Globalhealthnewsletter spring 2015 electronic

N EWS

Spring 2015

Global Health

CONTEMPLATION • COMPASSION • ADVOCACY

Spotlight: Global Health Video-BRIDGE Initiative Eunice Chen. MS3 Lindsay Confer, MPH program The Ghana B.R.I.D.G.E is a unique student group composed of medical students, Masters of Public Health (MPH) students, and nursing students. Students work together in small groups to develop and deliver interactive healtheducation sessions to a group of 6th8th grade students at the Assin Foso Demonstration School in Assin Foso, Ghana. We are able to deliver presentations using a state-of-theart TelePresence satellite videoconferencing system, thanks to the Hershey Company and the Hershey Story Working in an inter-disciplinary group allows the students to address their topics from multiple viewpoints and to learn from each field’s unique expertise. During our water safety and hygiene lecture, medical students led an excellent discussion on the life cycle and pathogenesis of V. cholerae, the causative agent of cholera, while a MPH student discussed prevention methods and the public health implications of recent outbreaks.

Together, the group presented an in-depth view on the impact of cholera in underserved populations.

Since our start in Spring 2013, we have successfully presented eight sessions on a variety of topics including, water safety and hygiene, first aid and CPR, food safety and nutrition, health professions, Ebola, malaria, cholera, and organ systems and their related pathologies.

As we finish up for the year, we look forward to another year of presentations and improving upon the foundations of what we have built.

We would like to thank our numerous faculty advisors and community partners: · Dr. Adae Amoako: Chief Resident PGY 3, Family Medicine · John Cromwell: TelePresence Technician, Hershey Company · Dr. Benjamin Fredrick: Director, Global Health Scholars · Eric Gyekye: Headmaster, Assin Foso Demonstration School · Beth Hiner: School Programs Supervisor, HersheyStory · Dr. Wenke Hwang: Director, MPH program · Dr. Gordon Kauffman: Professor and Vice Chair of Surgery · Dr. Kristin Sznajder: Assoc. Director of International Initiatives, MPH program · Leslie Womeldorf: Instructor, PSU College of Nursing

CUBA: A First-hand Look

Ghana: MountCrest University Update

Tom Lloyd, Ph.D., Professor Department of Public Health Sciences

N. Benjamin Fredrick, M.D.

In February 2015 Dr. Tom Lloyd spent a week exploring history, culture, art, and healthcare in Cuba. Here is an excerpt from his notes: After lunch we toured a tobacco farm, owned and managed by a broad shouldered guy with Burt Reynold’s rugged good looks and a name that sounded like “Bandito” or something of that ilk. Bandito claimed to speak Spanglish, but in fact his English was just fine. He gave us a quick tour of his tobacco drying barn, sat down on a wood chair, pulled a few tobacco leaves from a cloth sack, placed them on a board spread across his knees and effortlessly rolled a perfect Cuban cigar, which he trimmed, lit, drew on for a couple of puffs, then passed it to the crowd. We learned that as each plant of Cuban tobacco, the Corojo variety, grows its leaves are harvested sequentially, the earliest leaves being reserved for the cigar wrappers. When I asked Bandito about what he thought of the Virginia style varieties of tobacco grown in the Eastern US, he replied with a smile and a hint of disdain, “Oh yes, that is what you want for cigarettes.” From the tobacco farm we walked less than a quarter of a mile to the local state run medical clinic.

We had detailed conversations with the clinic’s nurse who explained that her clinic was responsible for the health of 871 local citizens and that the state provided living quarters attached to the clinic for both her family and the family of the clinic’s doctor, who happened to be in Venezuela on a two year state-sponsored professional exchange program. Loosely translated this means that Cuba sends doctors, nurses and other professionals especially to Venezuela in exchange for oil.

Although it is a voluntary program we got the impression that the individuals are happy to participate. The nurse was candid and proud of her role, as well she should be, as in response to all of our questions her answers showed that Cuba puts most of its health care resources where it matters, in preventative care.

For example, after a baby is delivered in a regional hospital and comes home the local clinic nurse is charged with visiting the mother and baby, at home, for the next 41 consecutive days. Thereafter the mother and baby must come to the clinic once a month over the next twelve months. And breastfeeding for 12 months is more than a recommendation. It’s mandatory unless there is a medical reason not to do so. Wow! In Cuba, as in the US, medical schools have more women students than men students. Now back to the hotel for some late afternoon sunbathing and valley viewing from the deck of the swimming pool followed by a buffet dinner and a slightly warmer night for sleeping.

In July 2014 Penn State College of Medicine signed a Memorandum of Understanding with MountCrest University School. MountCrest University is the first in Ghana to establish a private medical school. Through a series of visits to both campuses, our schools have identified a number of exciting areas for collaboration, including teaching and training, faculty development, and clinical care opportunities.

Mr. Kwaku Ansa-Asare and Mrs. Helena Ansa-Asare are the Founders of MountCrest University in Ghana. They are a magnanimous, generous couple who greatly value higher education and private sector investments. The university’s campus in rural Larteh, the village in which Mr. Ansa-Asare’s family hails, is being constructed on land donated by the Ansa-Asare family.

The Founders’ motivation to establish a new medical school and teaching hospital in Larteh is deeply rooted in their love for the region. Their commitment to humanistic medical education arose from a series of hurtful incidents experienced around the death of their nineteen year old son, Kwame AnsaAsare, in 1999 from leukemia. They desire better health for their region and their country.

The Health Sciences campus under construction in Larteh will include a Health Sciences building (lecture halls, small group rooms, library, etc), medical school building, and hospital. Faculty will be added to support a medical school, nursing school, lab sciences school, and midwifery school.

Ghanaian medical education is based on a European model of six year curriculum after graduation from High School. The first year primarily consists of the basic sciences, the second

and third years are pre-clinical years, and the remaining third through six years are clinically focused. MountCrest U. intends to include more active learning opportunities such as problem-based learning within the curriculum.

Also, MountCrest U. medical education will incorporate a longitudinal humanities-in-medicine curriculum, the first of its kind in Ghana.

Several exciting activities are underway related to Penn State Hershey’s collaboration with MountCrest U.: 1. Assistance with design of MCU’s medical education curriculum is being led by Dr. Eileen Hennrikus.

2. Our Global Health Scholars Program will expand to include sites in Ghana for 2015-16.

3. Volunteer clinical teams are being organized to visit Ghana in early 2016.

4. A Peer Mentoring Program between MCU junior faculty and PSU-Hershey senior faculty (Dr. Kent Vrana, Dr. Lisa Sinz) is underway 5. A Global Health course to be developed for our MPH Program in conjunction with MCU faculty.

CONGRATULATIONS to our Fourth-year Global Health Scholars

Angela Li

Catherine Nicka

Jennifer Rice

Hannah Wakefield

Chelsey Straight

Medicine-Pediatrics Rush University Medical Center, Chicago, IL

Pathology Dartmouth-Hitchcock Medical Center, Lebanon, NH

General Surgery Swedish Medical Center Seattle, WA

Pediatrics Medical University of South Carolina, Charleston, SC

Dermatology University of New Mexico School of Medicine, Albuquerque, NM

Pope Shenouda III Medical Center, Bolivia Veronica Chehate, MSIV Description of setting: The Department of Santa Cruz is located on the eastern side of Bolivia, in South America. The city of Santa Cruz is divided into rings. The first ring is located in the center of the city and is the wealthiest and most modernized. As one moves further from the first ring, to the second, and then to the third and so on, there is a trend to a more suburban, then rural environment and a general decrease in socioeconomic status. The Pope Shenouda III Medical Center is located on the “seventh ring” of the city of Santa Cruz de la Sierra, the capital of the Department (state) of Santa Cruz. Being on the seventh ring of the city, the medical center thus serves a rural population of lower socioeconomic status.

Student responsibilities at the site: I assisted the primary care physicians and to a lesser degree homeopathic physicians in seeing patients of all ages, mostly for acute care. Additionally, I participated in community service. Specifically, I participated in community outreach presentations (on health related topics) in several rural communities within 30 min-2 hours from the church, as well as visits to a local nursing home to check blood pressure and manage medications.

Contact info for the experience: Dr. Jaime Ortiz Moreno, clinic director; Phone number: +591 (3) 344-2928 Lodging/housing description: I stayed in housing provided at the adjacent Coptic Church complex. The housing was very clean and comfortable, and the church is very safe. I had one roommate, and we shared a private bathroom. The room was air conditioned.

Laundry facilities were available on-site. Meals were provided at the church as well.

Brief description of experience: Through this rotation I was able to experience medicine in a global setting. I learned about Bolivian culture, healthcare challenges faced, specific diseases encountered (such as Dengue, Chagas, parasitic infections), and the use of herbal treatment/homeopathic medicine. I was humbled by the opportunity to serve in the community to specifically raise awareness about hygiene to rural Bolivian children, and to visit a local nursing home. I also had the opportunity to learn and improve my medical and conversational Spanish. Finally, I enjoyed meeting and spending time with Bolivians in the clinic, at the church, and in Santa Cruz in general; all were very friendly and welcoming.

Three words that characterize the experience: Unique, Eye-opening, Enriching.

Total costs: Approximately $2, 000 (including plane ticket, vaccinations, personal expenses etc.

Foundation for International Medical Relief of Children (FIMRC), Uganda Ashley Brown, MSIV Description of setting: We worked at a small clinic run by the Foundation for International Medical Relief of Children (FIMRC) in a small village in Uganda (Kiholo).

There were 5 stations: intake, vitals, consult or pediatrics, dispensary, and lab. The village was 1 hour away from Mbale, a larger town; it was about 6 hours away from the capital of Kampala.

Student responsibilities at the site: We worked with the clinic staff in the various stations, shadowing for the first day or two, and then running the station with staff assistance. At the consult station, we worked with a PA, and then at the pediatrics station, we worked with a translator but acted as the primary medical workers. We also worked with the various groups - post-HIV diagnosis group, maternal health, etc. Occasionally we would go on outreach to the nearby villages to give out vitamins and de-worming medications.

Contact info: http://www.fimrc.org/ or missions@fimrc.org

Ki Chang, MSIV

Foundation for International Medical Relief of Children (FIMRC), Uganda

CURE children’s hospital of Uganda, a specialty hospital for all children needing neurosurgical care in the country.

Catherine Nicka, MSIV

CURE Children’s Hospital, Uganda

Description of setting: The FIMRC clinic was located in an extremely rural location. The nearest city was an hour away by matatu. The clinic was located right next to a primary school and served the needs of the entire community. Patients would walk up and down mountains for several hours in order to get to the clinic.

CURE hospital

Typical line at the outpatient clinic. Parents who have travelled for days to have their children evaluated for possible surgery.

Hydrocephalus and spinal chord disorders were the two most common conditions observed.

A patient with untreated hydrocephalus for 13 years. Due to the continuously elevated intracranial pressure, he is now blind and paraplegic. A scenario rarely seen in the developed countries.

Ki Chang performing a ventricular tap to analyze the CSF fluid and intracranial pressure in a child suffering from hydrocephalus.

Student responsibilities at the site: The site had several different stations such as lab, consults, vitals, pharmacy, etc.

Our duties were to man each station under the supervision of a clinic employee. We were never expected to treat patients without supervision Contact info: operations.uganda@fimrc.org

Lodging/housing description: The normal guest house for FIMRC is a 5 minute walk from the village, and a 1015 minute walk to the clinic. Rooms are dorm-style.There is running water during the rainy season, but while we were there, it was still dry season = bucket baths and pit latrines.

Meals are provided at the guest house for breakfast & dinner, and at clinic for lunch. There were many medical students there at the same time as us, so we stayed at a guest house associated with the Arlington Academy for Hope, which did have cold showers and toilets, but this is not the norm for medical student volunteers.

Brief description of experience: It was a good experience.

There were too many medical students while we were there (16 in total), so we doubled or tripled up for each station, meaning there was a lot of downtime. Outreach was the best, because you got to see so many people and really make a difference in their lives. Working at the consult and pediatric stations was great if there weren’t a lot of other students, because you got to practice your clinical and diagnostic skills. I really liked seeing how care in a small village in Uganda compares to the hectic & dysfunctional medical care of America.

Three words that characterize the experience: disorganized, valuable, educational Total costs: $2700 for FIMRC, which included housing, transportation to/from the airport, and meals. $900 for plane ticket. Going somewhere for the weekend was not included in the cost.

Lodging/housing description: We were housed at the Arlington guest house approximately 1/2 mile from the FIMRC clinic. The 5 of us stayed in 2 different rooms. The house had a dinning/living room as well as a kitchen. There were also showers and outhouse-style stalls. I think the housing situation was adequate Brief description of experience: This was a unique experience that allowed us to understand the barriers and catalysts to health care. Along with working in the clinic, we were given the opportunity to go on community outreach where we provided the community members with albendazole and the children with vitamin A. We were able to work closely with the clinic staff as well as the community volunteers. We were also able to help provide health education to community members.

Three words that characterize the experience: rewarding, unique, impactful Total costs: ~$2500 to work at the clinic and housing, $900 for plane ticket, $100 random expenses --> total $3500

Amazon Promise, Peru By: Hannah Wakefield, MSIV Setting: The setting is a combination of urban and rural.

Volunteers will spend part of their time in Iquitos, Peru, traveling to local clinics to deliver medical care. The other part of their time will be in the jungle—living in a lodge along the Yarapa River and traveling by boat to local villages to set up mobile clinics.

Student responsibilities at the site: Students will be responsible for delivering medical care under the supervision of an attending or residents, helping with collecting statistical data at the end of each day, and helping with inventory of supplies before and after the trip. They also will be responsible for presenting a talk on an assigned topic related to delivering tropical health.

Contact info for the experience: Patty Webster, President: patty@amazonpromise.org Dr. Rob Hyzy, Medical Director: rhyzy@amazonpromise.org Jacqueline Carroll, Coordinator: jackie@amazonpromise.org Lodging/housing description: Housing varies depending on the trip. During the Iquitos part of the trip, you will stay either at a local hotel or in a room at the Amazon Promise office. You will have running water and either a fan or A/C. There are plenty of restaurants nearby to obtain your meals, and volunteers are fed lunch during clinic days. During the jungle portion of the trip, everyone stays in a lodge along the

Yarapa River. There is running water, plenty of mosquito nets, and a cook for all meals, but it is the jungle, so long sleeves and insect repellant are a must.

Also, expect to meet some of the local wildlife, because you will!

Clinica Esperanza, Roatan, Honduras By: Benjamin Ruth

Brief description of experience: Amazon Promise provides medical volunteers with the opportunity to live near local communities and provide primary medical and dental care to the residents of villages along tributaries of the Amazon River. Volunteers will be either in Iquitos—an urban setting—or in a lodge along the Yarapa River—a jungle setting. In either case, there is plenty to learn about what conditions and diseases most commonly affect residents in this part of Peru, along with the opportunity to see tropical diseases like leishmaniasis, malaria, dengue, or leprosy. Volunteers may also have the opportunity to work alongside Peruvian physicians in local clinics and hospital emergency departments.

There is plenty of opportunity to practice medical Spanish, though translators are also there for anyone that may need them.

Three words that characterize Enlightening. Challenging. Enriching.

the

Setting: Clinica Esperanza is in Roatan, Honduras, a small island off the coast of mainland Honduras. While it is mostly known internationally as a tourist destination, a large part of the island is in great poverty. The clinic itself is set up to provide low-cost medical care to anybody in need on the island. While the island does have one “hospital”, it is very small and very low on resources, so the clinic provides the medical care to a significant number of people. It provides general medicine in addition to pediatrics, OB/GYN, and dentistry. It was originally started by an American nurse, but has grown significantly and is now run by a combination of Honduran doctors and American volunteers. The clinic relies heavily on volunteers from the US or abroad, frequently having visiting medical residents, students, and physicians.

experience:

Total costs: $3,000 for three weeks lodging + ~$1,800 for travel + $300 for local expenses = $5,100 total Student responsibilities at the site: Responsibilities vary depending on the level of training. 4th year medical students or above are able to see patients under the supervision of an attending/resident. Those with less training worked in the areas of triage or pharmacy. Students also attend daily lunch lectures and are responsible for giving one presentation during their time there. There are also 2 classes per week for Medical Spanish learning, as well as a textbook to work through for homework to help master doing H & P in Spanish.

Macha Mission Hospital, Zambia Brianna Moyer, MSIV

Contact info for the experience: info@clinicaesperanza.org Lodging/housing description: There are a variety of housing options available, which can be found on their website at clinicaesperanza.org. These vary from a volunteer house, local hostel or resorts, or finding private condos from clinic contacts.

Front entrance to Macha Mission Hospital

Main OR in the hospital.

Surgeries include hernia repairs, C-sections, and ex-laps. There are also two other rooms in the ‘operating theatre’ for minor procedures,

We would round Monday, Thursday, and Saturday mornings in the female ward. Afternoons would be spent in the outpatient clinic attached to the hospital. Tuesdays and Fridays were ‘theatre day,’ so we spent those days in the operating theatre doing surgeries. Wednesdays I would typically join one of the other doctors in either the male, pediatrics, or maternity wards.

Brief description of experience: I had an amazing experience working at Clinica Esperanza and living in Roatan. As far as my clinic experience, I spent 4 weeks working at the clinic, where my main role was seeing patients under the supervision of an attending/resident. I worked half of the time with a

Honduran doctor and half the time with US residents, so it was fascinating seeing the differences in how medicine is practiced. I saw a large variety of medicine during my time. Of course there was the normal chronic care issues like diabetes and hypertension, but I was also exposed to a lot of new tropical medicine issues like malaria, dengue, chickengunya, and many different parasites. I found it both frustrating and interesting to practice in low resource environment where I couldn’t just get an imaging exam or blood test done right away, and found that it really helped improve my clinical skills. In terms of the patients, there are a blend of several cultures on the island with native Islanders, Hondurans that moved from mainland, and ex-pats/tourists. Roughly 2/3 of the patients spoke only Spanish, with the other 1/3 speaking English, so there were definitely opportunities to practice Spanish.

While the majority of my time was at the clinic, there was certainly plenty of opportunities to explore the island and different cultures. We loved visiting different parts of the island and trying all of the different restaurants/cuisine, spending time on the beautiful beaches, snorkeling, or simply hanging out with all the great people we met.

Three words that characterize the experience: Inspiring, educational, refreshing Total costs: Approximately $3000/person (clinic requires a $750 volunteer fee)

Congratulations to the Donald and Shirley Stratton Global Health Scholars

Ivana Marji (MSI)

Olivia Munizza (MSI)

With this scholarship Ivana Marji (MSI), Olivia Munizza (MSI), and Darya Nesterova (MSI) will be traveling to Peru this summer as part of the Global Health Scholars Program. The students will develop a public health needs assessment to identify priority areas for future research and interventions at the site in Iquitos, Peru. They will also participate in ongoing work in Iquitos in conjunction with the US Naval Medical Research lab, NAMRU-6, related to gastrointestinal infections. The recipients would like to thank Mr. and Mrs. Stratton for their generosity in helping to make their trips possible, and to Dr. David Craft for his leadership with the Peru site.

Darya Nesterova (MSI)

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 Montilla- Guedez 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 Martin-Billings Olivia Munizza Darya Nesterova Rolfy Perez-Holguin Otto Schoeck Leah Sitler Elizabeth Thayer Jane Trinkkeller Jordan Trubiano

Global Health Scholars ALUMNI 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

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