Global Health Center Newsletter Fall 2015

N EWS

Fall 2015

Global Health

CONTEMPLATION • COMPASSION • ADVOCACY

SAVE THE DATES! DECEMBER 7, 2015 Mark Young Presentation 12 noon -1:00 p.m.

Junker Auditorium Connor Carmichael MSII presents: Nutrition Health Policy and Education in Ecuador JANUARY 13, 2016 Global Health Night University Conference Center 6:00 - 8:00p.m.

Mbour, Senegal

Mbour, Senegal

Temitope Adebayo, MSII

Lindsay Bacik, MSII

Brief description of experience: This has been my favorite experience so far in medical school.

It was an amazing opportunity to travel to another country and experience a culture that is foreign to mine. I got to shadow a lot of the physicians at the hospital and I saw first-hand how medicine is practiced in an area with very limited resources. In addition to this, we got to explore the culture and history of the people of Senegal. We visited a lot of historic sites and participated in various cultural events. All in all, I had a great time and I’m looking forward to going back during my 4th year.

Student responsibilities at the site: I helped out with the screening day event and then spent most of the trip with Dr. Kouka, a Urologist. I shadowed him during his regular office hours and also in the OR. I also worked with a medical student to collect some data for my MSR project.

3 words that characterize the experience: Transformative, Fun, Educational

Mbour, Senegal Julia Marsala, MSII Brief description of experience I had an incredible experience in Senegal. My days consisted of shadowing doctors in the ER, collecting data for my research, and learning about the community.

We were able to participate in community outreach, as well as practice the local dances and language.

3 words that characterize the experience Vibrant, Intriguing, Educational Description of setting Arid, dry environment with very little greenery. The city of Mbour is a coastal city, and many people work as fishermen. The climate is dry and hot, with very little rainfall.

In Mbour, there is only one pediatrician who handles all outpatient visits, emergency visits, and neonatal care. He was one of the most wonderful doctors I have ever interacted with. On the first day that I entered the pediatric unit of the hospital, within minutes of my walking through the door, a nurse entered holding a blanket with a baby inside. It was a premature delivery, only 700g. I have never seen such a tiny human. She was breathing with every muscle in her abdomen and thorax, and I couldn’t take my eyes off of her. Dr. Cice, the pediatrician, placed her gently in a makeshift incubator and watched her for a few minutes with a look of sadness and frustration in his eyes. He noted that she probably would not live past this afternoon, and we returned to his office to take care of the line of outpatient children waiting to be seen for various ailments. As the day went on, we saw two more tragic cases. A little girl who had fallen and hit her head, and was unconscious with unreactive pupils. Her parents could not afford a head scan, so there was nothing to do but wait. Dr. Cice watched this beautiful 18-month old the same way he looked at the premature infant—with a look of utter despair.

He then went on with his day as before. Finally, a mother brought her 2-week old baby in to the room wrapped in a blanket.

When she unwrapped the infant, what I saw was a tiny sac of bones with paper-thin, leathery skin. We took this baby to the incubators, and Dr. Cice told us that this baby had Down syndrome, and his mother had most likely neglected him on purpose because it is so difficult to care for a baby with disabilities in such a resourcepoor environment. He began treatment to rehydrate the baby, who was already in renal failure, but he died over the next evening. I am incredibly affected by sadness, and this day was more than I could bear. How could anyone want to devote his or her life to this sort of sadness? Dr. Cice was a true humanistic physician. He did what he could with what he had, and helped the countless number of children who could be helped. He did not break down when faced with such immense sadness—rather, he felt deeply for the patients and responded in whatever way he could. When his resources were too limited to save a child, he accepted that notion with frustration, but carried on nonetheless. This was a great lesson for me in bearing the burdens of difficult and often insufferable circumstances. As physicians, it is important to attempt to handle these situations with grace, doing everything in our power to help the patients, but accepting things as they are. While this is an extremely difficult lesson, I believe it will serve me well in my future.

3 words that characterize the experience: Transformative, Fun, Educational

M’Bour, Senegal

M’Bour, Senegal

By: Nicole Hammond, MSII

By: Zach Hutchinson, MSII Setting: The M’Bour Hospital is the main hospital for the area of several hundred thousand people.

Its departments include Pediatrics, Internal Medicine, Emergency, Surgery, Labor and Delivery.

Although it serves a large population, the hospital is very small. There are basic labs and imaging studies available to patients that can afford them. There is a pharmacy next to the hospital where patients must go to buy their medications, even for when they are admitted.

Student responsibilities at the site: We participated in a community Diabetes and hypertension screening event, during which we drew blood sugars and took blood pressures.

Roughly half of the remaining time was spent shadowing physicians in the hospital and half conducting research via chart reviews.

Brief description of experience: I loved my time in Senegal! I shadowed and did research with the pediatrician, who was very helpful and willing to teach. The people were extremely welcoming and kind. This was truly a transformative experience that I won’t forget. There was a good blend of seeing other parts of the Senegal and learning about Senegalese culture and history.

Three words that characterize the experience: Eye-opening, Moving, Transformative

I learned that: 1. For most people in Senegal, traditional healers are a first stop for medical treatment.

2. Traditional Healing is a combination of faith and healing.

3. The care delivery is significantly different in Senegal. Pain medicine is a luxury, needles are too large, kids are not treated any different than adults. Patients must pay for medications individually in the hospital, they are not given medications and billed later as in the United States.

4. People in Senegal are very open and will love to talk to you any chance they can.

5. The market is hectic but a lovely cultural experience.

Three words that characterize the experience: Eye-opening, Immersive, Influential Total costs: ~$3100 Passport, toiletries, plane ticket, spending money etc.

Update: Clinical Trips to Ghana, Africa Mike Malone, M.D.

As part of the ongoing partnership between Penn State College of Medicine and MountCrest University, a new medical school in rural Ghana, initial clinical experiences in Ghana are planned for February and March of 2016. During that time, medical students, residents, and faculty from multiple departments will be providing clinical care at the Regional Hospital and identify opportunities for future collaboration with our Ghanaian colleagues.

Master of Public Health Program offered to medical students The Penn State Master of Public Health (MPH) program offers a 5-year MD/MPH joint degree program for medical students enrolled at the Penn State College of Medicine. The MD/MPH is ideal for medical students who want to pursue advanced training in public health, wish to apply principles of public health to clinical practice, and have a special interest in community health and behavior change. The program is currently open to first and second year medical students. The application opens October 1, 2015. The deadline to apply is January 15, 2016. For more information, including curriculum and application instructions, please visit med.psu.edu/mph (select MD/MPH under Prospective Students).

Reflection By: Otto Schoeck, MSII [I was] watching a complicated caesarian section at the hospital. The surgeon made a vertical incision in order to take the infant out faster. At one point the power cut out and I took out my iphone flashlight to help illuminate the operating table before the generator kicked in. A visiting nurse from Italy helped with the surgery. A few minutes after making the first cut the baby was removed by the surgeon and sent to

the neonatology unit because it was premature. I went to check on the baby a few hours later. There was no heart monitor or nurse in sight. I went up to the bed and noticed that the baby wasn’t breathing. I thought to myself – I’m sure the doctor knows this already or the nurses know this already because the surgeon said the baby was too small to survive. That night at dinner I found out that the baby had in fact died. A few days later I was showing another student the neonatology unit. I noticed a baby wasn’t breathing and again no one else had noticed. This time, I knew that even though I was a student in a foreign country I should say something. I should contribute even if I had little training.

The other student and I got a nurse and the nurse performed CPR. I grabbed an oxygen tank and wheeled it over. The nurse took over and after the baby began

breathing the nurse turned to me and said some of the only English words she knew – “thank you.” I suppose I learned how important it is to be observant and also vocal as a student, even if I feel uncomfortable. Almost every day since that incident I went to the neonatology unit and watched all of the babies chests rise and fall – just to make sure.

Three words that characterize the experience: Hospitality, Drums, Learning

Senegal Laura Leuenberger, MSII

Brief description of experience In Mbour, I had a chance to get to know the community by spending time both exploring with a translator to find healers for our public health related research, and also by shadowing in the local hospital. The community knew the history of students spending time in Mbour, and welcomed us to be a part of many experiences.

My responsibilities at the site were to complete my research project, and to learn about senegal. As such, I spent two weeks interviewing traditional

healers about the care of chronic disease, and two weeks shadowing in the local hospital in internal medicine, outpatient medicine, pediatrics, and maternity.

Description of setting We were in Mbour, a small city, in the area close to both the hospital and the beach. The roads were sandy, and all living was doing in open air settings. The hospital itself was open air, with various buildings within a central compound. Senegal is a beautiful country, with beaches of white sand, dry desert air, and friendly people in colorful clothing!

3 words that characterize the experience community, dancing, learning

Peru By: Olivia Munizza, MSII Setting: Iquitos, Peru is known as the capital of the Peruvian Amazon. The city can only be reached by airplane or boat and is the largest city in the world that is inaccessible by road. The city sits along the Amazon River and is in a constant rainy season.

It has various elements of a jungle community, from the exotic trees and animals to the food and people. The primary modes of transportation are motorcycles and motokars, which are motorcycles with cabbies on the back. This creates a very noisy and polluted environment in the city.

Brief description of experience: Through the Global Health Scholars Program I spent four weeks doing research in Iquitos, Peru. I worked on a restaurant sanitation project where I performed an observational survey of fifteen restaurants and took ten culture swabs from different areas in each restaurant. I then brought the samples back to the NAMRU-6 laboratory where I cultured and analyzed the samples. On the weekends, I sometimes went into lab to process samples and then my colleagues and I took time to explore and see the Amazon Jungle.

Through the Peru site, I was able to learn more about microbiology and infectious diseases. I was able to see the effects of these diseases on people in the community, and I observed the treatments and medical practices used to treat

the conditions.

Furthermore, I was able to learn laboratory techniques and how to culture and analyze samples in the lab. I have become more proficient with interpreting data results and I feel more confident working in the laboratory setting. Outside of the lab, I have gained tolerance of other cultures and practices, and I have enjoyed learning about the differences between this culture and my way of life back home. I have also been able to practice my Spanish speaking skills and upon leaving the trip I felt much more confident in my ability to communicate in a Spanish speaking country. I further feel like I have gained insight into what it is like to live in a community with limited access to food and clean water. I feel that I will have more of an open mind when I am seeing patients, as I have been able to see that everyone has a story and deserves compassion and respect.

Three words that characterize the experience: unique, challenging, enlightening Total costs: $3000 (without weekend excursions)

Iquitos, Peru By: Ivana Marji, MSII Student responsibilities at the site: At the Peru site, I mostly participated in lab work and restaurant survey. Olivia and I were responsible for filling out the observational surveys for each restaurant visit.

Our return to the lab typically followed a 3 day sequence of processing for the samples we collected. The first day was usually culturing each of the ten samples we received on different media. The next day would be the biochemical workup, followed by reading the results and identifying pathogenic organisms on the third day. We also collected water samples from each restaurant and tested them for fecal coliforms in the cooking water.

Overall, we sampled 15 restaurants. We usually visited 1 or 2 restaurants per day.

Lodging/housing description: We stayed at a house that was owned by an NGO called Amazon Promise. The organization runs medical clinics in

Iquitos, Peru Wilbert Beachy, MSII Student responsibilities at the site:

The project also looked at determinants of health in the community with a 50 question survey that assessed the hygiene and sanitation practices with a home. My role in this study involved both field and laboratory work. In the field I was accompanied by a native Spanish speaker who administered the survey to head of household.

During or after the survey I collected water samples from the home and left a sample cup for the family to collect a stool sample from one of the children. I was responsible for keeping track of what homes were surveyed and what homes we needed to collect samples from. As the summer progressed and my Spanish became functional I was permitted to administer a survey with the help of a native Spanish speaker.In the laboratory I plated the stool samples to grow out potential pathogens. After I did biochemical tests to determine what bacteria had grown out. I prepared slides for microscopy with stool samples so that they could be examined by lab staff for the presence of parasites. I

various locations around the Peruvian Amazon. The house had 3 bedrooms, each with its own bathroom. The house was situated along a major boulevard (Malecon) overlooking the Amazon River. It was a short two minute walk from the Plaza de Armas.

Brief description of experience: Overall, this experience provided me with many opportunities for personal growth. I learned to adapt to a completely different and dynamic environment. The experience mainly consisted of restaurant surveys and lab work. I met many students and individuals who were working in different fields of research at the lab. I also had the opportunity to get a snapshot of the local economy in Iquitos. Iquitos is very much a city in a developing country. Through conversations with restaurant owners we got to understand some of the different economic struggles, business owners face in an emerging market. Aside from the community involvement, this summer was very heavy on microbiology. We worked with and learned about many enteric microorganisms and how they are impacting personal and economic growth among the local population.

Three words that characterize the experience: Adaptability, exceptional, challenging

also prepared plates for the water samples to determine if fecal contamination was present.

Overall I would say my experience was positive because I felt that I gained a lot of experience in conducting global health research. I was also able to learn a lot about infectious disease, particularly enteric pathogens. A few drawbacks to the experience were that our team had some friction between personalities that was never completely resolved, and everyone got sick. In my experience I had gastroenteritis for 2 weeks and this really sapped my energy. In the end though I had a lot of fun both with the work we did during the weeks and the trips into the jungle we took on the weekends.

Lodging/housing description: We were housed at an NGO in the city called Amazon promise. It was right next to a tributary to the Amazon river. The house had 3 bedrooms and I shared a bedroom with a colleague. The place had a small kitchen that we used for meals and a small common area with a TV which often had a soccer game on. There was no air conditioning, hot water, or wifi.

3 words that characterize the experience: Ambivalence, Frustration, Perspective Total costs: $2100

Ecuador

Quito, Ecuador

By: Rebecca Martin-Billings, MSII

Connor Carmichael, MSII

Setting: Quito: urban city located in the Andes mountains of Ecuador.

Cumbaya: suburban city outside of Quito inhabited by a middle to high income population.

Zumbahua/Quilapungo: Rural towns located in the Andes mountains of Ecuador.

Student responsibilities at the site: • Organize and run health clinic providing basic health screening.

• Shadow and assist national physicians of different specialties.

• Learn about the medical culture in country.

• Provide education about prevention and treatment of diarrheal diseases.

• Conduct research about knowledge of diarrheal diseases in the area.

• Teach English at local middle school.

• Acquire knowledge about the culture and customs of the local population.

Three words that characterize the experience: Seeing, Learning, Wondering Overall costs: $2250

Ever since I got to Quilapungo, however, I have been thrust into the realities of living in poverty. My host family does not have running water, they have no refrigerator and they rely primarily on staple foods like potatoes for sustenance. I had thought about living in poverty before; many people in my hometown relied on government assistance such as foodstamps and free lunch programs to make it through. I also saw the effects of poverty in the children that I worked with in Mexico. However, I had never had the chance to live in poverty like I do here. I am learning to understand how crippling it is to have no access to running water. It means you can’t raise many livestock. It means you can’t grow water-intensive crops. It means you can’t bathe frequently, or drink water as much as you should. All of these things affect your health and well-being and it’s no wonder that poor people disproportionately suffer from certain conditions, both in the U.S. and abroad.

3 words that characterize the experience: Community, indigenous, eye-opening

Ecuador Kayhla Halsor and Jordan Trubiano, MSII Brief description of experience: Our trip was broken into two segments. The first two weeks we spent in Cumbaya shadowing at two different hospitals and taking a medical Spanish course in the afternoons.

This was a great way to adjust to Ecuador and get familiar with the medical system, the ways doctors practiced there as well as improve our Spanish skills. The Spanish teacher at USFQ (the local University) was great with us and exponentially improved our skills within two short weeks. Living with host families in the area helped us to continue to improve our language skills but also more importantly I felt to learn about the culture and way of life first hand of the people in that community. The next two weeks we spent in Zumbahua, a very rural area as described above. These two weeks, though challenging for us due to the cold, food, and the lack of resources(bathrooms/showers) with our families, provided us with the most insight to the hardships of health care in the rural communities and the culture and way of life of the indigenous people. We were able to shadow the doctors in the free clinics. These doctors were assigned there as part of their rural year. We also had one day where we provided a free clinic for the community that included blood pressure, glucose, height, weight, vision care, information of childhood diarrheal issues, and a consult with Dr. Angel if needed.

Description of setting: Cumbaya: This is a suburban community a half hour from downtown Quito, located in the Andes. The climate is dry and warm with harsh sun (due to the altitude).

Nights are very cool. This community is made up of predominantly mestizos, meaning Ecuadoreans that are of mixed European and American-indian decent.

In this community there is a large population is comparison to other areas of European/white people and more European/light skin appearing mestizos.

The majority of people in this community are Catholic. This area is highly educated.

The community has a large proportion of students at the local Univeristy (Universidad San Francisco de Quito). This community is also comprised of wealthy individuals working in Quito that

want to live in a more suburban community. Thus many people are highly educated (lawyers, doctors). Children attend private schools and the majority attend university after their high school.

This community contains the wealthiest Ecuadoreans. The majority of the people are of the upper class of society.

Zumbahua: This is in Sierra region of Ecuador, which is characterized by the Andean mountains. The other two regions are the Oreinte (East) and Costa (coast). The sun is again very harsh yet the weather is fairly cool, much cooler than Cumbaya. It is very windy during the days. The area is very dry and dusty. At the end of the days we are coated in dust. The evenings are very cool, probably around low 40s. Almost every person in this community is indigenous. The majority of people in this area are either farmers or they work in the local businesses in the small downtown area near the central plaza.The overwhelming majority of people in this community are catholic. The women have children at young ages and so many will discontinue their education and begin their role in their own family cooking and cleaning and taking care of their children.

Men are also not as educated and leave to help their families on their farms. However with the newer generations there are more teenagers having the opportunity to complete high school and continue to study at a University. This is one of the poorest communities in Ecuador.

Lodging/housing description: Cumbaya: Host families. Upper class families. I shared a room with another student. We each had our own bed. We had our own bathroom attached to our room. Our host mom prepared breakfast each day and dinner if needed. We ate lunch at her restaurant in the afternoon. Cost was $20 a day.

Zumbahua: Host families in the indigenous community. I shared a bed with another student. Our families provided meals. We had a toilet and a cold shower. We showered at the local hostel.

Cost was bringing groceries when we arrived, and some Hershey chocolate gifts. We tipped $20 each (recommended amount) at the end.

Three words that characterize the experience: challenging, exciting, eye-opening

Macha, Zambia By: Leah Sitler, MSII Setting: Macha Mission Hospital and research center, located in Macha, Zambia: Rural Sub-Saharan Africa community. Most of surrounding area is inhabited by traditional villagers. 45 minute drive from the nearest town, and accessible only through dirt roads.

Student responsibilities at the site: My personal responsibilities included working with the onsite Early Infant Diagnosis team to collect social information from HIV-positive mothers bringing their infants in for HIV testing, helping to assess the efficacy of point-of-care testing, and analyzing collected data for correlations between maternal social factors and infant HIV positivity. In addition, I was able to travel with community education programs being sent out to rural health posts, and shadow doctors during rounds on the hospital.

My team members’ responsibilities included lab-based research with the on-site Zambian research team, and traveling and participating with community education and testing programs to promote HIV prevention and testing in local villages, schools, and health centers.

Update: MountCrest University By: J. O. Ballard, M.D, In July 2015 Drs. Eileen Hennrikus and J.O. Ballard visited with the faculty and staff of MountCrest University (MCU) in Ghana in support of a new educational partnership with the Penn State College of Medicine (PSUCOM).

The purpose of the visit was to assist in the development of the medical school curriculum, especially in the areas of critical thinking and medical humanities. After a warm welcome by the Chief and Elders in Larteh , they toured the construction site of MCU’s new six-year medical school in Larteh

Housing: We were housed in a “dorm” on the research campus site, just a short walk from the hospital and research center. We were able to cook for ourselves in the kitchen, and had running water and electricity. Other people living on-site included local doctors, hospital staff, and lab researchers working with us in the hospital and labs.

Brief description: We were able to work with research and community-education programs that the medical center has ongoing throughout the year. The two main areas of research at the site are HIV and Malaria, and we were able to learn a lot about how to effectively an practically create an effective locally-run health intervention program.

It was especially meaningful to get the opportunity to work alongside Zambian health professionals and researchers.

Three words that characterize the experience:

rural, authentic, responsible Overall costs: $3500

with Director Kwaku Ansa-Ansara and Dean Samuel Akor.

During the trip, Hennrikus and Ballard worked with faculty members to identify the perceived medical and educational needs of their community and the goals and objectives of the curriculum.

They showcased instructional techniques such as problem based learning and team based learning and facilitated microteaching exercises. Visits to regional and district hospitals—potential sites for student clinical rotations—completed the busy week’s schedule. Subsequent monthly teleconferences between PSUCOM and the MCU faculty in Ghana are providing progress reports on the development of their curriculum.

Welcoming ceremony in Larteh

Session with faculty at MCU in Accra

Books and Journals to Ghana Africa

Global Health Scholars ALUMNI

Two full containers of medical books and journals, donated by our Library, and sent out to Ghana on September 21st to support MountCrest University’s startup of their new medical school!

Class of 2012 Sean Boley, Emergency Medicine Regions Hospital/Health Partners, St. Paul, MN Shana Gleeson, Internal Medicine Rhode Island Hospital/Brown University Providence, RI Brian Galovic, Emergency Medicine University of Utah Affiliated Hospitals. Salt Lake City, UT Carolyn Pennay, Family Medicine University of Kansas SOM-Wichita. Wichita, KS Patrick Koo, Internal Medicine Case Western/University Hospitals, Cleveland, OH Todd Schneberk, Emergency Medicine University of Southern California. Los Angeles, CA Class of 2013 Ashley Morrison, Family Medicine Lancaster General Hospital, Lancaster PA Heather Bowers, Pediatrics Eastern VA Medical School. Norfold, VA Laura Gilbert, Internal Medicine Walter Reed National Military Medical Center, Bethesda, MD Megan Ferderber, Family Medicine UPMC St. Margaret, Pittsburgh, PA Meagan Horst, Anesthesiology Hershey Med Ctr/Penn State, Hershey, PA Michael Santos, Internal Medicine Hershey Med Ctr/Penn State,Hershey, PA Laura Young, Obstetrics/Gynecology University of Maryland Medical Center, Baltimore, MD Rachel Hardenstine, Medicine-Primary Rhode Island Hospital Brown University, Providence, RI Class of 2014 Alexandra Falvo, General Surgery Allegheny General Hospital, Pittsburgh, PA Juliette Mandel, Family Medicine Lancaster General Hospital, Lancaster, PA Derek McCleaf, Radiology-Diagnostic Presence Saint Francis Hospital, Evanston, IL Sara Roberts, Medicine-Primary University of Vermont-Fletcher Allen, Burlington, VT Andrew Hoover, Family Medicine Lancaster General Hospital, Lancaster, PA Kyle Lewis, Emergency Medicine University of Texas Medical School, Houston, TX Sarah Smith, General Surgery Bassett Healthcare System, Cooperstown, NY

Tina Lengle (OME) and Susana Larbi-Wumbee (faculty member from Ghana, Simulation Center), David Brennan (Library)—the timing of these shipments with Susana’s presence is really wonderful.

Thanks to everyone who helped make this a success!

Global Health Scholars Class of 2015 Erin Banashefski Angela Li Catherine Nicka Jennifer Rice Hannah Wakefield Chelsey Straight Class of 2016 Colin Andrews Kate Belser Daniel Brill Heather Clark Amy Du Michael Freiberg Cameron Hand Timothy Irwin Corinne Landis Nelson Onyango Rajasree Roy Elizabeth Wallace Kodjo Karikari

Class of 2017 Andrew Rogers Annie Huyler Mona Lotfipour Henry MontillaGuedez Hong Loan Nguyen Clay Cooper Jessica Rosenberg Ida Solis Jonathan Salter Kelsie Herring Kristin Berger Evan Foley Elise Mercier Allison Weinstock Jillian Mitchell Mena Abdelmalak Bilaal Ahmed Mark Nakhla

Class of 2018 Temitope Adebayo Lindsay Bacik Celeste Bailey Wilbert Beachy Nathan Bicher Connor Carmichael Emma Dahmus Kyla Halsor Nicole Hammond Zachary Hutchinson Eustina Kwon Laura Leuenberger Ivana Marji Julia Marsala Rebeca MartinBillings Olivia Munizza Darya Nesterova Rolfy Perez-Holguin Otto Schoeck Leah Sitler Elizabeth Thayer Jane Trinkkeller Jordan Trubiano

If you are interested in donating to the Global Health Center Scholarships you can: 1. Send a check to the Penn State University Global Health Center 2. Go to the Give Penn State fund on the web at giveto.psu.edu 3. Contact Devon Johnson to set up your own scholarship at ddominickjohnson@hmc.psu.edu