In Haiti and Rwanda, Fellows work to integrate mental health care into national health systems

A support group in Rwanda tends to the mental health needs of patients.

This past July, Dr. David Grelotti and Dr. Stephanie Smith became PIH’s first Pagenel Fellows. Dr. Grelotti will spend the 1-2 year long fellowship working with Zanmi Lasante, PIH's sister organization in Haiti, while Dr. Smith will work with Inshuti Mu Buzima, PIH's sister organization in Rwanda.

	Dr. Mario Pagenel

Established in 2011, the Dr. Mario Pagenel Fellowship in Global Mental Health Delivery provides psychiatrists and graduating senior psychiatric residents with the opportunity to develop service and academic career interests in global mental health, and support mental health training programs at PIH sites.

The Fellowship celebrates the life and work of Dr. Mario Pagenel, who died in Haiti's 2010 earthquake. Dok Pagenel – director of training and medical education at Zamni Lasante – had a special interest in mental health and health equity. 

Co-sponsored with Harvard Medical School, the Pagenel Fellowship is designed to facilitate training in mental health services for local health care providers in the places where PIH works, as well as for US-trained clinicians interested in global mental health.

Treating those in need, training the next generation of health care professionals

	A training for mental health clinicians in Rwanda.
	Health workers in Haiti discuss mental health issues at a recent training.

The Pagenel Fellows will share clinical expertise at the bedside and through didactic teaching, accompanying local health care providers in developing their skills in implementing clinical mental health interventions. Fellows will work side by side with Haitian and Rwandan clinicians who are the primary providers of mental health services. This program aims to facilitate opportunities for Haitian and Rwandan health care providers distinguished as leaders in mental health to develop their skills and careers, promoting their desire to practice and serve in their home communities. In turn, the Pagenel Fellows will directly experience the challenges that their colleagues experience in providing mental health care to the poor. 

In Haiti and Rwanda, the Pagenel Fellows will provide training to a range of health care workers (physicians, nurses, psychologists, psychiatric nurses, social workers, and community health workers). Cooperating closely with the Haitian and Rwandan Ministries of Health, they also will support efforts to strengthen mental health services nationally.

PIH's mental health strategy is coordinated with the construction of Butaro Hospital in Rwanda, and of Mirebalais Hosptial in Haiti. The Fellows will serve as expert clinician-teachers at these teaching hospitals, and will be instrumental in supporting expert multidisciplinary teams in mental health care and training at these facilities.

Integrating mental health care into local health systems

Ultimately, the Pagenel Fellowship is part of an overarching strategy focused on integrating mental health into every level of health care. Mental health care will be integrated along with psychosocial care into home visits, appointments at health clinics and care at district hospitals.

In order to meet patients' needs, all levels of health workers will eventually participate in mental health care to some degree. For instance, a community health worker might identify a potential patient, a physician might determine the appropriate course of treatment, and a nurse might manage treatment over time. Each health worker will know how to support decentralized mental health systems. This is a system where community health workers and social workers deliver the bulk of the care. Psychologists and physicians oversee care and take responsibility for treatment of the most severe cases.

Consistent with WHO guidelines, this care structure aims to maximize the efficient use of expertise in resource-limited settings. By supporting capacity building efforts, the Pagenel Fellows will facilitate the development of this "continuum" of mental health care.

In July 2011, the Fellows participated in the Harvard Global Health Effectiveness Program – an intensive program that trains people how to manage health care in resource-poor settings. They will spend most of their fellowship year in Haiti and Rwanda, while also developing an area of academic focus in global health related to mental health service delivery.

Meet this year’s Pagenel Fellows.

October 10 was World Mental Health Day, learn how PIH staff and patients in Haiti commemorated the day.