Global Health Newsletter Spring-Summer 2012

N EWS

Spring/Summer 2012

Global Health

CONTEMPLATION • COMPASSION • ADVOCACY

Global Health Experiences

Improving Education Through Global Exploration By: Catherine Nicka An Interview with Lawrence Kienle M.D. and Philip K. Wilson, Ph.D. of the Doctors Kienle Center for Humanistic Medicine Compassion inspired Lawrence Kienle, M.D. and Jane Witmer Kienle to improve the quality of care patients receive by educating medical students. In 1985 they established the Doctors Kienle Center for Humanistic Medicine at the Penn State University College of Medicine.

When asked about the Kienle’s, Philip Wilson, Ph.D., Director of The Doctors Kienle Center for Humanistic Medicine and Professor of Humanities, replied, “They were pioneers. They helped lay the foundation for the first wave of people who have come across the frontier of thinking about the integration of humanitarian principles within medical education.”

Dr. Lawrence Kienle recently returned to Hershey for a visit, and I was able to sit down with him and Dr. Philip Wilson to ask about the role that the Kienle Center plays in global health.

The Doctors Kienle Center for Humanistic Medicine is a strong supporter of global health efforts at Hershey. How did this come about?

Dr. Kienle- Global health support gradual developed as one of our projects, and then we had to promote the idea within Hershey to

send these wonderful kids for an experience in life that would maybe transform their medical practice. They sort of picked the places that they wanted to travel, and we supported them as far as we could.

Dr. Wilson- Global health has been one of the long standing initiatives long before we had a Global Health Center and before Dr. Fredrick came back to Penn State Hershey.

The Kienle Center has been there helping from the grass roots. For the past three years we have supported the spring break missions. Through Kienle Center support, we have been able to put students in most of the habitable regions of the world.

We have never believed in the travel for “medical tourism.” I think the things that the Kienle Center supports have a strong integrity behind them, and they have to be related with extra- or co-curricular areas.

Is there anything else that you wish the Kienle Center would have done?

Dr. Kienle- No. I am delighted in this overseas activity, and the fact that it’s very under served and it benefits worthy students.

Do you think that global health receives its fair share of funding?

Dr. Kienle- No. I just think that it is so obvious that we need to get more sources for support for helping health care for the needy. There is just not enough money to go around for deserved projects.

Why is it important for the Kienle Center to support Global Health?

Dr. Wilson- I think Global Health is one of the best ways to truly learn about human need. It forces you to focus on the very basic aspects of humanity. How do you communicate with people? How do you talk with people about their particular needs? What are the common concerns around the world when it comes to healing? What is the basic framework for someone that has suffered, and what is the framework of the healer? What are the common ingredients there? A lot of the things that the Kienle Center stands for are sharing of compassion, the importance of acting courageously, the importance of providing care and often care beyond cure, comfort, and communication.

Dr. Keinle- I also think it is important for students to follow one another from year to year. If someone develops a project and comes up with an answer or a suspected answer then someone should follow that the following year in addition to new ideas.

Deans Sign Memorandum of Understanding On April 20, 2012 Dean Harold Paz signed a Memorandum of Understanding (MOU) with Dean Rodolfo Farfan of the Universidad de Especialidades Espirtu Santo (UEES) Medical School. The MOU opens the way for faculty and student exchanges between our campuses and for potential future collaborations.

Located in Guayaquil, Ecuador, the UEES Medical School provides opportunities for two

of our important global health undertakings. The Penn State Hershey Children’s Heart Group has been providing heart surgeries and cardiology training for almost fifteen years through the Roberto Gilbert E. Children’s Hospital in Guayaquil. Our Global Health Scholars Program, now in its fourth year, has focused its community health efforts a drive up the coast from Guayaquil in the seaside town of San Pablo.

José Stoute, M.D.—Microwaving Malaria

By Hannah Ross-Suits (Class of 2015) The Gates Foundation announced in 2008 their new grant program, Grand Challenges Explorations, and Dr. José Stoute called his colleague, Dr. Carmenza Spadafora, to bounce around ideas related to malaria. After deciding several ideas wouldn’t work, Dr. Spadafora asked exasperatedly, “What do you want, a ray gun?!” to which Dr. Stoute replied, “Yes!” The idea of using microwaves to kill malaria was born. The first phase was funded for $100,000.

Based on successful initial results in test tubes, the project received an additional $1 million over a two-year period. Current studies are looking at in vivo microwave radiation in mice. The current project is in its second year and results look promising. Dr. Stoute and his colleagues will travel to Panama in June to present these results to the Gates Foundation Program Officer.

With his busy schedule Dr. Stoute was able to give me a few minutes to tell me about his research and to answer a few other questions: Since it isn’t probable to stick people in giant microwaves, how can your research in mice translate to treatment in humans?

Our goal is to develop a device that is safe, effective, and noninvasive. It would ideally be battery powered—a car battery or maybe smaller—and would be portable and made from inexpensive but durable materials. Because the body circulates about 5 liters of blood per minute, we could have someone expose an arm or a leg to the microwave device set at the right power and frequency to destroy the parasites that are traveling in the blood. Plasmodium likes to hide out in specific organs, like the liver, but eventually it has to get back into the bloodstream, and that’s when we can kill it with the microwave radiation.

Do you see any other applications of microwaves to other parasites or bacteria?

Yes, we’re actually planning to expand the research to Trypanosoma cruzi, (the parasite that causes Chagas disease) which has enzymes that iron in a state similar to that found in the hemozoin of

Plasmodium. Microwave radiation could also be used to sterilize donated blood, or to help treat cutaneous leishmaniasis (an ulcerative disease that can cause disfigurement if left untreated).

Why Plasmodium? Why not another parasite?

Malaria is the most important parasite in terms of morbidity and mortality. The organism is intriguing and the history to how we’ve learned about malaria is fascinating.

Who/What is your inspiration?

My mother. I grew up in Panama, and she was a nurse at one of the hospitals. She would come home and tell me stories about her work. I also was accident-prone as a kid, and I often had to spend time in the ER. I enjoyed seeing the dedication of the hospital workers while I was there.

Do you have any favorite books or movies?

For movies, my favorites are Out of Africa, Forrest Gump, and Saving Private Ryan. For books, I love history, so my favorite book is The Path Between the Seas by David McCullough, which is about the creation of the Panama Canal. I also enjoy books about the Civil War. Do you have any advice for medical students?

Well, sometimes not knowing as much can be an advantage; being naïve can open you up to more innovative ideas. Follow your dreams as far as they can go, and there’s always a way to make them happen.

For further news articles on Dr. Stoute’s research, please see: http://live.psu.edu/story/54135

http://www.nytimes.com/2011/08/23/health/23microwave.html

Congratulations to our Mark J. Young International Health Policy Scholarship Recipients 2012-13! http://www.pennstatehershey.org/web/phs/home/aboutus/young The purpose of the Mark J. Young International Health Policy Scholarship is to provide recognition and financial assistance to full time faculty, fellows, residents, or medical students at Penn State Hershey Medical Center and Penn State College of Medicine to undertake health policy study programs outside the United States.

Dr. Omar Zalatimo (PGY5, Department of Neurosurgery) Comparative Health Systems Workshop in Taiwan

Dr. Jane Schubart (Public Health Sciences) Conference on Communication in Health Care in Scotland.

Ms. Kimberly Faldetta (MSII, Global Health Scholar) Conference on Infectious Diseases in Peru Each recipient will be providing a presentation to our campus upon return. We will announce the presentations at a future date.

To view presentations (video) by prior recipients, please visit: http://www.pennstatehershey.org/web/phs/home/aboutus/young/archive

HEALTH FAIR On April 21, 2012, the Penn State College of Medicine Class of 2015 hosted the first Healthy Harrisburg! Health Fair at the John N. Hall Clubhouse of the Boys and Girls Club in Harrisburg, PA. Many Penn State College of Medicine clubs and independent students designed table presentations on an assortment of health-related topics including nutrition, exercise, fire safety and emergency response, smoking cessation, and safe sex.

Other presentations given by the Radiology and Dermatology Interest Groups sought to

excite students about science. The event was well-attended with over 100 guests who all walked away with arms full of pamphlets, healthy snacks and prizes.

Dauphin County Penn State Hershey Milton S. Hershey Medical Center), Marsha Peters (Assistant Unit Director - Boys and Girls Club John Hall Clubhouse)

Special thanks to these individuals: Elizabeth Bates, B.S., N.D., R.N. (Penn State Univ School of Nursing), Judy Dillon, M.S.N., M.A., R.N. (Community Outreach Coordinator - Penn State Milton S. Hershey Medical Center), Susan Rzucidlo, M.S.N., R.N. (Pediatric Trauma and Injury Prevention Program Manager - Coordinator, Safe Kids

UPDATE: Global Health Scholars The Global Health Scholars Program is a collaboration of faculty and students aimed at providing the knowledge and experience required to become competent and socially aware of global health service work through a 4-year longitudinal curriculum designed around international service-learning opportunities.

GHSP aims to promote global health education and awareness, and provide ongoing, sustainable community health solutions that measurably improve under served communities. This summer 12 students from the Class of 2015 will be travelling to Peru, Ecuador, and Kenya.

Water and Traditional Medicine in Iquitos, Peru Jennifer Rice – My project looks at the effects of sanitation, water quality, and hand-washing hygiene on the incidence of enteric pathogens.

Sara Abu-Tabikh – I will be delivering a water sanitation talk to women and I will test the longitudinal effectiveness of my intervention to see if they have learned the proper methods of water sanitation over time.

Hannah Ross-Suits – My project is looking at distance from the Itaya River as a risk factor for Giardia and Cryptosporidium infections among women in the Belen municipality of Iquitos, Peru. I will be controlling for other cofactors such as sanitation infrastructure, hand hygiene, socioeconomic factors, and health education.

Derek Reighard – Exploring the role of traditional medicine in the impoverished municipality of Belen. For four-weeks I will conduct numerous structured and unstructured interviews with community members, natural-medicine vendors, and traditional healers (“curanderos”) in order to determine the specific medications and healing practices used to treat diarrheal disease in this riverside Amazonian community.

Community Health in San Pablo, Ecuador Lauren Schmidt – Assessing the prevalence of asthma among children and will be educating the community on the symptoms

of asthma and how to use a spirometer and peak flow meter to monitor the disease. Our group will also be conducting HIV testing among at risk populations.

Diana Filtz – Training community health workers in San Pablo, Ecuador to measure blood pressure and to teach hypertension management skills to members of the community.

Anne Odom – Working on a small community health worker training that involves teaching local women about oral rehydration therapy. We will be talking about dehydration, diarrhea, and bacteria.

Rebecca Theophanous – Conducting a vision screening project in children ages 4-17 years old in San Pablo, Ecuador. My goals are to determine the prevalence of vision disorders in San Pablo and to learn more about local visual health resources. I also hope to provide eye care education for the entire community and distribute corrective lenses to those children who need them.

Telemedicine in Nyeri, Kenya Angela Li – Performing vision screening tests on patients visiting the Mashavu kiosks, to determine whether they have decreased vision.

Chelsey Straight & Catherine Nicka – Our project will focus on educating the Community Health Workers (CHWs) of Nyeri, Kenya through health education training modules.

Erin Banashefski – Conducting research on where the people of Nyeri go to receive health care (hospital, clinic, traditional healer, etc) and why they choose the facilities they do (cost, distance, recommendation, etc). This information will then be used to determine how best to integrate tele-medicine kiosks into the existing health care options, ie where the kiosks would most benefit the local population.

Congratulations to our graduating 4th year scholars: Sean Boley, Brian Galovic, Shana Gleeson, Patrick Koo, Carolyn Pennay, Todd Schneberk

What can we do about Refugee Health? (Part 3 of a 3 part series on Refugee Health)

By Pulkit Bose, MSI The United States continues to be the largest single country recipient of new refugees among industrialized nations.

In 2008, Pennsylvania was ranked eleventh in the country for refugee resettlement efforts with more than 75 percent of those individuals resettled in four counties: Philadelphia (23 percent), Erie (21 percent), Lancaster (17 percent), and Allegheny (16 percent).

The number of newly arriving refugees to Pennsylvania is only increasing with a total of 3,500 predicted for 2013.

According to the Pennsylvania Medical Society, the top three countries from which Pennsylvania refugees have fled are Bhutan, Burma and Iraq.

The resettlement process for refugees requires them to undergo an initial health assessment by a physician with at least four years of experience (called a Civil Surgeon). There are many regions in our state that are experiencing not only primary care physician shortages but also shortages in Civil Surgeons who are committed to a government-appointed role in serving the immigrant population. The county of Erie is a major resettlement region and currently there are only two Civil Surgeons in Erie.

The U.S. health care system is particularly difficult to navigate for refugees because of the complexity and barriers to access including literacy, health literacy, transportation, language, and culture. Additionally, a sense of fatalism may be present in those who have experienced extremely difficult circumstances, including torture and violence. Healthcare providers, including physicians,

residents and medical students can truly serve this multi-cultural and vulnerable population only when they are equipped with tools and resources critical to providing continuous care in a culturally sensitive manner.

Medical students at the Pennsylvania State University College of Medicine (PSU-COM) can be engaged in the care of refugees through underserved Area Health Education Center (AHEC) primary care rotations in major resettlement regions, such as Erie. Students who are interested in global health or generally working with people from other cultures and nationalities should consider doing a clinical rotation with refugee clinics through AHEC. Additionally, there may be opportunities to shadow physicians who serve in such clinics for shorter periods of time. For instance, the Northwest PA AHEC refugee clinic in Erie is able to offer a two-day shadowing experience for medical students. Due to a large number of patients served by a few physicians, the clinic is limited in its ability to offer an extended learning opportunity for medical students.

As a medical community we can engage in the care of refugees in a few different ways. From an academic and educational perspective, we can encourage students to do primary care rotations in underserved refugee resettlement regions. Including a focused seminar on refugee health and multi-cultural clinical practice in the curriculum may also benefit students and residents. Additionally, PSU-COM should strongly consider developing a specific refugee health primary care

clinical rotation in partnership with AHEC at sites in central and north-west Pennsylvania for students interested in underserved medicine. Some of the regional refugee health care providers include Lancaster General Hospital, Southeast Lancaster Health Services, Welsh Mountain Medical & Dental Center.

Currently, there is only one health provider in Dauphin County that provides refugee health assessment services regularly: Hamilton Health Center (Harrisburg). The Penn State Hershey Medical Center could also consider signing the Pennsylvania Participating Providers Agreement with the Pennsylvania Department of Health and work closely with the local Voluntary Agencies (VOLAGS) to provide health care services to refugees in Dauphin County. These are just some of the ways we can start thinking about the possibility of helping.

Refugees settling in our communities encourage us as a medical community to have a greater awareness of their unique background and challenges.

The physical and mental healing needed in their lives creates an opportunity for individuals and communities to practice compassion. It is the gift and privilege of the medical community to assist in the healing of the refugee’s trauma. Refugee health in the U.S. is an extension of global health and it is vital that medical institutions interested in the issues of social justice participate actively.

FIELD NOTES Ghana, Unite for Sight The mission of Unite for Sight® is to work with local ophthalmologists to support local efforts at improving access to visual health services. The leaders of the initiative are the Ghanaian ophthalmologists who live in Ghana and who have had practices established in the country for many years. Unite for Sight sends volunteers to Ghana for outreach screenings.

Volunteers must raise money and bring glasses to support the mission of the local ophthalmologists. In return, volunteers are made a part of the team that goes on outreaches. The volunteers are well supervised and under the direction of the local organizers. We have the opportunity to learn from the local teams about what makes an effective outreach program.

During my month in Ghana, I had the opportunity to see approximately 1000 patients. The optometrist taught me how to use the direct ophthalmoscope, about common eye diseases that affect Ghanaians, and the barriers that villagers face to receiving high quality eye care. I learned that Ghana has one of the highest rates of glaucoma in the world. It is the second leading cause of blindness, just after cataracts. However, the strategies used to prevent blindness from glaucoma are different than those used for cataracts. Cataracts are a reversible cause of blindness. With one surgery, a patient’s vision can be greatly improved. We met people who had been completely blind due to cataracts and who now have perfect vision after their cataract surgery.

My experience in Ghana will make me a better physician because it taught me about barriers to care. More importantly, I learned which barriers I can have a direct impact on and which ones are more structural.

For example, as a practice, we were able to provide medications at affordable prices and transportation and lodging for those patients we brought to Accra for cataract surgeries. Structural barriers are those things such as poor quality roads, lack of access to physicians for emergent eye issues (trauma, chemical burns, etc…), and general health education.

My experience with Unite for Sight in Ghana has solidified my desire to make international ophthalmology an integral part of my career. The opportunity to work with ophthalmologists from Ghana was an excellent learning experience. The money from the Graham and Elizabeth Jeffries International Health Fund was used to defray costs of my transportation to and from Ghana. I would like to thank Dr. and Mrs. Jeffries for all they have done in support of myself and other students interested in global health.

Penn State is a truly better place because of their efforts.

Christian Medical College, Ludhiana, Punjab, India The Christian Medical College and Hospital in Ludhiana, India is a tertiary care teaching center in the state of Punjab that provides a myriad of clinical opportunities for students and residents and excellent care to their patients. My rotation at CMC-Ludhiana was in the Obstetrics and Gynecology department, which includes inpatient, outpatient, delivery services, and family planning clinic. Its ward has 56 beds, 16 labor beds, 2 delivery rooms, a newborn nursery and 11 incubators in a neonatal intensive care unit.

Since many low risk pregnancies are handled by community health leaders and midwives in the villages or distant cities, CMC-Ludhiana sees mostly high risk patients. This greatly enhanced my medical education as I was able to care for women who in many cases had received no prior prenatal care and were being admitted with severe cases of eclampsia, intrahepatic cholestasis of pregnancy, thalassemia, iron

Joanna Olson, MSIV

Mita Sharma, MSIV

deficiency anemia, and gestational diabetes and hypertension.

Overall, the delivery protocol in India was similar to that I learned in Hershey. One difference I noticed was that all patients at CMC-Ludhiana received an episiotomy in the delivery room, and many of the doctors were surprised to hear that this was not the protocol in America.

Mrs. A was 22 weeks into her sixth pregnancy, but her previous five pregnancies had resulted in miscarriages. Workup in the past had not revealed a cause for this excessive number of miscarriages, but her family and the Ob/Gyn department were very hopeful that this pregnancy would be successful.

This was the furthest any of her pregnancy had gone, and she was admitted to the high-risk pregnancy ward for close observation after experiencing abdominal pain. She was subsequently placed on bed rest, which would continue until her pregnancy was term and she delivered. Complicating the matter, a fibroid was present on the lower end of her uterus, which would make a caesarean section more favorable. I sat with Mrs. A everyday and talked to her about her life in Punjab, her previous pregnancies, and her emotional struggle with five miscarriages. Learning more about the patient’s point of view and emotions was an invaluable experience

Christian Medical College continued

Hato Mayor, Dominican Republic

that will allow me to be more empathetic with other patients in the future. Being on bed rest in this ward for fifteen weeks where there were six other beds separated by curtains with little to do other than read, sleep, or talk to family members or other patients seemed like the most difficult

Josh Burkhardt (MSIV)

and tiring thing a patient could go through. Mrs. A would read the Bible and pray for hours. She became good friends with all the other inpatients in beds nearby, even though it was frustrating for her to see them stay for only a few days before delivering a baby while she knew she had weeks left in the hospital. She and her husband promised God in their prayers that if this pregnancy was successful, they would raise the child and then give the child to the church to become a priest.

I left India praying that Mrs. A’s final eight weeks on bed rest would be uneventful, followed by the delivery of a healthy baby.

Cervical cancer was the third largest cause of cancer mortality in India in 2004. Patients often present at advancing stages of cervical cancer, likely due to the lack of annual gyn visits, education about the disease, and current Pap smear guidelines. Seeing patients present with an advanced stage of cervical cancer while I was in India will affect my practice in clinic as I hope to greatly emphasize the importance of annual gyn visits, Pap smears, and the HPV vaccine with my patients.

I greatly appreciate the Derry Presbyterian Church’s contribution toward my global health education. I am so grateful to have had this opportunity to use my medical knowledge and clinical skills that I gained over four years at Penn State College of Medicine while enhancing my educational base and humanistic medicine skills in a new cultural environment.

In March students and faculty from Penn State Hershey partnered with Meeting God in Missions and Cornerstone College Ministry at University of Pittsburgh to minister to the physical and spiritual needs of the Haitians migrants who live and work in the vast sugar cane fields of Hato Mayor, Dominican Republic. These men and women bring their families from Haiti to the Dominican Republic, looking for a better life, but still live in extreme poverty. Our team consisted of 3 physicians, a pediatric NP, 20 medical students, 2 graduate students, 3 nurses, a pharmacy student, and other non-medical personnel.

Traveling to a different village each day, we ran a medical clinic for 5 days and saw around 500 patients. We cared for all ages, including infants (our youngest patient was 8 days old) as well as the elderly (one man was 92). Clinic was set up so that students would take vital signs, interview the patient, perform a physical exam, and then diagnose and prescribe treatment under the supervision and guidance of the physicians. Hundreds of medications were handed out, health education was provided, wounds were cleaned and bandaged, abscesses drained, and Dr. Les Scorza (Radiology) performed numerous ultrasounds.

Beyond all this, perhaps the greatest care we provided was a listening ear for each individual’s story. In doing so we also learned from our patients: even in their impoverished living conditions, many of these people are content with their lives and make the most of each day they have been given. It was a truly eye-opening, life-centering experience for many students and reminded us all of why we have chosen medicine as our career path.

We’ve put together two slideshows to share our experience with others. The links are provided below: El Batey Margarita http://animoto.com/play/dzHS87WX1l3sUfJTwI376g Mission Trip 2012 http://animoto.com/play/xpRj05tIs4BeASBk3kZUIQ In addition, we would like to give a special thanks to The Doctors Kienle Center for their generous support and to the Deans for the Dean’s Travel Award, which provided support for two of our students. Medical missions are a great opportunity for all of us, especially students, and we hope that you can share in our accomplishments and the success of this trip.

Hospitals of Hope, (HOH) Bolivia I went to Hospitals of Hope (HOH) for a surgery rotation. There was a wide variety of procedures – everything from orthopedic surgeries to trauma surgery to laparoscopic cholecystectomies to Cesarean sections, and even the occasional trauma-related neurosurgery or pediatric surgery. It was a unique opportunity to have this mixture, as the US medical student generally is required to select only one or two specialty surgeries in which to rotate, so I was able to see many different procedures that I never would have otherwise.

to go around. For future students going to this location, I would recommend doing either a primary care rotation or an emergency rotation. The ED is by far the busiest and most interesting area of the hospital, and I found myself spending extra time there because the work load was greater.

I also spent some of my time in the capacity of an HOH outreach volunteer.

We held clinics at orphanages or out in the community, we visited orphanages just to spend time with the kids, and helped out in whatever capacity

A horrible accident occurred one Tuesday morning.

The story goes that the brakes of a small bus gave out and the bus fell over a 200m cliff. There were several fatalities at the scene and the rest of the injuries came to HOH. They included a man with a traumatic arm amputation and in need of a chest tube, another man with severe head trauma and resulting subdural hematoma, and several others with broken bones, cuts, bruises, etc. After stabilizing things in the ER, I went along with the trauma surgeons to work on repairing and closing the arm and immediately following, the neurosurgeon did a craniotomy and evacuation of the hematoma. They were two of the most interesting surgeries I have ever seen. Both patients are still alive, but the head trauma patient was in critical condition in the ICU for the remainder of my time at the hospital.

While there is at least one procedure a day, it is unrealistic to be able to scrub in on each one since there were so many students, so about half the time I found myself observing rather than assisting. At a busier surgical hospital, there would have been plenty of work

needed. My favorite experience was on Friday afternoons with the clef eros or glue-sniffers. This is a community of young men and women who spend their lives in a certain plaza in the city with a bottle of glue practically attached to their noses. I had never seen such obvious manifestation of addiction. Their addiction has brought them all to the absolute bottom of life.

They congregate in packs, sitting in circles or laying on the grass, filthy and with glazed eyes, sniffing a bottle of glue every other second. My heart was broken for each one. For me, the ministry to the clef eros was the most impacting experience of my time in

Faith Seitz Pulllinger (MSIV) Bolivia. In my first encounter with them, I felt that all I could do was take it in and deal with so many emotions at seeing this way of life. Thereafter, I was ready to engage, pushing aside my fear and disgust and getting close enough to talk to them, feed them, and bandage their wounds. That week, my heart was completely opened with compassion to them. I began to look forward to Fridays and time with the glue-sniffers more than any other work here in Bolivia.

I want to share a story of one of the glue-sniffers who I came to know named Maria. She was a regular in the plaza and knew the missionaries well, even joining them at church a couple of Sundays. The last few weeks, though, Maria’s health steadily declined. She was getting thinner and weaker by the week, and by the last week when we saw her, she lay huddled under a blanket unable to move. The other glue-sniffers told us that she hadn’t eaten in days and had severe diarrhea for a couple weeks. She was obviously severely malnourished and needed hospitalization immediately. For most glue-sniffers, our pleas to allow us to take them to the hospital would be met with a quick reply, “No.” Maria, by God’s grace, said, “yes.” Driving to the city hospital I was almost overcome by the smell of dirt, glue, and urine coming from her, but every time I looked at her frail, lethargic body, I knew that my discomfort was minimal compared to what she was feeling.

At the hospital, we were faced with the possibility that she would not be admitted, coming from the street with only a glue jar in her pants pocket to confirm her identity. However, the combination of four white people with her and a compassionate doctor helped to open the doors to treatment. She

would receive testing and treatment, at least for the night, with the possibility of coming to HOH the next day. When we returned the next day to see her, she was transformed! She was alert, asking for food, sharing smiles, and wanting to read the Bible and pray with us.

Amazing what a night of warm sleep, cleanliness, and care can do! I was sure that she was on the road to recovery, and since I would be traveling for the next 4 days, I said goodbye with a promise to visit her later the next week. We arrived back to HOH after our travels, and were met by Rachel and Shelly, two of the missionaries, having just come back from the city. I could tell something was wrong immediately, and they shared

the shocking news that Maria had died at 4:30 A.M. that morning. I couldn’t believe it. I had just seen her so much better after one day in the hospital, and now after four she was dead. We were told that she tested HIV and TB positive, and the malnourishment and advanced TB was more than she could battle. This was not the ending to the story that I imagined at all. I was convinced that she would be the poster child for the ministry, getting better, being free from the glue, reuniting with her family. But God had a different plan – a few wellcared for days before taking her to heaven.

I think that this experience in particular helped to reinforce an essential lesson

in my medical school experience, one that I hope makes me a better humanitarian physician. While modern medicine can do amazing things to cure illness and prevent disease, there are limitations and the body is not meant to live forever. As physicians, we have the choice to focus solely on the physical being, relying on our armamentarium of scientific advances to treat our patients.

Or we can choose to see our patients as the body, mind, soul, and spirit beings that I believe they are. When we engage the emotional and spiritual sides of a medical illness, I’ve learned that both the physician and patient benefit.

For the patient, it is an opportunity to receive hope and sometimes, even physical healing. For the physician, it is an opportunity to more fully understand ourselves and our patients and to relate in a more honest way. In Maria’s case, I was initially bitter that modern medicine was unable to keep her alive. After much thought and prayer, I realized that we gave her in her last days more than medications ever could – a chance to feel value and worth, a chance to have human companionship and love, a chance to have hope, even in her last days.

Thank you from the bottom of my heart for supporting me in this endeavor with the Jeffries International Health Fund and the Teeter International Scholarship.

I hope to continue to represent Penn State College of Medicine in future medical work overseas.

Fundraising Opportunity This summer, a group of Global Health Scholars will be traveling to Iquitos, Peru to study water usage, sanitation, and hygiene practices, along with training Iquitos-based health promoters to be advocates for oral rehydration therapy. At the end of their five weeks in Peru, these scholars will present their findings to Peruvian health officials and Penn State’s Global Health Center so that they can use the information to implement broader initiatives and improve water quality. They are asking for support to help cover costs for research supplies and daily expenses. If you are interested in learning more about their projects or would like to support their efforts, please see their Indiegogo page: http://www.indiegogo.com/RiversideRelief?a=524846.

Clinton Global Initiative Conference Attendees

Western Regional International Health Conference:

Kimberly Faldetta, MSII

Michael Santos, MSIII

This March, Katie Dickinson, Derek Reighard, Chloe Wang and I attended the Clinton Global Initiative University (CGIU) in Washington, DC for our Water for Iquitos project. Our Water for Iquitos project helps determine the cause of the high rates of diarrheal diseases in a community in Iquitos, Peru. It began last year and has since been incorporated into the Global Health Scholars Program as the third field site. At the CGIU, our team heard from countless activists, politicians, and celebrities (including Bill Clinton, Madeleine Albright, Usher, and Jon Stewart) about their experiences as global leaders. We attended workshops on public health education, fund raising, and harnessing the power of social media to promote causes, all while meeting globally minded students from all over the world.

This conference was exciting, student-oriented, and highly relevant to our project.

This past April, I ventured out to Seattle, Washington to attend what started out as a small event hosted by a group of University of Washington Medical students in 2002. Since then, this event has matured into a spectacular weekend. The Western Regional International Health Conference (WRIHC) attracts representatives from up to thirty-one different schools from seventeen different states. It has become one of the largest interdisciplinary student-run global health conferences in the nation. The conference’s clout is demonstrated by a history of influential speakers, including Paul Farmer, Jim Yong Kim, Jeffrey Sachs and Mirta Roses Periago, to name a few.

At a Crossroads: Choosing Hidden Paths in Global Health April 27th - April 29th, 2012

This year’s edition of the WRIHC conference was centered on the theme of “Choosing Hidden Paths in Global Health”. By focusing on politics of the global health agenda, training of health care professionals and other various topics in the field, the conference organized these themes into multiple plenary debates and smaller discussion sessions. The keynote speaker for this year, Kavita Ramdas, is currently the Executive Director of Ripples to Waves, a non-profit grass roots organization dedicated to conservation, health, and community service through education and the arts. She is also known as former President and CEO of the Global Fund for Women from 1996 to 2010, a fund primarily focused on providing women in more than 170 countries critical access to financial capital, acting to fuel innovation and change. In addition, she has received an endless number of philanthropic and leadership awards including “The most Inspiring People Delivering for Girls and Women 2010”, amongst numerous others.

The overall make-up of the convention was quite diverse, with students hailing from Stanford to the University of Missouri. Participants filled the weekend with insightful questions and various poster presentations concerning infectious disease, maternal health, access to health care and the environmental effects on health. Moderators and panelists fueled the discussions with backgrounds in medicine, public health, social work, nursing, engineering and even specialists in information technology.

After walking around the beautiful campus deep in thought, it was clear that the students at the University of Washington successfully created an exciting event for all to attend. The field is in a persistent mode of analyzing and reflecting on which populations we are not properly responding to and why that might be. Are there constraints of normative paradigms that must be readdressed? Is it simply a question of limited resources? Are we successfully continuing to build upon work that has already been completed in local communities? Though the educational backgrounds are markedly distinct, leaders from each field continue to transcend these boundaries with the shared goal of advancing what we know and understand as global health.

I’d like to take this opportunity to thank the Global Health Department and the Kienle Center along with Dean Simons for their gracious support in broadening my own horizons and encouraging personal growth.

Photo Competition Winners In the fall edition we asked readers to submit their favorite photos from their global travels. The following are the top three winners, as judged by the Humanities department. Thank you to everyone who submitted an entry!

First Place: Mother and Child, Iquitos, Peru Derek Reighard

How to Donate to The Global Health Center Scholarship Fund 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.

Second Place: Lightness in Hue, Vietnam Kimberly Faldetta

If you would like to contribute to the quarterly newsletter, please contact the Global Health Center (nfredrick@psu.edu).

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, M.D. Family and Community Medicine Student Global Health Newsletter Co-Editor: Erin Banshefski (Class of 2014)

Third Place: Dawn Under the Baobab Tree, Dankunku, The Gambia Hannah Ross-Suits

Global Health Center Advisory Board: Elizabeth Bates, BS DN (Nursing) Dennis Gingrich, MD (Fam Med) Brandt Groh, MD (Pediatrics) Graham Jeffries, M.D. (Medicine) Gordon Kauffmann, MD (Surgery) Philip Wilson, PhD (Humanities) On the Web: http://www.pennstatehershey.org/ web/globalhealth

C O R R E C T I O N The photo next to the “CMS Mission Trip to the Dominican Republic” article in the Winter 2012 GHC newsletter was not properly credited. This photo was taken

by Derek Reighard.