health Sciences conducting educational series Ugandan residents general practitioners with others including Abhijeet Danve MD MHS Trina Pal MD MPH Lillian Tugume MD MPH Anthony Makhoba MD.

With curriculum covering ten topics using case-based approach series ending June was well-received “We had anywhere from 60-120 people participate each session” Hsieh added noting some participants were physicians from Tanzania Kenya too.

Faculty currently building patient registry advance understanding epidemiology gaps challenges treatment Uganda part grant “Scarcity rheumatology care providers low middle-income countries like Rwanda Uganda significant challenge patients face missed delayed diagnoses resulting inadequate treatment” Bilsborrow said “Our educational series aims help address gaps empowering local general medicine physicians knowledge skills necessary provide basic rheumatology care.”

Hsieh notes educational series example addressing disparities promoting equity through global partnership “Significant investment engagement both faculty Yale Uganda everyone actively participating partners make happen.”

Empowering Patients

In addition provider training increase patients’ knowledge Pal led patient education series co-mentored by Hsieh Kaddumukasa collaborating Auther Jjunju Arthritis Association Uganda patient advocacy group Series developed direct patient input covered topics understanding arthritis diet exercise medications women’s health considerations

“The series focused self-management goal empowering patients better understand condition recognize ways make health behavior choices optimize disease control overall well-being” Hsieh said Additional patient-centered programs include Yale Lupus Wellness Program led Jacinta Renaldi MSN APRN

Increasing Access Care

Collaborating West Haven VA Medical Center Home-Based Primary Care Program David Podell MD PhD instructor medicine former chief Waterbury Hospital developing home visits program homebound veterans receive needed care assessment chronic conditions anticipated begin fall Podell excited opportunity address need new visits another example helping individuals otherwise unable obtain care

“Here around world our goal work together bridge access gap populations significant challenges” Hsieh said For more information visit Yale Rheumatology Program Global Community Health

Yale School Medicine Department Internal Medicine Section dedicated providing care educating future generations conducting research fundamental questions autoimmunity immunology To learn more visit Rheumatology Allergy Immunology

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