Daria Szkwarko, DO, MPH and co-PI Hussein Elias, MBChB, MMed, have been awarded a $6.5 million grant funded by Gates Foundation, Novartis, Eli Lilly and Company, and Merck through its Merck for Mothers initiative, with support from Panorama Global to support point-of-care ultrasound (POCUS) education and care integration in western Kenya. As part of the Academic Model Providing Access to Healthcare (AMPATH), the POCUS project will deliver POCUS devices and provide training on POCUS to healthcare workers so that they can quickly perform real-time images inside the body, often right at a patient's bedside to help with early diagnosis and treatment. This kind of diagnostic imaging is not easily available in low- and middle-income countries like Kenya, especially in rural areas. This project will focus on three topics that have high morbidity and mortality in Kenya - complex conditions during pregnancy, breast cancer, and heart failure where detection is vital for improving patient outcomes. 

In Brown’s Department of Family Medicine, Szkwarko is an Associate professor, director of the global health faculty development fellowship, and research physician scientist. She is the co-course director for health system science 2 and 4 within the primary care population medicine program, and the Co-Director for the Reproductive Health Scholarly Concentration at The Warren Alpert Medical School. She is on the Advisory Committee for your own Center for Global Health Equity (CGHE). She directs a Regional Tuberculosis (TB) infection ECHO (expanding community healthcare outcomes) course to train primary care members across 16 states. And clinically, she is a hospitalist at Kent Hospital and does urgent care and TB infection management at Blackstone Valley Community Health Center. 

Szkwarko first became affiliated with Brown while she was in medical school. Between her third and fourth year she was selected to be a Fogarty International Clinical Research Scholar. She moved to Eldoret, Kenya for a year, where she conducted research at Moi University through the AMPATH collaboration under the mentorship of Dr. Jane Carter.

Szkwarko’s relationship with Dr. Carter inspired Szkwarko to become involved in tuberculosis prevention research. Dr. Carter is a Professor Emerita of Medicine at Brown, an international tuberculosis expert, and served as the PI for the Fogarty International Clinical Research Scholars program at Brown. Szkwarko’s experience in Eldoret solidified her desire to pursue global health and continue working with global health collaboratives like AMPATH. So, Szkwarko came back to Brown to complete her residency in Family Medicine and continued to collaborate with Dr. Carter and her other AMPATH colleagues, returning to Kenya twice during her residency. Working with Dr. Carter, Szkwarko became fascinated by how implementing simple strategies can better identify gaps in care and better prevent TB in vulnerable populations such as young children. Following this path, Szkwarko now works to democratize TB infection management into primary care for all populations domestically. 

While Szkwarko’s domestic TB work was expanding, she continued to collaborate with the Moi University Family Medicine team in education and care. She continued going back to Kenya, for approximately three months each year, and during that time her Kenyan colleagues made it clear that point of care ultrasound could be a useful modality to improve care in western Kenya. Szkwarko and her Kenyan colleagues were quick to get started, searching for and participating in as many training sessions as they could find, even before they had access to the smaller handheld ultrasound devices. Eventually, they were able to secure one handheld device for the Moi University family medicine residency. 

After witnessing the value of the POCUS program firsthand, Szkwarko and Elias, one of the Moi University Family Medicine faculty who pursued POCUS training, submitted a proposal that was successfully funded to expand the program across western Kenya. Szkwarko Elias co-lead the initiative to expand POCUS across the region, knowing the access it would give other healthcare workers to learn and integrate ultrasound diagnostic imaging into their practices. Together they manage their largest team of more than twenty Kenyan and North American clinicians, educators, researchers, and consultants, encouraging every member to contribute to all parts of the project regardless of their written role. Additionally, they manage relationships with device manufacturers, local tech support organizations, financing partners, and educational partners, all while working to ensure that communication is streamlined and effective. After improving POCUS access to training on a small scale for nearly a decade they are now the co-PIs for one of the largest multiple-use POCUS programs in the world. With an anticipated deployment of 900 probes across six counties and 4,000 trained healthcare workers, they have spearheaded an amazing development that will increase early recognition, and management, of diseases that would otherwise cause great suffering and loss of life.

Szkwarko sees her current work with POCUS and her TB education work as linked — both are related to her mission to implement and evaluate educational innovations that help democratize knowledge and improve healthcare access for vulnerable populations globally — and she is happy for the opportunity to do this important work. 

She is grateful for the professional relationships and friendships she’s built over the last fifteen years, among them Dr. Elias and Dr. Carter. Through their productive collaboration, Szkwarko and Dr. Elias learned much from each other and developed a strong foundation of trust. Szkwarko shared three mottos they have that demonstrate how they lead. One, “We are not important, but the work is important.” reminding them to leave their egos at the door and keep the goals of the program as their main priority. Two, “Fail Fast.” The quicker you find out how something is not succeeding, the quicker you can fix it. They challenge each other to figure out what is not working so that they can work together and improve. Three, “Work smarter, not harder.” They are always looking for ways to be efficient and not waste time by collaborating with others and sharing crucial strategies, techniques, and materials. Szkwarko is similarly grateful to be collaborating with her Kenyan colleagues. By working with them, she learns from every conversation and interaction. Together, they are working to break down the lines drawn between clinics based on the type of care needed to further integrate health systems and provide easier access to patients. 

Several of Szkwarko’s trainees have successfully obtained a Global Health Scholars Training grant (formerly called the Framework grant) in the past and many of these have supported small projects at AMPATH, including their early POCUS work at Moi. She believes that the Center for Global Health Equity is a fabulous opportunity for Brown and Brown faculty to collaborate and work together to expand health equity efforts both globally and locally.