Bio

Clinical Focus


  • Emergency Medicine

Academic Appointments


Administrative Appointments


  • Director of Informatics, Department of Emergency Medicine,Brigham and Women's Hospital, (2013 - 2015)
  • Director, Urbanization and Crises Program, Harvard Humanitarian Inititative (2010 - 2015)

Boards, Advisory Committees, Professional Organizations


  • Advisor, World Humanitarian Summit Urban Expert Working Group (2014 - Present)
  • Member, International Society for Urban Health (2010 - Present)
  • Member, Society for Academic Emergency Medicine (2010 - Present)

Professional Education


  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (2011)
  • Residency:Brigham and Women's Hospital / Massachusetts General Hospital, Harvard Affiliated Emergency Medicine (2010) MA
  • Internship:Brigham and Women's Hospital / Massachusetts General Hospital, Harvard Affiliated Emergency Medicine (2007) MA
  • Medical Education:University of California, San Francisco School of Medicine (2006) CA
  • Professional Education:Johns Hopkins Bloomberg School of Public HealthMD

Research & Scholarship

Projects


  • Innovating Disaster Microinsurance for Local Market Recovery, Stanford University (2014 - Present)

    The recovery of local markets is critical to moving from an immediate relief to recovery phase in humanitarian crises. Often, very small and micro-enterprises (SMEs) comprise the markets for goods and services that the urban poor use. Recovering these markets may improve livelihood and market restoration making disaster relief easier and more cost-effective. Unfortunately, these SMEs are excluded from access to risk financing in the form of insurance. This grant was awarded by the Humanitarian Innovation Fund to conduct a trial of disaster microinsurancce provided to such SMEs and test the impact on market recovery as well as financial and risk reduction behavor. The project is planned as a randomized controlled trial in three cities of india.

    Location

    India

    Collaborators

    • Mihir Bhatt, Director, All India Disaster Mitigation Institute
  • Urban Slum Vulnerability and Indicator Development for Slow Onset Urban Emergencies (IDSUE), Concern Worldwide (2013 - Present)

    The world is rapidly urbanizing with the majority of the world’s population now living in urban areas. In many rapidly urbanizing cities, the slum population now makes up over 60% of the urban populace. This demographic transition is creating complex urban landscapes with disproportionately large slums that concentrate hazards and vulnerabilities to natural and man-made disasters. Often, these populations have standards of living that fall well below the core minimum humanitarian standards (Sphere Standards) and live in a state of "chronic crisis" moving in and out of acute crisis. This is an USAID-OFDA funded multi-slum longitudinal study in collaboration with Concern Worldwide to investigate urban vulnerability, identify indicators of early acute crisis and understand coping mechanisms to tailor interventions.

    Location

    Kenya

  • Urban Violence in Honduras (2014 - Present)

    This project aims to better measure the extent and impact of urban violence in one of the most violence countries in the world.

    Location

    Honduras

    Collaborators

    • Marie-Renée B-Lajoie, Assistant Professor, McGill University
  • Resilience and the Fragile City, United Nations University and the World Bank (7/15/2015 - Present)

    This project has two key objectives: 1) to provide an accurate analysis of vulnerability and resilience in disaster and violence prone cities; and 2) to identify feasible options to reduce the vulnerability and enhance the resilience of urban populations most at risk to multiple and interlocking crises. To that end, this project will document how cumulative risks can exacerbate vulnerability in cities, making them fragile; outline capacities and assets that can be harnessed to mitigate these risks; and describe how practical and targeted investments in protective factors by donors and governments can help diminish these risks and reverse fragility.

    Location

    Stanford, CA

    Collaborators

    • John deBoer, Senior Policy Advisor, Unite Nations University Center for Policy Research
  • Developing an Urban Refugee Integartion Scale, Refuge Point (2013 - Present)

    Refugees, traditionally confined to large camps, are increasingly dispersing into large urban centers in search of autonomy and better lives. As the urban refugee community grows, the often-neglected durable solution of local integration as a viable option for these refugees has re-emerged. But measuring local integration as a goal and/or proxy for stability and improved welfare has remained understudied. This project developed a scale to measure integration of urban refugees in Nairobi, Kenya among the local host population.

    Location

    Nairobi, Kenya

  • Investigating Social Cohesion and Resilience in Haiti, Catholic Relief Services (7/1/2014 - 1/30/2015)

    This project investigated social cohesion and resilience in two urban informal settlements of Haiti. The primary objective of this research was to determine the contribution of social cohesion and various demographic features to resilience in the communities of Solino and Tesso.

    Location

    Port au Prince, Haiti

  • Identifying Populations in Need in Urban Humanitarian Crises, Oxfam / Tufts University (8/24/2015 - Present)

    Lead a team of researchers to conduct an evidence synthesis on identification practices in urban humanitarian response including, but not limited to, profiling tools, mapping approaches and technologies, needs assessment strategies (for individuals or communities), and documentation instruments

    Location

    Stanford, Ca

    Collaborators

    • David Sanderson, Professor, Norwegian University of Science and Technology

Teaching

Publications

All Publications


  • Health outcomes of crisis driven urban displacement: A conceptual framework Disaster Health Deola, C., Patel, R. 2015; 2 (2): 92-96
  • Microfinance: Untapped Potential for Global Health JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Patel, R. B. 2014; 25 (4): 1718-1722

    Abstract

    Microfinance has recently come under criticism for not meeting its potential for poverty reduction and its exploitation by for-profit entities. Access to finance still remains limited for many of the world’s poor. This re-examination of microfinance should not impede its proliferation and development into a tool to improve health for the underserved. There are significant returns on microfinance investments in health at the household level. Microfinance that allows the consumption of goods and services that can improve health can also lead to increased savings and productivity making it a financially viable and powerful tool for both health improvement and development.

    View details for Web of Science ID 000345732200019

    View details for PubMedID 25418237

  • The need for data in the world's most violent country BULLETIN OF THE WORLD HEALTH ORGANIZATION B-Lajoie, M., D'Andrea, S., Rodriguez, C., Greenough, G., Rodriguez, C., Patel, R. 2014; 92 (10): 698-698

    View details for DOI 10.2471/BLT.14.136713

    View details for Web of Science ID 000343967500001

    View details for PubMedID 25378719

  • The high cost of diarrhoeal illness for urban slum households-a cost-recovery approach: a cohort study BMJ OPEN Patel, R. B., Stoklosa, H., Shitole, S., Shitole, T., Sawant, K., Nanarkar, M., Subbaraman, R., Ridpath, A., Patil-Deshmuk, A. 2013; 3 (4)

    Abstract

    Rapid urbanisation has often meant that public infrastructure has not kept pace with growth leading to urban slums with poor access to water and sanitation and high rates of diarrhoea with greater household costs due to illness. This study sought to determine the monetary cost of diarrhoea to urban slum households in Kaula Bandar slum in Mumbai, India. The study also tested the hypotheses that the cost of water and sanitation infrastructure may be surpassed by the cumulative costs of diarrhoea for households in an urban slum community.A cohort study using a baseline survey of a random sample followed by a systematic longitudinal household survey. The baseline survey was administered to a random sample of households. The systematic longitudinal survey was administered to every available household in the community with a case of diarrhoea for a period of 5 weeks.Every household in Kaula Bandar was approached for the longitudinal survey and all available and consenting adults were included.The direct cost of medical care for having at least one person in the household with diarrhoea was 205 rupees. Other direct costs brought total expenses to 291 rupees. Adding an average loss of 55 rupees per household from lost wages and monetising lost productivity from homemakers gave a total loss of 409 rupees per household. During the 5-week study period, this community lost an estimated 163 600 rupees or 3635 US dollars due to diarrhoeal illness.The lack of basic water and sanitation infrastructure is expensive for urban slum households in this community. Financing approaches that transfer that cost to infrastructure development to prevent illness may be feasible. These findings along with the myriad of unmeasured benefits of preventing diarrhoeal illness add to pressing arguments for investment in basic water and sanitation infrastructure.

    View details for DOI 10.1136/bmjopen-2012-002251

    View details for Web of Science ID 000329809200010

    View details for PubMedID 23558731

  • Rapid urbanization and the growing threat of violence and conflict: a 21st century crisis. Prehospital and disaster medicine Patel, R. B., Burkle, F. M. 2012; 27 (2): 194-197

    Abstract

    As the global population is concentrated into complex environments, rapid urbanization increases the threat of conflict and insecurity. Many fast-growing cities create conditions of significant disparities in standards of living, which set up a natural environment for conflict over resources. As urban slums become a haven for criminal elements, youth gangs, and the arms trade, they also create insecurity for much of the population. Specific populations, such as women, migrants, and refugees, bear the brunt of this lack of security, with significant impacts on their livelihoods, health, and access to basic services. This lack of security and violence also has great costs to the general population, both economic and social. Cities have increasingly become the battlefield of recent conflicts as they serve as the seats of power and gateways to resources. International agencies, non-governmental organizations, and policy-makers must act to stem this tide of growing urban insecurity. Protecting urban populations and preventing future conflict will require better urban planning, investment in livelihood programs for youth, cooperation with local communities, enhanced policing, and strengthening the capacity of judicial systems.

    View details for DOI 10.1017/S1049023X12000568

    View details for PubMedID 22591767

  • Urbanization and Humanitarian Access Working Group: toward guidelines for humanitarian standards and operations in urban settings. Prehospital and disaster medicine Janneck, L. M., Patel, R., Rouhani, S. A., Burkle, F. M. 2011; 26 (6): 464-469

    View details for DOI 10.1017/S1049023X12000118

    View details for PubMedID 22559311

  • Urbanization and Humanitarian Access Working Group: a blueprint for the development of prevention and preparedness indicators for urban humanitarian crises. Prehospital and disaster medicine Rouhani, S. A., Patel, R. B., Janneck, L. M., Prasad, A., Lapitan, J., Burkle, F. M. 2011; 26 (6): 460-463

    View details for DOI 10.1017/S1049023X12000106

    View details for PubMedID 22559310

  • The depressed patient and suicidal patient in the emergency department: evidence-based management and treatment strategies. Emergency medicine practice Chang, B., Gitlin, D., Patel, R. 2011; 13 (9): 1-23

    Abstract

    There are approximately 12 million emergency department (ED) visits related to mental health/substance abuse annually. Approximately 650,000 patients are evaluated annually for suicide attempts. Evidence to guide the management and treatment of depression and suicidal ideation in the ED is limited. A large variation exists in the quality of care provided due to the lack of standardized guidelines aiding emergency clinicians. Depression ften manifests as unexplained somatic complaints, adding to the challenge of making this diagnosis in the ED. Recognition of depression by emergency clinicians has proved poor. Suicide is associated with multiple risk factors, of which a prior history of suicide attempts is the single strongest predictor. A systematic approach is required in the ED to identify patients with or at risk of having depression, and screening tools may offer utility to identify high-risk patients.

    View details for PubMedID 22164363

  • Human trafficking in the emergency department. The western journal of emergency medicine Patel, R. B., Ahn, R., Burke, T. F. 2010; 11 (5): 402-404

    Abstract

    Human trafficking continues to persist, affecting up to 200 million people worldwide. As clinicians in emergency departments commonly encounter victims of intimate partner violence, some of these encounters will be with trafficking victims. These encounters provide a rare opportunity for healthcare providers to intervene and help. This case report of a human trafficking patient from a teaching hospital illustrates the complexity in identifying these victims. Clinicians can better identify potential trafficking cases by increasing their awareness of this phenomenon, using qualified interpreters, isolating potential victims by providing privacy and using simple clear reassuring statements ensuring security. A multidisciplinary approach can then be mobilized to help these patients.

    View details for PubMedID 21293753

  • Improved health outcomes in urban slums through infrastructure upgrading SOCIAL SCIENCE & MEDICINE Butala, N. M., VanRooyen, M. J., Patel, R. B. 2010; 71 (5): 935-940

    Abstract

    The world is rapidly urbanizing with over half the population now living in urban areas. As the urban population grows, so does the proportion of these persons living in slums where conditions are deplorable. These conditions concentrate health hazards leading to higher rates of morbidity and mortality. This growing problem creates a unique challenge for policymakers and public health practitioners. While the Millennium Development Goals (MDGs) aim to address these conditions and standards for water and sanitation as well as pertinent health outcomes, little evidence on interventions exists to guide policymakers. Upgrades in slum household water and sanitation systems have not yet been rigorously evaluated to demonstrate whether there is a direct link to improved health outcomes. This study aims to show that slum upgrading as carried out in Ahmedabad, India, led to a significant decline in waterborne illness incidence. We employ a quasi-experimental regression model using health insurance claims (for 2001-2008) as a proxy for passive surveillance of disease incidence. We found that slum upgrading reduced a claimant's likelihood of claiming for waterborne illness from 32% to 14% and from 25% to 10% excluding mosquito-related illnesses. This study shows that upgrades in slum household infrastructure can lead to improved health outcomes and help achieve the MDGs. It also provides guidance on how upgrading in this context using microfinance and a public-private partnership can provide an avenue to affect positive change.

    View details for DOI 10.1016/j.socscimed.2010.05.037

    View details for Web of Science ID 000280949400013

    View details for PubMedID 20599311

  • Traumatic Retinal Detachment Essential Emergency Trauma Patel, R. edited by Shah, K., Egan, D., Quass, J. Lippincott, Williams & Wilkins. 2010: 89-90
  • Urbanization--an emerging humanitarian disaster. New England journal of medicine Patel, R. B., Burke, T. F. 2009; 361 (8): 741-743

    View details for DOI 10.1056/NEJMp0810878

    View details for PubMedID 19692687

  • The effects of ambulance diversion: A comprehensive review ACADEMIC EMERGENCY MEDICINE Cuong, J., Patel, R., Millin, M. G., Kirsch, T. D., Chanmugam, A. 2006; 13 (11): 1220-1227

    Abstract

    To review the current literature on the effects of ambulance diversion (AD).The authors performed a systematic review of AD and its effects. PubMed, EMBASE, the Cochrane database, societal meeting abstracts, and references from relevant articles were searched. All articles were screened for relevance to AD.The authors examined 600 citations and reviewed the 107 articles relevant to AD. AD is a common occurrence that is increasing in frequency. AD is associated with periods of emergency department (ED) crowding (Mondays, mid-afternoon to early evening, influenza season, and when hospitals are at capacity). Interventions that redesign the AD process or that provide additional hospital or ED resources reduce diversion frequency. AD is associated with increased patient transport times and time to thrombolytics but not with mortality. AD is associated with loss of estimated hospital revenues. Short of anecdotal or case reports, no studies measured the effect of AD on ED crowding, morbidity, patient and provider satisfaction, or EMS resource utilization.Despite its common use, there is a relative paucity of studies on the effects of AD. Further research into these effects should be performed so that we may understand the role of AD in the health system.

    View details for DOI 10.1197/j.aem.2006.05.024

    View details for Web of Science ID 000241978400026

    View details for PubMedID 16946281

  • Vasopressin-induced neurotrophism in cultured neurons of the cerebral cortex: Dependency on calcium signaling and protein kinase C activity NEUROSCIENCE Chen, Q., Patel, R., Sales, A., Oji, G., Kim, J., Monreal, A. W., Brinton, R. D. 2000; 101 (1): 19-26

    Abstract

    Neuronal process outgrowth has been postulated to be one of the fundamental steps involved in neuronal development. To test whether vasopressin can influence neuronal development by acting on the outgrowth of neuronal processes, we determined the neurotrophic action of the memory-enhancing peptide, vasopressin, in neurons derived from the cerebral cortex, a site of integrative cognitive function and long-term memory. Exposure to V(1) receptor agonist significantly increased multiple features of nerve cell morphology, including neurite length, number of branches, branch length, number of branch bifurcation points and number of microspikes. The dose-response profile of V(1) receptor agonist-induced neurotrophism exhibited a biphasic function, with lower concentrations inducing a significant increase while higher concentrations generally induced no significant effect. The neurotrophic effect of V(1) receptor activation did not require growth factors present in serum. Analysis of the regional selectivity of the vasopressin-induced neurotrophic effect revealed significant V(1) receptor agonist-induced neurotrophism in occipital and parietal neurons, whereas frontal and temporal neurons were unresponsive. Results of experiments to determine the mechanism of vasopressin-induced neurotrophism demonstrated that vasopressin-induced neurotrophism is dependent on V(1)a receptor activation, requires L-type calcium channel activation and activation of both pathways of the phosphatidylinositol signaling cascade, inositol trisphosphate and protein kinase C. These studies are the first to describe a functional cellular response for vasopressin in the cerebral cortex. The findings are discussed with respect to their implications for understanding the role of vasopressin-induced neurotrophism, the associated signaling pathways required for this response, and the ability of vasopressin to enhance memory function.

    View details for Web of Science ID 000165265200004

    View details for PubMedID 11068133