From Ruli to Detroit: Cross-Continental Learning

When Henry Ford Health System visited Rwanda in partnership with Robert Wood Johnson Foundation, they visited Ruli District, Rwanda and were impressed by TIP Global Health’s Hope Initiative research. TIP developed the Hope Initiative to better understand the influence of health system design on hope among nurses and mothers in rural health centers of Rwanda and the impact of hope among this same population on sustainable improvements in health outcomes. The Henry Ford Health System recognizes the common challenges of hopelessness among clinicians and pregnant women served in their health care delivery system in Detroit, Michigan and saw the broad applicability of the Hope Initiative research worldwide. Together, the Henry Ford Health System and TIP Global Health Hope Initiative teams have come together to demonstrate that hope is critically relevant to any local primary health care delivery system – whether in Rwanda or the United States – and that hope can be influenced and thus contribute to the successful achievement of good health outcomes. 

The Henry Ford Health Systems and Dr. Ijeoma Opara from Wayne State University invited TIP Global Health’s Director of Behavior Change, Angele Bienvenue Ishimwe, and her team to visit Detroit, Michigan to share their experience with this research and discuss the possible solutions to issues discovered in the findings, which are applicable in many cultural contexts. Communities from Low Middle Income Countries (LMICs) are often given the false impression that health care challenges exist in the Global South and health care solutions exist in the Global North. to conduct a three day workshop This was a critical opportunity to better understand the commonality of opportunities and challenges of providing frontline healthcare to vulnerable populations.

When TIP Global Health’s research team began conducting Hope Initiative focus groups in Rwanda, they heard discussions about the systemic factors that contribute to a person’s deficit mentality and the impact of racist norms. Focus group participants also described open and communicative relationships with their health care providers as contributing to their sense of hope and hopefulness in their health outcomes. Many of these discussions and findings from the Rwandan focus groups mirror Dr. Opara’s findings from the research conducted in Detroit.

Participants of a recent focus group held in Rwanda.

The Detroit workshop brought together stakeholders from a wide variety of institutions including hospitals (HFHS, Wayne State Medicine, Detroit Medical Center), funders (Robert Wood Johnson Foundation), community based and global health organizations (TIP, HFHS-GHI), and educational institutions (Johns Hopkins University). The group included experts in medicine, nursing, midwifery, psychiatry, education, social sciences, as well as administrators, program managers, and foundation relation representatives. 

Together, participants sought to answer the following questions to guide the development of the Hope Initiative intervention in Detroit. 

• What does a thriving Detroit look like? 
• What factors inspire hopefulness among health care workers (HCW)? 
• What factors diminish hope for HCW? 
• What factors inspire hopefulness for health care recipients (HCR)?
• What issues diminish hope for HCR?

Each stakeholder was asked to introduce themselves and offer one word that encompassed what a thriving Detroit would look like to them. Below is a visual representation of participants’ response, with the larger words occurring more frequently. These words, when taken together, are how respondents describe a sense of hope.

Stakeholder one word responses to the question of what a thriving Detroit would look like to them. Together, these collections of words describe hope.

The Hope Initiative was initially developed by TIP Global Health to understand the influence of health system design on hope among nurses and mothers in rural health centers of Rwanda and the impact of hope among this same population on sustainable improvements in health outcomes. The Henry Ford Health System recognizes the common challenges of hopelessness among clinicians and pregnant women served in their health care delivery system in Detroit, Michigan.
While the TIP Global Health team is striving to reduce the maternal mortality rate in Rwanda, today the United States’ rate lags behind other industrialized high income countries at more than 17 deaths per 100,000 births. This rate is driven by ever-widening racial health disparities found in the U.S. healthcare system, where black women’s pregnancy-related mortality is 3.2 times that of white women’s. These disparities are caused by structural, systemic, and institutionalized racism as well as the intergenerational trauma and chronic stress that affects black communities in the United States. The provider-patient relationship impacts health outcomes such as this. By building partnerships so both parties feel valued, the aim is to build hopefulness to create better, healthier outcomes.

In order to truly drive this change and create a better sense of hopefulness, Dr. Opara suggests the healthcare industry reject a deficit service approach and instead adopt a hopefulness model to their processes, models, practices, and care approaches to create a stronger health system that will empower all involved. There is also evidence that this approach also helps prevent high rates of burnout among frontline health workers. By designing systems of engagement with patients and communities that are built upon a cultural and professional humility model, it creates the opportunity for both parties, professional and lay, to learn from each other. Building systems in reference and reverence of those folks being serviced is an asset, and assists in frontline health worker wellness.

This model for collaboration serves as an important model for how the United States can learn from innovative work performed in LMICs in a reciprocal way that also builds the capacity of the LMIC team. We are building upon one another’s strengths and contributing uniquely meaningful research to the health sector. Through our work together, the Hope Initiative holds great promise for demonstrating the critical role hopefulness plays in achieving and maintaining good health outcomes.

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