Introduction
Solving the world’s health challenges requires multidisciplinary collaborations
that bring together the talents, experiences, resources, and ideas from multiple sectors in low and middle-income countries (LMIC) and high -income countries (HIC).1 In addition, a commitment to working together, can lead to the development of creative and multidisciplinary solutions required to tackle system challenges such as those in global health.1 To create an effective collaboration between institutions from LMIC and HIC, stakeholders should be willing to work together. Each stakeholder can bring varying strengths and resources to the partnerships, but they also bring their own organizational cultures, regulations, and expectations.1 Ideas to overcome geographic, economic, social, and political challenges should be addressed early in any collaboration. It is extremely important to be sensitive to cultural and religious differences in different LMIC countries. Understanding these differences helps connect people in these countries. Overcoming the cultural and language barriers in different countries/cultures can be achieved through having medical and cultural interpreters.
Cystic Fibrosis (CF) was thought to be a disease of Caucasian populations from European decent. However, it has been shown to affect people from all ethnic backgrounds.2 CF care varies significantly for people with CF (pw CF) from HIC with median survival approaching 50 years of age,3 to LMIC with pw CF dying in infancy or early childhood. LMIC face significant challenges to promote CF diagnosis and improvements in CF care due to financial constraints and significant burden of other diseases.4Health disparities for pw CF in LMIC can result from limited access to clinical care owing to lack of its availability on a national or local level, to limited diagnostic tools for the disease in some countries, to restriction of access to specialized services or therapies (financial or physical), and/or to lack of knowledge or education regarding how the disease should be treated, resulting in poor outcomes.5 Western European countries show significantly different clinical outcomes compared to countries in Eastern Europe including Turkey as shown from the European Cystic Fibrosis Society Patient Registry (ECFSPR).6Disparities could be due to several factors including differences in resources and available medications. A paucity of resources and medication contributes to suboptimal treatment, lower lung function, poor nutrition, poor quality of life and shortened lifespan.
To address the discrepancy in quality of care and outcomes, we report on a collaboration between our team at the University of Michigan cystic fibrosis center (UoM CFC), through support from the Middle East CF Association (MECFA) and the CF Foundation (CFF), and a CF center in Turkey (Marmara University CF Center, Istanbul) to address deficiencies and improve quality of care in that center.