PSU-COM Global Health Newsletter Summer 2014update

N EWS

Summer 2014

Global Health

CONTEMPLATION • COMPASSION • ADVOCACY

Dominican Republic (Christian Medical Society)

By John Kang (Class of 2017)

The Christian Medical Society went on a medical mission trip to the Dominican Republic for 8 days during spring break. Around 40 medical students, nursing students, nurses, physicians, and a few of their family members from Penn State Hershey were joined by a group of undergraduate students from Waynesburg University and University of Pittsburgh. The mission trip was operated in partnership with Whitefields Foundation, a Christian organization based in Pittsburgh, PA. On Saturday March 3, we arrived at the Las Américas International Airport in the country’s capital, Santo Domingo, and we took an additional 2 hour bus ride before finally arriving at the Meeting God in Missions (MGM) compound in a town called Hato Mayor Del Rey. MGM is a non-denominational Christian ministry with a permanent presence in Hato Mayor and seeks to spread the gospel by connecting short-term mission trips with their long-term work in the area. The next day, after visiting a local church to attend their worship service, we spent the entire day preparing for a full week of traveling clinics. The main bulk of the preparation was sorting and counting the dozens of medications from the bottle containers into Ziploc bags.

During the next five days (from Monday to Friday), we visited various towns around Hato Mayor to provide the local people with the much needed medical care. Our average day would start at 7AM with a brief morning worship service, and after breakfast, we loaded the trucks and left for the local towns. Our mode of transportation was the so-called “cattle trucks.” We would literally get on the back of trucks and hold onto the metal bars—or each other. For the clinic, we were divided into three teams—triage, clinic, pharmacy— and rotated once a day after lunch. First year medical students were paired with upperclassmen for the clinic. The students did the patient interview, physical exam, and wrote the SOAP notes after which one of the physicians came to confirm the assessment and plan. Although a few students were fluent in Spanish, most of us needed assistance from one of the local translators that work for MGM. After seeing each patient, we offered to pray for them, which most of them accepted and greatly appreciated. While the Penn State Hershey team was running the clinic, the Waynesburg University and University of Pittsburgh team ran a one-day vacation bible study (VBS) for the children in the town.

This trip was my first evangelical and medical mission trip.

Coming into the field of medicine, one of my goals has been to serve those who are underprivileged, so being a part of this trip was a great honor for me personally. It was a great opportunity to practice interviewing and physical exam skills, and I also got to know my classmates, upperclassmen, and the physicians much better. However, at times, I was saddened by the limitations of being on a short-term mission trip. Giving out medications that will only last for a certain period, and knowing that you will never see these patients again broke my heart and made me ponder on the role and purpose of our trip. For this reason, I think the spiritual component of the trip was as important

Christian Medical Society Dominican Republic Medical Missions Trip By: Juliana Xie, MSI

Now that I am back from the Dominican Republic and looking at the pictures I took, some of the feelings are starting to rush back.

The blue sky, the meadows, the brisk breeze against my face. The strange concoction of landscapes: palm trees with the backdrop of densely forested hills and fields of plantain trees. The bumpy cattle truck rides; the shabby houses built with pieces of corrugated iron; dirt roads, running dogs, and strolling chickens.

We went to a different village every day of the week, and we averaged in seeing more than 200 patients per day. We really felt every individual on the team was indispensable to our care.

Limited medical care It is true that on short-term missions, we are medically limited to medicines such as pain killers, antibiotics, vitamins, and packets of vitamin-enriched rice. All of this is good and have their utility, but now I started to understand why Brother Kim (one of the missionaries there) said that the top priority was to train the local people (capacity development). There is a dire need for medical knowledge transfer to local doctors to better take care of patients and for them to teach the local people about hygiene, hydration, nutrition, diabetes management, and many more.

In our temporary clinic, we did not have the luxury of obtaining blood tests, urine samples, histology slides, or needless to say an X-ray or an MRI. Without the multitude of tests we use back home, it was impossible to pinpoint an underlying problem. Moreover, we were only able to treat the people’s symptoms for a short duration of time (most medications were

given to take for a week or a month).

Many people came in for chronic back pain, headache, high blood pressure, lack of appetite, etc. There were also a lot of women who had vaginal pain and other obstetrics issues. We did the best we could – gave our patients medicines for the disease that they were most likely to have. But despite this, I felt a sense of dissatisfaction at the beginning.

Patient education and need for capacity development With time, I began to learn to appreciate the powerful meaning of our missions work. One was patient education. One day came in a man who worked to pick tangerines all day under the sun. He said he experienced a lot of headaches and knee pain when he worked long hours under sun exposure. I asked him if he drank water, and he said “no”. We then took the opportunity to encourage him to stay hydrated throughout the course of his work. To protect his eyes from the glaring sun, we gave him sunglasses and talked about the importance of wearing them when working.

There was also a very thin diabetic patient for which the glucometer test value was beyond the maximal reading possible.

Our nurse said it must have been higher than 500 mg/dL. Also tachycardic at the time of the visit, he told us that he hasn’t been controlling his sugar for years. We then gave him 6 months dose of metformin, and some glipizide as well.

Importantly, we also discussed with him about limiting sugary foods and to follow-

up with his local doctor.

Furthermore, one of the doctors on our team even taught the patient with back muscle pain how to best lift heavy objects using thigh muscles. Details like these can reach far and deep into the patient’s lives, and this is where I felt our work had more long-term influence.

Spirituality and Healing Did you know that the Dominican Republic’s flag is the only flag in the world that has a Bible on it? People in the Dominican Republic are highly spiritual.

For every one of our patients, we asked them if they wanted to pray with us, and they all gladly accepted. Many patients I met were Christians. We then held hands together, bowed our heads, and prayed for the patient. We prayed that the Spirit may be with them to heal them and to help them grow in faith. I loved how the patient’s eyes brightened up after the prayer, and one patient even merrily said that he felt that he would not need the pain medications for his headache because God will cure him!

Throughout our time at the clinic, I felt that one of the most important parts to our short-term missions was engaging with the people in the villages, to talk to them about their pains and troubles, to hold their hand and to listen to their body. To give them medicine and to pray with them.

During our last day at the clinic, we danced with the kids in the village and sang the vibrant song “Espiritu de Dios” (The Spirit of God) with them. There was so much love, energy, and laughter. We were one under the azure sky.

1st-year Global Health Scholars

Global Health Scholars

COMMENTS

CURRENT Class of 2015 Sara Abu-Tabikh Erin Banashefski Diana Filtz Angela Li Catherine Nicka Anne Odom Jennifer Rice Hannah Ross-Suits Lauren Schmidt Chelsey Straight Rebecca Theophanous

Clay Cooper, MSI I chose to be part of the Global Health Scholars program because it is a great way to learn about how to apply global health concepts both globally and domestically. I am interested in working with the growing but underserved Hispanic population in the US, and gaining Global Health experience in Latin America will help me to better understand cultural perspectives of medicine among Hispanic patients.

Henry Montilla, MSI, As an international student being born in Venezuela I chose to be part of the Peru team in order to give back to Latin America.

Also, working in Latin America gave me an opportunity to use my Spanish skills and learn more from the experience.

Kelsie Herring, MSI While I’ll argue that they do have the best fruit juice, I am also really excited about the medical insights and other cultural experiences I will gain from this trip. While my previous trip to Ecuador was not medically related, this time I look forward to shadowing in the women’s water birthing and other clinics. Also, I think that reciprocity is crucial, and I can’t wait to be the first group to make connections with the people living in Quilapongo and Zumbaua. We will be starting what will hopefully become a lasting connection between our PSUCOM students and these small villages. To new friends, spreading knowledge, and adventures!

Bilaal Ahmed, MSI My team will be working on projects in Sierra Leone’s third largest city, Makeni. Sierra Leone ranks among the world’s poorest countries on the Human Development Index. The resource rich country is slowly recovering after a civil war (as depicted in Blood Diamond) that decimated its infrastructure and health care system. As a result, there are opportunities to conduct research in a poorly-studied region and to pilot new interventions to improve people’s lives.

We will also be traveling with a team of engineering students from the University Park campus who will be working on deploying technological interventions relating to public health, economic development, and agriculture.

Kristen Berger, MSI The Global Health Scholars Program is part of the reason why I chose to attend Penn State.

I really enjoy traveling internationally and spending time immersed in different cultures.

I was interested in traveling to Senegal because the students spend a lot of time working with the diabetic population in M’Bour. I wanted to learn more about how chronic illness is managed in a resource-poor area.

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

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

Whose duty is it to help the poor?

By Nicolai Wohns, MSIV The burden of poverty in the world is staggering. According to the United Nations’s Human Development Report of 2013, 1.2 billion people live with under $1.25 a day, adjusted for purchasing power, and more than 30,000 children under the age of 5 die each day due to hunger and other preventable causes. With numbers of this magnitude, it is natural to feel overwhelmed. But to take this calamity seriously is to debate how much we ought to sacrifice in order to help. More precisely put, we must ask who ought to do what for whom.

One response is to say that we should only give what we can, all things considered. There is no doubt that the need of the impoverished is great, but, the argument goes, an individual may have other valid and compelling interests -- for example, in providing for one’s family -- that compete for the same resources. Furthermore, it might be contended that simply donating money to the poor is not the best way of addressing the problem.

Poverty is more a matter of systems and institutions than individual agents, and as such it is much more suitable to a solution on the order of governmental and regulatory bodies.

This could be taken one step further by claiming that, regardless of geographical location, it is primarily the duty of the local government to

ensure the health and well-being of its own population, not the duty of individual people halfway across the globe. If the government fails to do so, it doesn’t fall to me or you to help, but rather to the appropriate international governing bodies, in recognition of such agreements as the International Covenant on Economic, Social and Cultural Rights.

One could object and claim, to the contrary, that world poverty is a matter of basic rights, and we as individuals and as human beings have a duty to do as much as we can to help those who are suffering: if I have the power to help alleviate suffering, then I have a moral obligation to help. Consequently, in answering the original question, we all must give significantly more to the needy than what the first response implies. In fact, this line of reasoning suggests that I donate up to the point where, by giving any more, my wellbeing would fall below those that I could help.

However we answer the question of who ought to do what for whom, whether it is via libertarian or cosmopolitan reasoning, we must come to terms with what we value and what we should value. Only in this way will we be ready for the construction of a durable and morally acceptable solution.

Stratton Global Health Scholar Announced!

Congratulations to Allison Weinstock, MSI the 2014 Stratton Global Health Scholar! Allison will be pursuing a scholarly project in Senegal during June 2014 with the Global Health Scholars Program, under direction

by Dr. Rhonda Belue (Biobehavioral Sciences). The Stratton Global Health Fund was established through the generosity of Mr. and Mrs. Donald and Shirley Stratton of Hershey. After her return to campus Allison will provide a presentation of her work and this will be open to the public.

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

The Global Health Center provides organization and oversight for the medical center’s educational, service, and community research activities in global health. The Center is responsible for promoting global health issues on campus. If you would like to contribute to the quarterly newsletter, or if you are not receiving this publication, but would like to be added to the list, please send an email to nfredrick@psu.edu.

Director of Penn State College of Medicine’s Global Health Center: N. Benjamin Fredrick, MD, Family and Community Medicine Global Health Center Advisory Board: Dennis Gingrich, MD (Fam Med), Brandt Groh, M.D. (Pediatrics), Graham Jeffries, M.D. (Medicine), Daniel Wolpaw, M.D. (Humanities), Jose Stoute, M.D. (Infectious Disease), Jim Holliman, M.D. (Emergency Medicine), Alawia Sulliman, M.D. (Pediatrics) On the Web: http://www.pennstatehershey.org/web/globalhealth Like us on Facebook: http://www.facebook.com/PSUGlobalHealth If you would like to receive Global Health Center announcements, please notify Tina Lengle: tlengle@hmc.psu.edu.