Kristen Breslin, MD, MPH, is an attending in the Divisions of Emergency and Hospitalist Medicine at Children’s National. She received her medical degree from Harvard Medical School and completed her pediatric residency at the Boston Combined Residency Program. She finished her Pediatric Emergency Medicine Fellowship at Children’s National while completing her Master’s in Public Health at George Washington University. Dr. Breslin volunteers annually in Roatán, Honduras providing both clinical care and education through partnerships with Clinica Esperanza, Public Hospital Roatán, and the Roatán Volunteer Pediatric Clinic (RVPC). She has also contributed her clinical and teaching expertise to projects in Haiti, through Project Medishare in the central plateau and through the CRUDEM Foundation at Hôpital Sacré Coeur in Milot. She is a Global Health Faculty Mentor for pediatric residents, and can serve as a faculty contact for residents interested in doing similar work in Honduras and Haiti. Dr. Breslin has a particular interest in addressing issues and systems which affect delivery of care. She aims to improve access and timeliness of care provision in resource limited acute care pediatric settings, and is actively engaged in educating and training the next generation of global health providers here at Children’s.
Dr. Breslin’s interest in global health began during an exchange program to Guatemala in medical school. At the time, she saw the opportunity as a way of exploring the ways medicine is different in rural areas, as well as the challenges to providing care in these regions. “Medicine is very different in resource limited settings compared to the resource rich teaching hospitals I was familiar with,” recalls Dr. Breslin. “I saw it as useful to my development as a physician and as a person, and it encouraged me to do more to help my fellow providers who are working abroad.”
Inspired by her experience in Guatemala, Dr. Breslin got involved with Clinica Esperanza in Roatán, Honduras. The project “has a mission of helping providers work overseas and share education with local providers.” Travelling again to Roatán in 2007, 2009, and 2012, Dr, Breslin provided clinical care in both an outpatient clinic and in an inpatient setting at the Roatán Volunteer Pediatric Clinic and Public Hospital Roatán. Both of these locations provide critical access to pediatric care, and are staffed by a US nonprofit that operates within the local hospital.
After her second visit in 2009, Dr. Breslin became increasingly interested in providing something educational, and more sustainable, for local providers. She identified the Emergency Triage Assessment and Treatment (ETAT) curriculum created by the World Health Organization (WHO) as “a great curriculum for empowering nurses to deliver care and operate more independently in the immediate response to the emergency.” Dr. Breslin hoped the program would “be a great educational tool for the nurses, for building their pediatric assessment skills” and for “encouraging the nurses to initiate emergency treatment, giving them the first steps to get kids treated faster.” The ability of ETAT to standardize emergency care was another draw, especially as Dr. Breslin is personally focused on improving care delivery systems. The class went “really well,” and Dr. Breslin is helping to lead a similar workshop for providers here at CNHS in September 2018.
Dr. Breslin has also travelled to Haiti several times. Her first trip was through a partnership between George Washington University’s International Medical Office and Project Medishare. A team of providers and students organized by GWU travels to the central plateau region in Haiti annually, setting up mobile clinics in the most rural areas which receive hardly any medical care. The trip provides medical students the opportunity to experience a low-resource health system, and volunteer physicians to deliver clinical care. Dr. Breslin went as the pediatrician on the mission. The group travelled to four different villages over the course of a week, providing mostly primary care and treating acute problems. Following her first trip and interested in what the Haitian health care system had to offer, Dr. Breslin returned to Haiti, this time to Hopital Sacre Coeur in Milot. She went with a surgical team, providing additional clinical support both inpatient and outpatient for the increased volume of patients receiving operations.
One of the most notable aspects of this trip for Dr. Breslin was observing the differences between care facilities and regions within the same country. At the hospital, providers would see patients who had travelled hours on foot or by bus to get there, in addition to local community members. “The patients we saw and the problems we saw (in both places) were very different,” she remembers, highlighting the significant variability of resources and illnesses in different countries and even within the same country, a major challenge when planning for and operating globally.
However, says Dr. Breslin, the important thing to realize is the differences in outreach lie in the standards of care these communities are capable of supporting, not the way in which those standards are adopted, “we may be talking about a different issue but the process of delivering care, advancing care, and advancing treatment is very similar.” This dynamic is one of the principal things Dr. Breslin has learned from her time in global health and has informed both her further international outreach and her efforts at training providers here at Children’s National.
Dr. Breslin hopes to share her experiences and the lessons she has learned with the next generation of global health providers at Children’s. At the moment, she is primarily focused on education, training, and getting younger providers involved. She wants to make sure residents know they don’t have to spend months or years abroad, “if you have the interest, there is a way that it can be put to use for patients around the world.”
The potential of “global health as a way to learn about how most people experience healthcare” is an opportunity Dr. Breslin wants others to understand, be prepared for, and eventually experience for themselves. As part of this goal, Dr. Breslin is helping to lead the ETAT workshop for CNHS nursing in September. It’s about systems improvement, she says, “what we are really trying to do is provide more general care, quickly, to as many patients as possible. ETAT is really about doing that–how can we intervene in serious illness and how do we provide different kinds of treatment for various illnesses.” Ultimately, says Dr. Breslin, the question to answer is “how can we provide the most good for the greatest number of patients?”