Palliative care focuses on improving quality of life for patients with serious illness – addressing pain, symptoms, and the emotional and social challenges that accompany disease. However, in many parts of the world, access to this type of care remains extremely limited.
In Ethiopia, where access to palliative care is especially scarce, Eleanor Reid, MD, PhD, assistant professor of emergency medicine at Yale School of Medicine (YSM) and a faculty affiliate of the Yale Institute for Global Health (YIGH), has been working to expand access through community-based approaches.
Reid currently co-leads the Yale-Uganda Network and is a member of the Yale Crisis, Emergency, and Disaster (CED) Network. These networks are part of YIGH’s broader faculty network program, which supports interdisciplinary collaboration to address complex global health challenges.
“The estimated gap in Ethiopia between need for palliative care and access is over 95%, resulting in unnecessary physical suffering and significant costs that are absorbed by the individual and family,” Reid says.
Reid’s work in Ethiopia began several years ago during her master’s training, when she met her now close colleague and collaborator Ephrem Abathun, PhD, who works in home hospice in Ethiopia, to better understand the need for palliative care in the region.
“People were selling farmland and wedding gold and pulling their children out of school to pay for medical care,” she says. “They had end-stage, incurable disease – and they didn’t know.”
She also saw how the financial consequences of illness extended far beyond individual patients. “We know from microeconomics that this kind of poverty cycle can last generations,” she explains. “In settings where wealth is inherited, you’re not just affecting one person, you’re impoverishing families for generations.”
Reid soon began to think about how care could reach patients earlier, before they ever entered the formal health system. “Without widespread screening programs, by the time people were presenting to oncology clinic, we were already too late,” she says.
Building on this work, Reid applied for a YIGH Global Health Spark Award in 2023 to develop a new, community-based approach to palliative care delivery in Ethiopia. The award, offered biannually by YIGH, supports early-stage global health projects and enabled the launch of the Iddir-PC project.
“Iddirs are informal neighborhood organizations that support communities throughout Ethiopia,” Reid explains. “They’re a social support system that’s deeply embedded in the culture.”
The Iddir-PC project leverages these traditional social networks to identify patients with serious illness and deliver culturally congruent, home-based care through trained volunteers and clinicians.
“We have these incredible existing structures, and the idea was: what if we could train community members to identify neighbors experiencing health-related suffering and connect them to hospice care?”
Although the project is still underway, it has already generated important momentum. The team is tracking patient-reported outcomes related to suffering and cost, while also conducting an ethics sub-study and ongoing focus groups to refine the model.
As the work has evolved, Reid has drawn on cross-disciplinary collaborations to further develop the project. She partnered with Daniel Ebbs, DO, assistant professor of pediatrics at YSM, whose expertise in community-based participatory research has helped refine the model and strengthen engagement with local stakeholders. She first connected with Ebbs at a YIGH-hosted event, where an initial conversation led to their collaboration.
Building on the Iddir-PC project, Reid’s work has already begun to expand in new directions. The model has inspired a parallel initiative in Greece, where she and her collaborators are working to introduce emergency department–based palliative care. At the same time, she is leading a new system dynamics–based project in Ethiopia aimed at understanding why previous efforts to expand palliative care have struggled and how to build more sustainable solutions.
For Reid, these next steps reflect the value of working across disciplines and settings. Through her involvement with YIGH, she has connected with collaborators from different fields, helping to shape and strengthen the direction of her work.
“Through the Yale Institute for Global Health, I’ve met people working in this space from different perspectives. Some of the most interesting things happen on the fringes between specialties – that’s where new ideas are exchanged and created. Especially in the current climate, that collegiality, mentorship, and support has been really important.”
Reid emphasizes that this work remains deeply collaborative and rooted in the communities it aims to serve.
“We’re working in a setting where care has to be culturally grounded,” she says. “None of this is possible without my Ethiopian colleagues. Everything has been co-created. It’s not something you can design from afar and expect to work. It has to come from the community itself.”
Yale faculty engaged in global health can become YIGH Affiliates, gaining access to funding opportunities, grant support, and expanded visibility through YIGH communications. To learn more about affiliation, contact Mike Skonieczny.