Traditionally, the terms “global health” or “global medicine” bring to mind efforts focused on addressing the most urgent and dire of injuries and illnesses affecting people in middle-to-low-income countries. These range from outbreaks of infectious diseases such as the West African Ebola virus epidemic in 2014, to respiratory diseases that plague areas hit hard by air pollution, infections caused by bacteria in contaminated water, and vaccine-preventable diseases such as measles, which the World Health Organization declared a “global health crisis” earlier this year.
While many of Penn Medicine’s Global Health efforts are aimed at addressing these issues, the health needs of those in middle-to-low-income countries are evolving, and now more closely resemble the needs of those in high-income countries like the United States. Though traditionally a major concern only in more resource-rich countries, in recent years, cardiovascular disease has started to affect people around the world.
That’s where Marietta Ambrose, MD, MPH, an associate professor of Cardiology and the new director of Penn Cardiology International (PCIL), comes in. Ambrose is the first director of the new program which aims to bring heart health initiatives and the world-class care of Penn Medicine, to those in middle-to-low income countries. The endeavor comes as the rates of cardiovascular disease in those countries is rising. According to the most recent data from the American Heart Association, 80 percent of cardiovascular disease deaths happen in middle and low-income countries.
“In many ways, medical care has improved dramatically in low to middle-income countries,” Ambrose said, adding that one obvious benefit to better health care is that people are living longer. Unfortunately, often with an aging population comes an increase in cardiovascular disease. “It’s certainly a problem, but it’s a problem that exists because of better management of other health problems.”
In addition to the increasing life expectancy, the lifestyles and diets of people in middle-to-low-income countries also more closely mirror those familiar to the western world. For example, people abroad are more sedentary, smoking more, exercising less, and embracing fatty and processed foods, Ambrose said.
“A lot of people are seeing an overall superior quality of life around the world, but that comes with new health challenges that we want to address,” she said.
With nearly two decades of experience treating people with cardiovascular disease in the western world where rates of CVD have been historically pervasive, Ambrose is uniquely positioned to take on the direction of the program. With institutional support, she plans to tap into the resources and administrative knowledge Penn uses to treat patients in Philadelphia, such as how staff efficiently deliver care to large numbers of patients.
The University of Cambridge medical school grad also brings international perspective and experience. She has treated patients in many countries outside the United States, including the United Kingdom, Australia, and in the Caribbean. Originally from St. Lucia, her experiences abroad have allowed her to realize the importance of having cardiologists from high-income countries share their knowledge and experience, from already treating cardiovascular disease for many years, with other physicians in low-to-middle-income countries.
With the help of grant funding, Ambrose foresees PCIL expanding Penn’s reach in places like Vietnam (where’s there’s already a full-time onsite Penn cardiologist), Jamaica, and Haiti. Though PCIL is still in its infancy, it’s already working toward these bigger picture goals. The division facilitates monthly CME-accredited teleconferences where Penn Medicine cardiologists converse with physicians in Jamaica and Haiti. The doctors there discuss specific cases, including treatment of patients and related scenarios, as a group. In this way, clinicians can learn from each other and create focused strategies for treating future patients with the same conditions, while contextualizing it to the local needs.
Along with facilitating educational opportunities, they have plans to provide remote monitoring capabilities such as providing cardiology consults to our partners in Vietnam and bringing more cardio-imaging services to areas of the world in need. Some Penn faculty have organized teams that travel to China and India to educate physicians about cardiac MRI. China specifically has seen an increase in recent decades in cardiovascular deaths caused by narrowing of arteries. Ambrose would also like PCIL to help patients from countries abroad obtain advanced care at Penn such as more complicated heart surgeries that can’t feasibly be done in the patients’ home countries.
“Sometimes there are poor environmental conditions or a lack of the particular expertise,” she said. “Surgeries like heart transplants are usually best done in resource-rich countries like the United States. They require a large amount of resources even here. Those challenges are magnified in middle-to-low-income nations.”
Ambrose’s future includes traveling. Her next trip will be to Vietnam after the new year. But Ambrose wants PCIL to function like the majority of Penn Medicine’s efforts abroad where the goal is to empower clinicians in those countries to have an impact on the healthcare of their own country. Global health efforts, she said, shouldn’t create dependency.
“There’s talent everywhere,” Ambrose said. “And Penn has a lot of resources that can be deployed much more effectively by people who live and work in the area and who understand unique cultures and needs. Our job is to identify talent, make connections, and form partnerships.”
Today, Ambrose dedicates much of her time to identifying the best partners and opportunities to make a difference abroad. Her efforts come at a fortuitous time as clinicians around the world are focusing more on the often sneaky issue of heart disease. It’s a time of new problems and new solutions.
“I have no doubt that in 20 years, physicians will look back at our current knowledge, the obstacles we face, and our healthcare challenges at home and abroad, and consider them to be antiquated,” Ambrose said. “And I’m excited for that time to come, because it will show how much more progress we have made.”