Interested in global public health? Bridge to Health Medical and Dental has worked in partnership with local grassroots organizations and government agencies in rural communities across southwestern Uganda and Kenya to provide education and training, clinical services, and build innovative solutions to complex problems. Come learn about these initiatives, connect with Rotarians who build sustainable collaborations to improve health and education, and be inspired to take action.

1. IMPROVING ACCESS TO HEALTHCARE
FOR LOW-RESOURCE COMMUNITIES
Rotary International, June 25th 2018
Dr. William Cherniak MD, MPH, CCFP/DABFM - Executive Director, Bridge to
Health Medical and Dental
Ms. Tina Papacosmas RRDH – Dental Director, Bridge to Health Medical and
Dental
@WilliamCherniak

2. WHO AM I?
• Dr. William Cherniak (Bill)
• Family and Emergency Medicine
Physician
• Lecturer, DFCM, UofT, Division
of Emergency Medicine in
Toronto, Canada
• CoFounder and Executive Director of
Bridge to Health Medical and Dental
• www.bridgetohealth.ca
• Clinical Assistant Professor, USC
Keck School of Medicine

3. Peyto Lake, AB

5. UGANDA

6. UGANDAN HEALTHCARE
• Healthcare provision is a mix of public and
private sources1
• Public Healthcare:
• Provided on a district health system, with
level one to four health centers (four
being the most advanced)
• Private Healthcare
• Delivered predominantly by faith-based
organizations such as the Uganda
Catholic Medical Bureau (UCMB) and
others
1. World Health Organization. Health System Profile for Uganda. 2005. Accessed online on February 22nd, 2016 at https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0ahUKEwjI-
4y91IvLAhWKWh4KHfneA0IQFgg3MAM&url=http%3A%2F%2Fwww.afro.who.int%2Findex.php%3Foption%3Dcom_docman%26task%3Ddoc_download%26gid%3D2835&usg=AFQjCNFFP8HT_nk97BWpJLNuHy
pX1hIh9Q&sig2=BXpgMRSr1yIGdZG_RbYLmw&cad=rja

7. WHERE IN THE WORLD IS…

8. • Population of ~600,000
• Rural region of Uganda
• Serviced by only a handful of healthcare providers
• Mountainous topography
KABALE DISTRICT

9. THE REALITY
• Healthcare workers flock to
urban centers
• Communities isolated from
main town
• Limited or no access to care in
rural communities
• Minimal access at main referral
centers

11. LOCAL
PARTNERSHIP:
• Kigezi Healthcare Foundation, southwest Uganda
• Not for profit, non governmental community
development organization
• HIV/AIDS
• Maternal health
• Malnutrition
• Microfinance
• Disease, ignorance and poverty

13. WHO AM I?
• Tina Papacosmas
• Restorative Dental Hygienist
• Private practice 18 years
• Instructor: didactic and clinical
15 years
• Co-founder and Dental Director
of Bridge to Health

14. ETHIOPIA 2011

15. KENYA
2012

17. Our aim is to provide sustainable healthcare in a cost effective
manner, having a lasting impact on the communities we serve.
MISSION STATEMENT

18. Bridge to Health aspires to:
1) Build partnerships with not-for-profit healthcare organizations
in under-serviced regions of the world
2) Provide high quality medical and dental services
3) Educate local populations and healthcare practitioners
4) Develop sustainable healthcare infrastructure through
innovative models
MISSION STATEMENT

19. OUR MODEL

20. Untitled

21. OUR MODEL

22. UGANDA
• Nearly 30,000 patients seen
over the last six years
• Partnered with KIHEFO
• Working with local
government and Academia

23. KENYA
• Launched new partnership with
Africa Cancer Foundation and
Kisumu County Government in
February, 2018
• Began discussions with Dr. James
Alaro at NIH/NCI, Center for Global
Health in March, 2017
• Developed collaborative
arrangements over 12 months
• Treated nearly 3,000 patients in first
year

26. SOME STATS ON KISUMU
• Population of 1,031,485 as of 2012 vital statistics, 20% under 5 years old
• >50% rural, 60% in absolutely poverty (<$2/day)
• Infant mortality rate 54/1000
• Canada, by comparison, is 5/1000; still one of the highest in the developed world
• Maternal mortality rate is 495/100,000
• Canada is 11/100,000
• Doctor to population ratio 0.02/1000
• Canada is 2.2/1000 or 110X greater
https://www.google.ca/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&cad=rja&uact=8&ved=0ahUKEwjvrKmNiIHaAhVL94MKHfm3BGcQFghkMAY&url=http%3A%2F%2Finf
otrakresearch.com%2Fwp-content%2Fuploads%2F2017%2F04%2FKisumu-Countytrak-April-release.pdf&usg=AOvVaw2ffDcfs7wRbkZ-CVhgedQJ

29. Banner

32. ORAL
HEALTH
AND
FLUORIDE

37. HYGIENE

38. DAILY SET
UP

39. SURGICAL

40. RESTORATIVE

41. PROSTHO

42. After

43. OUR MODEL

50. BANANAS!

57. Prostho

58. OUR MODEL

59.  Only ~54% percent of women ever see a health care provider during pregnancy1
 Only ~30% of these women actually deliver with a health care provider2
 High rates of HIV in women
◦ 1.4 million in Uganda HIV+ (prevalence rate of 6.5%)3
◦ Women aged 15-49 estimated prevalence of 7.2%-8.3%3
 Major lack of infrastructure and services
1. Data obtained from White Ribbon Foundation
2. Unpublished data obtained from Kigezi Healthcare Foundation/Bridge to Health Medical and Dental
3. Obtained online from UNAIDS, Dec 9th, 2017: http://aidsinfo.unaids.org/
MATERNAL HEALTH

60. • Old idea!
• The WHO (2003) recognizes
ultrasound technology
• Effective in rural East African
settings
• Simple and non-invasive procedure
• Reduces fear
ULTRASOUND IN PREGNANCY

61. THE QUESTION
Can offering a free obstetric
ultrasound, through use of a
portable ultrasound, increase
the rates of women presenting
for antenatal care?
• Is advertising via word of
mouth enough, or do you
need to use radio?
• Will women who have
previously seen a traditional
healer be more likely to
come when ultrasound is
advertised?

62. ROTARY IN ACTION
• Purchased two portable ultrasound machines
• Designed health clinics on WHO PMTCT
guidelines
• Enrolled 159 women in study, rate 11.1/1,000
pregnant women on control days and
65.1/1,000 on internvetion days.
• 4% HIV+, 2% syphillis+
• Ultrasounds left with KIHEFO, in use today

63. Prostho

64. CERVICAL CANCER
Entirely preventable cancer, kills very
few in wealthy countries
• highest cause of cancer death in
women in Uganda
• Need high quality screening and
treatment programs
Developed first ever educational
program for screening and treatment
• Taught 15 Ugandan healthcare
workers
• Screened more than 600 women
• Treated dozens for pre-cancerous
lesions
• Road to sustainability

68. PUBLICATIONS
• New England Journal of Medicine
• Syphilitic Gumma
• The Lancet
• Pathology in Low and Middle Income Countries
• Annals of Global Health
• Host Perspectives of International Electives
• Presented at CUGH in Washington, DC
• PLOS One
• Presented at American Public Health Association Meeting in Chicago, IL
• Presented at Canadian Conference for Global Health in Ottawa, ON
• Article in New York Times
• Numerous Student presentations and publications

72. OUR GENEROUS SPONSORS

73. QUESTIONS?
E: william@bridgetohealth.ca
W: https://www.bridgetohealth.ca
www.facebook.com/bridgetohealthorg
Be in touch!