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A second day job half a world away

March 2012

Published in the March 2012 issue of Today’s Hospitalist

WHEN HOSPITALIST KEDAR MATE, MD, isn’t seeing patients or supervising trainees at Manhattan’s New York-Presbyterian/Weill Cornell Medical Center, he’s likely half a world away helping improve how health care is delivered in Africa.

Working in global health has been Dr. Mate’s passion since before medical school. He now splits his time between the hospitalist service at Cornell, where he is an assistant professor of medicine, and the Cambridge, Mass.-based Institute for Healthcare Improvement (IHI), where he collaborates with others to redesign health systems around the world.

His interests dovetail together nicely, Dr. Mate says, because hospitalists tend to be interested in ways to improve safety, efficiency and equity. All of those skills, he adds, are as relevant to patient care in New York as in a regional clinic in Tanzania.

“Equity is big when it comes to global health,” he explains, but it also is a major problem on Manhattan’s Upper East Side. “The question is how do we design health care systems that provide higher quality service to vulnerable patients, including here in the U.S.”

Dr. Mate notes that there are lessons to be learned from other models of health care. While the concept of “hospital at home” is only now gaining traction in the U.S., for instance, it has been the default model in Africa, where patients simply have no other options.

“We have had to figure out how to take care of people who are really sick, without a lot of resources, in a community-based environment,” Dr. Mate explains. “We have to start thinking about how to do that here too.”

He’s now used to leading a peripatetic life. Until 2010, he lived in South Africa for as many as nine months out of the year. “Now, I travel to Africa, Asia or Latin American practically every month for a week or two at a time,” Dr. Mate says.

He is now leading an IHI initiative in South Africa to increase the number of HIV patients on antiretroviral therapy and stem the transmission of the virus from mothers to babies. He’s also working on projects to reduce childhood mortality in Ghana, and improve maternal and neonatal survival in Malawi.

And he works with Cornell’s global health program at the Bugando Medical Centre in Tanzania, where medical residents and faculty collaborate on quality improvement projects. “We are teaching basic QI techniques and tools,” says Dr. Mate.