WHO IS THE WHO. INTERCONNECTIVITY

WHO IS THE WHO. INTERCONNECTIVITY

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MODULE #III. CIC/WHAG: WHO IS THE WHO. INTERCONNECTIVITY

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A triad may be as simple as a series of three things that form a group. People in Christian faith- based groups might be inclined to think of a triad as the Trinity. In medicine, it could be a triad of symptoms that occur together, as we will see for stroke and other advanced clinical conditions. After examining “the why” and “the what” questions, it would be natural to now look at “the who” as the third part of an introductory triad.

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It may be helpful to also specifically think of triads in terms of musical chords as a tonal blending of three notes, often called the root, 3rd and 5th. Arguably the root note of our major triad chord is “the who”, or the individuals whose contributions have brought us from passion and creativity to reality. It is these individuals who ultimately help create our particular harmony. You will be exposed to many of those powerful individuals and organizations who have travelled on this journey with us and helped to define our shared purpose.

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Informed consent is an important concept in medicine, building on the tradition of health literacy discussed in Module VII. We have determined that in order for you to make an informed decision about whether to respond positively to an invitation to join the CIC/GHN it is imperative that you know everything there is to know about Colleagues In Care. Built on the foundation of CIC/WHAG, CIC/GHN is the Glocal (or Global to Local) Hypertension Network (for low-resource venues). We have opted for full transparency and full disclosure of who we are, and who we have worked with on this developmental journey. In the next Module IV on situational analyses, we will then start the process of determining more of who you are, and whether this is a good fit for you and your organization. If it appears to be reasonable to proceed, then we start the knowledge sharing process in earnest starting with the essentials and education modules V to VII, strongly suggested as a requirement for all participants.

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With respect to the evolutionary development of the CIC/ World Hypertension Action Group (WHAG) as the foundation for CIC/GHN, we were very fortunate to have the support and input of two individuals whose contributions were immeasurable

Dense Factual Information About Colleagues In Care or Partner Organizations and Individuals.

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Michael A. Weber MD FACP, FACC, FAHA is a Professor of Medicine in the Cardiovascular Division at the State University of New York (SUNY) Downstate College of Medicine. Dr. Weber is an international hypertension thought leader, involved in and directing many international hypertension clinical trials. He has authored more than 500 articles, as well as serving as the editor-in-chief of the Journal of Clinical Hypertension. He has also authored or edited 16 books on hypertension including co-authoring the classic reference book HYPERTENSION.

Michael has served on the Executive Committee of the International Society of Hypertension, and was a founding member and President of the American Society of Hypertension. Indeed, it might be taken as good karma that essentially the founding meeting of WHAG occurred at the final ASH meeting in NYC. Dr. Weber has been very supportive of evaluating low resource Best Possible Practice hypertension approaches in Haiti.

He was primary author of the oft-cited 2014 Clinical Practice Guidelines for the Management of Hypertension in the Community, A Statement by the American Society of Hypertension and the International Society of Hypertension. We will be highlighting Dr Weber’s important work in Series Book Two on hypertension management.

Daniel T. Lackland Ph.D. is Professor of Epidemiology at the Medical University of South Carolina (MUSC), where he directs the Division of Translational Neuroscience and Population Studies and the Masters of Science in Clinical Research Program. Dan has more than 275 scientific journal publications, and has been a major player in the development of many hypertension guidelines ranging from the panel for JNC 8, NHLBI Global Risk Assessment, the ACC/AHA Clinical Practice Hypertension Guidelines, and multiple others. He is the Principal Investigator of NIH studies evaluating disparities in cardiovascular disease and hypertension.

As the previous Deputy Editor-In Chief of the Journal of Clinical Hypertension, Dan is encyclopedic in his knowledge of hypertension and public health. Dr Lackland is immediate past President of the World Hypertension League, and in that WHL leadership position has endorsed the FBO global outreach initiative, developing a special envoy position.

The philosophical and practical importance of interconnectivity under Dan’s WHL leadership will be discussed in more detail. Consistent with the philosophy that hypertension learning is a lifelong endeavor, Dr Lackland has also organized an excellent CME program endorsed by MUSC.

III.A. THE IMPORTANCE OF INTER-CONNECTIVITY

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Prevention and control of global hypertension is a complex challenge. When faced with complexity, it is advantageous to step back and take a systems approach, while examining how things inter-relate. It is only then that you collectively can develop a whole that is indeed greater than the sum of its parts, and understand the importance of interconnectivity and interdependence. As we move from analysis of separate components to synthesis of an innovative integrated model to address hypertension in low-resource venues, we must look at interconnectivity and interdependence from an organizational perspective. As we do so, we must also remain focused on interconnectivity and interdependence of individuals who move from acting in isolation to working in relationship.

III. A.1. WHL AND ORGANIZATIONAL INTERCONNECTIVITY

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Over the last decade of leadership and growth, WHL has been on a journey from a silo- based federation of 60 individual and separate national hypertension societies.  The journey has been characterized by communication, education, and a dynamic partnering focus.

Communication and education have fused and focused on multiple published statements that have set standards, many to be cited as a backbone support for what follows.  Examples include statements on standard uniform reporting, and policy statements on BP measurement as well as train the trainer modules for BP Screening programs.  Vigorous education efforts have included fact sheets on hypertension and salt, and extensive resources on the science of salt with salt education as a major focus.

At times, WHL has lobbied hard, and even taken the bully pulpit to challenge other cardiovascular organizations to develop strategic plans for the prevention and control of hypertension, and to bind together over salt initiatives.

CIC/WHAG leadership has grown from the WHL experience.  Dr Kenerson has been privileged to be co-chair of the WHL committee on BP Screening and BP measurement, as well as the WHL envoy for Global Faith-Based Hypertension Control Initiatives.   As president of WHL, Dan Lackland has been inspirational in his support of efforts to develop innovative solution responses to the challenge of hypertension prevention and control in low-resource venues.  The FBO medical mission hypertension initiative has been a shared vision, and the shared CIC and WHL overlap territory of WHAG.

The virtue of active inter-connectivity has been manifested most clearly by initial strong WHL partnerships with the World Health Organization (WHO) and the International Society of Hypertension (ISH).

There are other geared relationships of active inter-activity as well.  We have seen the importance of vital and vibrant WHL bonds with PAHO/CDC and the Caribbean based Global Standardized Hypertension Treatment Project (GSHTP) Barbados Pilot. Most recent important active WHL partnerships include the Global Hearts Initiative and Resolve to Save Lives Program.

The focus of these partnerships has been on developing and implementing systems for primary care delivery of hypertension integrated services through clinics focused on prevention and control.  This is a WHO-inspired cardiovascular primary care blueprint that has worked well in high- to many middle- income countries, and some urban low-income countries.  Unfortunately, it often does not diffuse down to the rural destitute poor level, and the low-resource venue outcome gap has widened.

The difficult 2020 reality is that there is just not enough money to allow these clinic models to penetrate into rural destitute poor communities, which ironically are exactly the communities where FBO and NGO medical missions serve.  In this scenario, it is a binary decision:  either there is enough financial resource to adequately support the primary care clinic model, or there is not.  Many of these communities simply do not make the cut, and have no hypertension control services of consequence.

Working with WHL, the World Hypertension Action Group (CIC/WHAG) looks to develop the complementary and supplemental pre-primary care niche by working with FBO and NGO medical missions in low-resource areas of the destitute poor, fostering ICT interconnectivity.  WHL therefore plays a critical intermediary position connecting partnering efforts at both the pre-primary care and primary care sides of the spectrum. It is a silo busting mentality

III.B. INTERCONNECTIVITY OF INDIVIDUALS BOTH WITHIN AND WITHOUT ORGANIZATIONS. MORE A TAPESTRY THAN A QUILT

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Interconnectivity of larger organizations may resemble a patchwork quilt, as it is dependent upon alignment along the defined margins.  It can be very artistically and creatively done, even as you incorporate squares of very different size and color.  It is however by definition a piecemeal composition of different components put together without altering internal design significantly, many with imbedded emblems and logos.

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            For more of a grass roots small size organization, when you speak of inter-connectivity it is generally related to individuals.  Those individuals may or may not be part of large organizations, but are connected by virtue of the development of personal relationships.  The art generated is a woven design that is made up of different individual color threads and different type materials from cotton or wool with augmentation of silk, gold, and silver.   The component colors and textures tend to be more nuanced without clear boarders. 

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 CIC/WHAG is more a tapestry of developed relationships with individuals within or without organizations. As we recognize and show our appreciation for these individual’s contributions and support, the identification characteristics are not always simply of one primary color.  Many have components of multiple categories or colors, and are not unidimensional, but all are part of the woven matrix that is becoming our tapestry.  The unifying theme is that all are our colleagues, teachers, and mentors in the journey. 

III.B.1. CIC/WHAG TAPESTRY: HYPERTENSION

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In 2010, we went to the Vancouver International Society of Hypertension (ISH) meeting including a combined meeting with WHO on global gaps in hypertension care.  We simply showed up and asked for help.  Though ISH at that time was known more as an organization dedicated to support of academic hypertension research, starting with the gracious introduction by previous Presidents Drs Lars H. Lindholm and Anthony M. Heagerty, sequential Presidents of ISH were very supportive of our efforts.

Professor Stephen Harrap M.D. was perhaps the most impactful, as he encouraged Dr Michael Weber to work with us on a different management approach for hypertension in the low-resource community of Haiti.  As this one aspect of the Haiti mustard seed grew into the ASH/ISH guideline for management of hypertension in the community, President Ernesto Schriffrin M.D. was also very supportive.

One aspect of large organizations is that the concept of official “endorsement” is more of a lateral construct existing between major organizations, whereas relationships between individuals who are part of large organizations are more personal.  This concept of large organizational endorsement may be much more difficult for asymmetrically sized small groups in the formative stages with simple aspirations to serve.  Rather than officially endorsing, the key important interaction is more the concept of “enabling” the smaller group.  The large player can influentially support nascent efforts, even if only by virtue of listening and having a dialogue. 

One aspect of large organizations is that the concept of official “endorsement” is more of a lateral construct existing between major organizations, whereas relationships between individuals who are part of large organizations are more personal.  This concept of large organizational endorsement may be much more difficult for asymmetrically sized small groups in the formative stages with simple aspirations to serve.  Rather than officially endorsing, the key important interaction is more the concept of “enabling” the smaller group.  The large player can influentially support nascent efforts, even if only by virtue of listening and having a dialogue. 

The 2010 Vancouver meeting was such a critical event for CIC, beginning a long and productive relationship with “the enabler- in- chief” Norm Campbell M.D. who became the President of the World Hypertension League.   It was a distinct honor for Dr Kenerson to serve as the Co-Chair of the WHL committee focused on BP Screening and BP measurement with the Hypertension Canada Distinguished Service Award designate Lyne Cloutier RN, Ph.D.  Lyne is yet another advisor and friend who traveled to Haiti with us to perform BP screening and discuss national nursing hypertension education. 

WHL committee members Eugenia Veiga RN, Ph.D and Tej Khalsa MD, MS, FRCP also had major influences as noted in Modules V and VI on BP Screening and BP measurement.    Mark Gelfer MD, CCFP, FCFP was very helpful in acquiring knowledge about automated devices and specifically Automated Office Blood Pressure Measurement (AOBPM) device development.  Eoin O’Brien MD, DSc, FCFP not only was the ultimate resource on validation of BP measurement devices, but also offered the practical experience of working with a faith-based group in Haiti.

It is ironic that the first WHAG formation meeting bringing CIC and WHL together was the last meeting of the American Society of Hypertension in NYC.  We are appreciative of the support by Professor Dominic Sica M.D., President of the American Society of Hypertension (ASH) 2014-2016, and also very appreciative of the ongoing support of 2016-2018 ASH President Professor John Bisognano M.D.  Ph.D. 

Recognized U.S. hypertension leaders such as South Carolinians Professor Brent Egan M.D. from Medical University of South Carolina College of Medicine (MUSC) and Distinguished Professor Don DiPette MD, from University of South Carolina (WHL Envoy to Latin America and the Caribbean) from the beginning have always been available for dialogue and have been supportive.   Others, including Professor Raymond R. Townsend M.D. the Director of Hypertension Program at the University of Pennsylvania, have been more than willing to enthusiastically share their extensive knowledge and counsel as those also who are also experienced in medical missions and hypertension in low-resource venues.

Special recognition and thanks to our Haitian hypertension colleagues Roger Jean-Charles M.D., Director of Centre Haitien d’Hypertension (CHH) and Jean Claude Cadet M.D., Dean of the Faculte de Medicine et de Pharmacie de l’Universite d” Etat d’Haiti (FMP-UEH).  We would also like to recognize the fine regional hypertension work of the Health Caribbean Coalition (HCC), in partnership with the Pan American Health Organization (PAHO), and the U.S. Center for Disease Control (CDC).  HCC is a model for NGO networks and the importance of inter-connectivity. 

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