FSM’s Global Health Poster Session Presenter Abstracts
Co-sponsored by FSM’s Center for Global Health, FSM’s Student Committee for Global Health, & the Global Health Initiative at Chicago Lake Shore Medical Associates
September 7, 2011
Dear guests, students, faculty, and administrators, Good evening. I would like to offer a warm welcome to each of you and thank all of our guests for attending FSM’s first annual Global Health Poster Session to learn more about the diverse global health projects and programs in which FSM’s medical students have engaged over the last year. I believe it is also in order to offer our sincere congratulations to the presenters tonight, who have worked diligently to prepare for this event. They have each made a significant decision to incorporate global health into their medical education in a meaningful way and this event is an opportunity to share their global health experiences with the Northwestern community. The impetus for this event in part comes from the unprecedented interconnectedness of our times, which is rapidly transforming our institutions and communities as well as our health care systems. Prior beliefs and ideas about international health and global disease burdens are changing rapidly and the field of global health is growing partly due to high interest from medical trainees, clinicians, and researchers, but primarily due to pressing public health issues, including questions relating to health equity and access to care, which are creating urgent dilemmas in resource-limited and resource-replete communities around the world. Many of the posters you will see tonight grapple with these difficult issues. FSM’s Center for Global Health is very pleased to co-sponsor this event with the Global Health Initiative at Chicago Lake Shore Medical Associates, who we thank for their generous support. Also, FSM’s Student Committee on Global Health has played an integral role in conceptualizing and planning the event and by encouraging their peers to present and attend. I would like to extend particular thanks to student committee members Victor Roy, Chelsea Carlson, and David Grant for their ideas and contributions, and the Center for Global Health is especially proud that this is a student-sponsored and supported initiative. Please enjoy the poster session and continue reading to learn more about the FSM student projects. Sincerely,
Robert L. Murphy, MD, Director, FSM Center for Global Health Daniel Young, MPA, Associate Director, Global Health Education 1
Poster Title
Presenter(s)
Institution / Location
Abstract 1: “Accompaniment” as a Primary Care Strategy for Rural Liberia
Victor Roy
Tiyatien Health, Liberia
victoryroy@gmail.com
Abstract 2: Assessing Key Risk Factors for Diabetes and Hypertension in Rural Bolivia
Gabrielle Ahlzadeh
Centro Medico Humberto Parra, Palacios, Bolivia
Gabrielle-Ahlzadeh@fsm.northwestern.edu
Danielle Chun
Danielle-Chun@fsm.northwestern.edu
Annsa Huang
Annsa-Huang@fsm.northwestern.edu
Abstract 3: CDC Experience in Public Health
Erika Wallender
CDC Experience in Applied Epidemiology, Atlanta, GA
ekwallender@fsm.northwestern.edu
Abstract 4: Clinical Shadowing and Community Based Malaria Prevention in Uganda
Laura Eder
Makerere University, Kampala, Uganda
laura-eder@fsm.northwestern.edu
Carolyn Price Matt Rowland
Abstract 5: Global Health in Uganda: An Experience Within Makarere University’s Community Based Education and Service (COBES) Program
Abstract 6: The Integration of Traditional and Modern Medicine in Coastal Mexico
Sarah Chuzi
carolynn-price@fsm.northwestern.edu m-rowland@fsm.northwestern.edu
Makerere University, Kampala, Uganda
sarah-chuzi@fsm.northwestern.edu
Allie Goodwin
alexandra-goodwin@fsm.northwestern.edu
Natsai Nyakudarika
Natsai-Nyakudarika@fsm.northwestern.edu
Michele Sciaudone
Child Family Health International, Puerto Escondido, Mexico 2
michele-sciaudone@fsm.northwestern.edu
Poster Title
Presenter(s)
Institution / Location
Abstract 7: Le Secret Medical et le SIDA – HIV Confidentiality in Senegal
Chelsea Carlson
Cheikh Anta Diop University, Dakar, Senegal
c-berdahl@fsm.northwestern.edu
Abstract 8: My Experience at a Teaching Hospital in Ghana
Sadia Sahabi
Komfo Anokye Teaching Hospital, Kumasi, Ghana
sadia-sahabi@fsm.northwestern.edu
Abstract 9: Postpartum Family Planning: Programmatic Gaps and Issues
Shauna Gunaratne
World Health Organization, Geneva, Switzerland
shauna-gunaratne@fsm.northwestern.edu
Abstract 10: Preventing Pediatric Burn Injuries in the Kibera Slum of Nairobi, Kenya: Understanding the Problem
David Grant
International Health Fellowship, Nairobi, Kenya
david-grant@fsm.northwestern.edu
Abstract 11: Prevention of Malaria in Children Under Age Five: A Public Health Project in Namagabi, Uganda
Blair Dina
Makerere University, Kampala, Uganda
blairdina@fsm.northwestern.edu
Abstract 12: Primary Care Experience in the Himalayas
Eric Farmer
Himalayan Health Exchange
Eric-farmer@fsm.northwestern.edu
Doug Curphey
Stellenbosch Hospital, Stellenbosch, South Africa
Douglas-Curphey@fsm.northwestern.edu
Abstract 13: Providing for the Public: Healthcare in South Africa
Caroline Minkus
Abstract 14: Psychosocial Challenges of Immigrant Patients Living with HIV in France
caroline-minkus@fsm.northwestern.edu
Vanessa Stubbs
vanessa-stubbs@fsm.northwestern.edu
Mimi Wu
yue-wu@fsm.northwestern.edu
Joan Tankou
Avicenne Hospital, Paris, France 3
Joan-Tankou@fsm.northwestern.edu
Poster Title
Presenter(s)
Institution / Location
Abstract 15: 16 and Pregnant: Reproductive Health in Quito, Ecuador
Laura Banks
Child Family Health International, Quito, Ecuador
laura-banks@fsm.northwestern.edu
Abstract 16: Rotation Experience in Hospital Dalinde in Mexico City and Public Health Experience in Malinalco, Mexico
Mania Kupershtok
Universidad Panamericana, Mexico City, Mexico
mania-kupershtok@fsm.northwestern.edu
Abstract 17: Preliminary Chagas Treatment Protocol for Centro Medico Humberto Parra
Gabriel Heiber
Centro Medico Humberto Parra, Palacios, Bolivia
gabriel-heiber@fsm.northwestern.edu
Abstract 18: Tropical Medicine and CommunityBased Care in Puerto Escondido, Mexico
Mitra Afshari
NU AID / Child Family Health International, Mexico
m-afshari@fsm.northwestern.edu
Abstract 19: Unite for Sight, Ghana
Eric Ahlstrom
eric-ahlstrom@fsm.northwestern.edu
Josh Knapp
Joshua-knapp@fsm.northwestern.edu
Mania Kupershtok
mania-kupershtok@fsm.northwestern.edu
Silvia McClandish
Silvia-McCandlish@fsm.northwestern.edu
Jasmine Rassiwala
Jasmine-rassiwala@fsm.northwestern.edu
Muthiah Vaduganathan
muthu@fsm.northwestern.edu
Staci Vanderjack
s-vanderjack@fsm.northwestern.edu
Allison Ramsey
Unite for Sight, Ghana
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a-ramsey@fsm.northwestern.edu
Abstract 1: “Accompaniment” as a Primary Care Strategy for Rural Liberia Victor Roy The lives of rural Liberians are fraught with dire suffering and illness. Forty percent of Liberians suffer from depression. HIV/AIDS is the second leading cause of mortality. Maternal mortality increased from 578/100,000 live births to 994/100.000 live births between 2002 and 2010. For these Liberians who are almost always the most vulnerable and in need of care, access to such care is difficult to reach and often absent. The average distance to walk to a clinic in the southeastern part of Liberia is 6.9km. Only two physicians work in a entire county – called Grand Gedeh – of over 200,000 people, and one public hospital exists for this entire population. In this setting, building towards a more robust medical care system is only a small part of the puzzle. Organizing care in the community – not just in the hospital – is crucial for improvements in health outcomes. Ongoing support for treatment adherence, side-effect monitoring, home-based counseling, and community health promotion are all key advantages of a community health worker model that “accompanies” patients outside of the clinic. Working with Tiyatien Health for six weeks, I observed and supported a community health worker model near Zwedru, Liberia (in Grand Gedeh county) which aims to bring care and support into the homes of patients by training laypeople on basic health information as well as care in HIV, depression, and epilepsy. Through shadowing 3 accompaniers with 10 patients over the course of three weeks as well as 2 accompanier leaders and the community health worker management staff for the next three weeks, I developed a basic protocol and identified challenges to be addressed for the program. The protocol includes basic areas of a community health worker program, including recruitment, training, management, links with clinical and social services, and resources/equipment. Challenges identified include stigma towards disease-focused community health workers, a clinic-centered approach (rather than communitybased) to accompaniment of patients, as well as effective support and payment for the CHWs. Community health worker programs must address the challenge of both focusing on specific disease areas while also being more “village-based” to address a broader range of social and biological determinants of health. Additionally, all CHW programs must build protocols for high-quality systems of support for these workers to ensure long-term quality as well as motivation. Identifying these issues can serve as the foundation for a new pilot program that can mobilize action as well as new evidence to propel community health worker models forward in Liberia and indeed around the world.
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Abstract 2: Assessing Key Risk Factors for Diabetes and Hypertension in Rural Bolivia Gabrielle Ahlzadeh, Danielle Chun, & Annsa Huang Objective With its rapidly increasing global prevalence, diabetes has evolved into a major public health concern, especially for developing countries in Latin America. Bolivia is a prime example of a low-income country struggling under the strain of chronic disease. The main objective of this study was to assess key risk factors (obesity, diet, smoking, exercise habits, and alcohol consumption) that contributed to the high prevalence of diabetes and hypertension in four communities in the rural eastern lowlands of Bolivia. This information will be used to help Centro Medico Humberto Parra (CMHP), a free primary care clinic in Palacios, Bolivia, improve its current diabetes self-management and education program. Methods Data was collected from four communities with the largest patient representation at CMHP: La Arboleda, Buena Vista, Warnes and Yapacani. The total sample size was 482 participants. Participants were screened for diabetes, hypertension, and relevant risk factors by measuring weight, height, blood pressure, and fasting blood glucose levels. Criteria set by the American Diabetes Association were used to identify cases of prediabetes (fasting blood glucose reading between 100-126 mg/dL) and diabetes (fasting blood glucose reading greater than 126 mg/dL). Cases of prehypertension (blood pressure reading between 120-139/80-89 mmHg) and hypertension (blood pressure reading greater than 140/90 mmHg) were categorized based on recommendations made by the American Heart Association. Participants were also interviewed about their medical, social, and family histories. Results The overall prevalence of diabetes in the four communities combined was 36.9%, while the prevalence of prediabetes was 14.7%. The overall prevalence of hypertension was 43.1%, and the prevalence of prehypertension was 22.9%. It is likely that bias in participant recruitment contributed to the elevated prevalence of diabetes and hypertension. Comorbidity of diabetes and hypertension was common, such that hypertension was also found in 57.5% of diabetics, compared to only 34.4% of people without diabetes. Based on statistical analysis, alcohol consumption and current smoking behavior did not appear to be correlated with either diabetes or hypertension. However, being overweight or obese was found to be a significant risk factor for both diabetes and hypertension. Lack of exercise and a carbohydrate-rich diet also contribute to the high prevalence of disease in these communities. Conclusion Diabetes and hypertension are serious public health problems in rural Bolivia. The high prevalence of prediabetes and prehypertension suggests that the burden of these conditions will increase due to a general lack of understanding about the nature and treatment of chronic disease. Further research needs to more specifically assess lack of health education as a potential risk factor for diabetes and hypertension in these communities.
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Abstract 3: CDC Experience in Public Health Erika Wallender The Public Health Service and the Centers for Disease Control and Prevention (CDC) have long used epidemiology and laboratory science to improve health, from eradicating malaria in the United States in 1947, to their present day global anti-smoking campaign. Physicians are also deconstructing the division between individual and population health as patient centered medical homes and global collaborations for healthcare improvement in resource-limited settings become more prevalent. The CDC Experience Applied Epidemiology Fellowship is a paid 10-12 month fellowship for second and third-year medical students interested in developing their public health skills. Based at CDC in Atlanta, the fellowship is structured to expose students to the full breadth of public health’s practice, while providing a strong foundation in surveillance, epidemiologic study design, field work, data analysis, scientific presentation, peer-reviewed manuscript development, and journal article review. Under the mentorship of a CDC epidemiologist, each fellow conducts his or her own public health project with the goal of publication. In addition, each fellow joins a CDC team on an outbreak investigation (Epi-Aid), and participates in a series of small group discussions focused on public health fundamentals. As a CDC Experience fellow, my primary project involved the analysis of contributing factors to outbreaks associated with drinking untreated groundwater in the United States, from 1971–2008. Untreated groundwaterassociated outbreaks comprised 30% of all waterborne outbreaks reported to CDC. We found that the improper construction or location of untreated groundwater sources contributed to the greatest number of outbreaks, at 69%. The results of my outbreak review will be used to improve CDC’s Waterborne Disease Surveillance System and will offer guidance to local health departments as they work to prevent outbreaks. During my fellowship year, I also worked at the Emergency Operations Center during the first weeks of the Haiti Cholera Response. Side by side with CDC’s cholera subject matter expert, I helped develop a model to predict cholera’s health impact in Haiti over the next five years. The model was presented to CDC’s director and to USAID to encourage increased clean water and sanitation development funding for Haiti. I also traveled to California to help investigate DTaP vaccination status among pertussis cases reported during the 2010 outbreak. The CDC Experience fellowship provided me an unparalleled opportunity to explore a career in public health. Through one-on-one mentorship and total immersion in my project, I was able to develop a study method, analyze my own data, and produce results which will influence public health practice. As a member of the Epidemiology and Surveillance Team for the Haiti Cholera Response, I learned about public health in an emergency, and the challenges of interventions based on incomplete and changing data. I am now confident that my career will incorporate public health, and after a year at CDC I have many more tools to pursue my interests in barriers to healthcare access and infectious diseases.
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Abstract 4: Clinical Shadowing and Community Based Malaria Prevention in Uganda Laura Eder, Carolyn Price, & Matt Rowland A six-week course of study was undertaken in Uganda to better understand global health inequities and the delivery of care in an under-resourced setting. Three weeks were spent in the Ugandan capital of Kampala, rotating through Mulago Hospital, the national referral hospital. In Mulago, shadowing was completed in the cardiology, infectious disease, and pediatric wards, demonstrating the challenges of urban health care in Uganda. Mentorship from Ugandan physicians provided a better understanding of pathophysiology and clinical diagnosis. Unlike many United States hospitals, overcrowding led to a lack of patient privacy. The volume of patients and clinicians’ limited time necessitated that a family member provide most of the daily care. Following the experience in Mulago, three weeks were spent in Kayunga, shadowing in the district hospital and participating in community health outreach. Working in the diabetes clinic, male medical circumcision clinic, and outpatient department revealed the need for more physicians in rural areas. Community Based Education and Service (COBES), a medical education program through Makerere University, is a recent addition to the medical school curriculum established to address the shortage of physicians in rural areas. COBES provided the opportunity to participate in home visits with a community health worker. Examining hospital records and conducting interviews with mothers showed that malaria is the primary medical burden of the community and district hospital. Through the COBES program, education for mothers with children under the age of five was conducted to address the prevalence of malaria. Those families who reduced mosquito breeding sites around their homes were rewarded with insecticide-treated nets. Working in Kampala and Kayunga demonstrated that the Ugandan health care system in both urban and rural settings is limited by a shortage of equipment, medication, and clinicians. Such limitations contribute to a high rate of malaria in the Ugandan population, resulting in unnecessary death and further depleting resources. Medical students participating in a global health experience in Uganda can gain clinical knowledge, understand the challenges of providing health care in a developing country, and obtain an appreciation for Ugandan culture.
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Abstract 5: Global Health in Uganda: An Experience Within Makarere University’s Community Based Education and Service (COBES) Program Sarah Chuzi, Allie Goodwin, & Natsai Nyakudarika Although more than 80% of the Ugandan population lives in rural areas, only 20% of the country’s doctors are found in these areas. In order to address this problem, and make an effort towards meeting the healthcare needs of underserved communities, Makerere University School of Medicine instituted the Community Based Education and Service (COBES) program. Through this initiative, students are posted to rural settings throughout the country for three to five weeks each year in an experience that couples public health with clinical experience. The ultimate goal of the program is to not only familiarize students with the social, economic and cultural context of medicine, and the necessity for increased health care delivery in rural communities, but to also foster a sense of social responsibility. Included in the list of COBES sites is Kumi Hospital, a district health facility that is located in eastern Uganda, approximately 300km from the capital, Kampala. Originally a leprosy center, this hospital caters to a population of over 38 000, and offers a variety of services including on site health education and promotion, maternal and child health screening, and community outreach, during which healthcare workers visited with local villages to provide basic services such as vaccinations and to discuss pressing health concerns. Our group worked alongside these local health care providers and engaged community members in an effort to understand the cultural context of medicine, to identify the challenges to achieving optimal healthcare, and to better community health. While the hospital is faced with a number of obstacles, amongst which are a shortage of staff and a lack of medical equipment, we found malaria prevention within the community to be inadequate. Despite the Ugandan Ministry of Health’s efforts to reduce the burden of the disease in the community, analysis of hospital records showed that in both children and adults, the most common diagnosis was malaria. This was supported by observations made during community visits in the hospital’s catchment area. As such, we committed our project funds to providing the hospital with 45 mosquito nets – enough for all the beds in the general medicine ward. Our project at Kumi Hospital was only a very small step towards meeting the healthcare needs of the local community. With continued involvement in the COBES program, as well as ample time to assess the community and explore potential projects, Feinberg students can take large leaps towards improving health care, and bridging the disparities that currently exist.
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Abstract 6: The Integration of Traditional and Modern Medicine in Coastal Mexico Michele Sciaudone Traditional medicine is still widely practiced in Mexico, especially among the indigenous people and those of low socio-economic status. The purpose of this work is to examine how traditional and modern medicine interact to shape the healthcare system of the coastal communities of the state of Oaxaca, in southern Mexico; what factors affect the community members’ attitudes towards traditional and modern medicine – and consequently influence their healthcare choices – as well as to illustrate some of the initiatives the Mexican government is implementing in order to integrate the traditional and modern healthcare systems. The information presented in this work was gathered during a month-long trip to the coast of Oaxaca, where I was a participant in a global health program run by Child Family Health International, focusing on tropical medicine and community health. During my stay in Mexico, I interviewed two traditional midwives, one traditional healer, one community health promoter, several community members – both in the clinic and during house visits – and I had informal talks with several doctors whom I was working with in the clinic about their role in the community, their views on traditional medicine, and the Mexican healthcare system. Furthermore, I attended three lectures on the Mexican health care system, traditional medicine, and the Mexican government’s most recent initiatives aimed at improving its citizens’ health. Among the factors that drive people to seek medical attention from traditional healers and midwives are language barriers (some indigenous people don’t speak Spanish), modesty (many women prefer to be seen by other women, while most doctors are men), lack of modern healthcare facilities in the most remote villages, social class issues, and attachment to age-old beliefs. On the other hand, using traditional medicine could be harmful to the patient and the whole community because it is ineffective in most cases and it fails to diagnose many infectious diseases. The Mexican government is aware that forcing people to abandon traditional practices and use modern healthcare would be inhumane and detrimental. Therefore, rather than discouraging traditional medicinal practices, it is implementing initiatives aimed at integrating the traditional healthcare system into the mainstream modern system, while improving the quality and accessibility of modern healthcare, in order to better the health of the communities while allowing them to maintain their traditions. For example, they have mandated the creation of professional partnerships between doctors and midwives, they have trained members of the community to take blood samples from suspected malaria or dengue cases, and they have opened “casas de salud” in the smaller and more remote villages. These are small clinics where a member of the community who has been appropriately trained can take care of patients’ most basic needs. These initiatives could be a model for other parts of the world where the use of traditional medicinal practices is still negatively affecting the health of the community, because they expand the reach of the healthcare system and promote cooperation between doctors and traditional healers, thus allowing more people to obtain good healthcare without betraying very deep-rooted traditions.
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Abstract 7: Le Secret Medical et le SIDA – HIV Confidentiality in Senegal Chelsea Carlson Confidentiality is one of the ethical cornerstones of medical practice and has been recognized in codes of medical conduct from Hippocrates to the present. When clinicians have good reason to suspect that their patients’ behaviors will put other people at risk, they face a moral choice- should they maintain confidentiality or should they disclose key information to protect those at risk? Within the context of HIV and other sexually transmitted diseases, the issue of patient confidentiality is particularly sensitive and emotionally charged. Reaching an adequate ethical conclusion requires an understanding of the complex legal, social/cultural, and economic undercurrents in a society. This summer, I had the opportunity to participate in an eight-week clinical rotation on the HIV wing of the Infectious Disease Department at Fann Hospital in Dakar, Senegal. Through onsite coursework, review of the current literature and press around HIV confidentiality in Senegal, and conversations with medical students, patients and physicians, I sought to gain an understanding of the factors that shape Senegalese clinicians’ decisions. Senegal recently adopted Law n° 2010-03, relating to HIV and AIDS, which gives physicians the freedom to warn partners at risk provided that sufficient attempts have been made to support and counsel the patient to disclose their status to sexual partners. This mandate changes the legal climate in Senegal to an intermediate position between France’s strict confidentiality code and the United States’ obligatory mandate to warn those at risk. This shift means a greater degree of individual freedom for Senegalese physicians as ethical decision makers and demands great facility with the many considerations around HIV confidentiality within Senegal’s specific context. Considerations to be discussed include: the pressing need to control a rising epidemic, the current incidence of stigmatization and the importance of extended family support in Senegalese culture, the vulnerability of certain groups particularly young women with respect to sexual rights and economic opportunities, and the desire to respect individual privacy and maintain trust between the patient and clinician. Future directions for this work include a more formal analysis of the acceptability and practicality of HIV status disclosure among Senegalese medical students and practitioners as well as its impact on public health efforts and patients’ social support systems.
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Abstract 8: My Experience at a Teaching Hospital in Ghana Sadia Sahabi Healthcare in Ghana made headlines in recent years due to the introduction of the National Health Insurance Scheme (NHIS). Ghana is one of three countries in sub-Saharan Africa to take such an audacious step in healthcare. It seeks to provide all registered Ghanaian residents free/affordable primary medical care. The largest group that benefits is women in their reproduction age. All women are guaranteed free obstetric care but only if they have access to the few overcrowded government hospitals or to private clinics that have registered with the NHIS. Despite the introduction of NHIS, maternal mortality rate still remains high, a staggering 214 per 100,000 live births with regional variations as high as 453 per 100,000 live births. These numbers aroused my curiosity about the exact nature of clinical care received by the few lucky women who make it to the Komfo Anokye Teaching Hospital (KATH) in Kumasi. I spent four weeks shadowing a team of obstetricians at KATH during which I observed the intricacies of providing obstetric care in an environment that is overwhelmed with hundreds of patients every single day. During my clinical rotation, it did not take long to identify the direct causes of maternal mortality to be clinical events such as hemorrhage, obstructed labor, and eclampsia (hypertensive disorder of pregnancy). Beyond these clinical events, there are other structural and more complicated factors that contribute to the high rates of maternal mortality. •
•
•
•
Due to the strategic location of Kumasi, KATH receives referrals from most of the ten regions of Ghana. As a matter of fact, most of the obstetric and gynecological cases I observed were referral cases from smaller clinics from the towns and villages surrounding Kumasi. The first impediment to the delivery of care to these women is the fact the doctors do not adequately know their patients before delivering their babies either through vaginal or caesarian sections. The second biggest problem is the dire state of the women when they arrive at KATH. Most women in rural areas utilize traditional caregivers for prenatal care, and sometimes during active labor. They would only come to KATH at terminal stage when there’s already excessive bleeding, or fetal distress and the like. Such occurrences have created a system of constant friction between physicians at KATH and traditional “medicine men”. Last but not the least is the sheer number of patients the limited facilities have to support. Since its establishment in the 1950s, the OB/GYN ward at KATH has not undergone major structural expansion to accommodate the increasing number of women who are now seeking care at the hospitals due to the NHIS. Nevertheless, the brilliant and hardworking doctors at KATH take care of every patient with compassion, skill, and dedication.
In conclusion, the NHIS has definitely reduced the financial burden for most women who receive care at government hospitals. However, other structural changes are needed in order to achieve lower rates of maternal mortality. Future work at KATH could include more in-depth research and analysis into the clinical and non-clinical contributors to the high maternal mortality rate. Feinberg students who have interests in other areas also have the option to do research or clinical rotations in the following departments: the department of anesthesia, child health, intensive care, internal medicine, surgery, and the accident and emergency unit. 12
Abstract 9: Postpartum Family Planning: Programmatic Gaps and Issues Shauna Gunaratne Effective postpartum family planning strategies have numerous implications for the health of women and their communities worldwide. Postpartum family planning strategies promote women’s rights by allowing them to control the rate of pregnancy and space births adequately in order to promote the healthiest environment for both mothers and their children. However, there is a large gap in programmatic guidance for postpartum family planning, especially from the World Health Organization publications. To actually see what gaps existed in programmatic guidance, I reviewed 47 documents published by country governments such as those from the United States, United Kingdom, and Canada, non-governmental organizations such as International Planned Parenthood Federation, and international organizations such as the World Health Organization, to identify what existed and what crucial information was missing from these guidelines. I also helped conduct interviews of eight country officials and family planning experts in five developing countries. I have questioned these family planning experts about a wide range of topics, from service delivery, to contraceptive commodities, to policy work and advocacy, to social barriers and community-based programs. From my research, it is evident that great gaps exist in programmatic guidance, especially in advocacy and creative financing. These are two areas that are often not addressed in guidelines, especially those created by the World Health Organization or other United Nations organizations. Most of the postpartum materials covered recommendations for methods of postpartum contraception and appropriate timing of initiation of these methods (many methods cannot be used at certain times during the postpartum period). Some guidelines, such as the World Health Organization guidelines, those produced by the United States Agency for International Development (USAID) and JHPIEGO (from the Johns Hopkins Bloomberg School of Public Health) cover guidelines on counseling women on postpartum contraception methods. There are also training and education guidelines available, such as those produced by Family Health International (FHI), USAID, and International Planned Parenthood Federation (IPPF). Moreover, through the country interviews, clear gaps exist in some of these programs; many of them are under-funded and under-resourced and cannot keep up with demand. Programmatic issues vary with each country, as each country has their own unique political and social concerns, and funding can vary widely across nations. However, a resounding theme from talking to officials was that postpartum family planning is an often over-looked concept and not emphasized by providers themselves or at the policy level, making it difficult to secure funding to create programs. In the end, the project on which I have been working will result in the development of effective guidelines for programs concerning postpartum women. The mapping I conducted has laid the groundwork for what materials and information are available to develop postpartum programs. The field interviews will be used to develop further guidance in developing effective programmatic guidelines, based on what has worked and not worked in the past, and what very real issues are confronting the program directors of postpartum family planning programs. Ultimately, this information will be contained in a WHO publication and update to their existing “Selective practice recommendations,� which will be updated and published as a new edition in 2012.
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Abstract 10: Preventing Pediatric Burn Injuries in the Kibera Slum of Nairobi, Kenya: Understanding the Problem David Grant Introduction: Over 95% of fire-related deaths alone occur in low- and middle-income countries (LMICs). The primary burn injury and its sequelae result in large economic burden because they are expensive to treat and often result in physical deformities. Furthermore, burns typically occur in the young working person, and the infant, and without adequate treatment, disability from burn injuries can remain with patients for life. While burn injuries are most often preventable, major differences between LMICs and high-income countries (HICs) in proximate causes and legislative climates drive the need for new burn prevention strategies for LMICs. Such developments are however impeded by the lack of data on burns in LMICs. This is especially true for informal urban settlements (slums), such as Kibera, a very congested slum of an estimated one million residents in Nairobi, Kenya. The present work was therefore carried out to understand the causes of burn injuries among children in Kibera. Methods: Methods included site visits around Kibera, noting cooking practices and tools, electrical wires and connections, and local first aid and support services. Interviews and Focus Group Discussions (FGDs) were conducted with community health workers (CHWs) from the Non-governmental organization Carolina for Kibera, which is based in Kibera. Haddon Matrices were used to organize preliminary findings and possible burn prevention strategies bsed on these data. Findings: Poverty and lack of development is the underlying cause of burn injuries in Kibera, however several proximate causes exist: unsafe access to electricity is a main cause of house fires and electric burns, caused by exposed wires traveling in the ground and within shack walls; congested domestic conditions drive cookingrelated burn injuries in children as well as house fires; educational and cultural systems that are in place foster competition between profit-driven local chemist and healthcare providers at NGO clinics, resulting in inappropriate first aid that predisposes sepsis, which delays patient recovery and raises costs; and access to the spectrum of rehabilitation services along the continuum of care, such as physical rehabilitation, is broken by high costs and long travel distances. To analyze such risk factors for burn injuries, two Haddon Matrices were constructed: one organized preliminary data and the second organized possible burn prevention strategies based on these data. Major areas for primary prevention exist: safer electrical cooking devices, and simple barriers to prevent unattended children from exploring floor-level charcoal jikos or paraffin stoves. Secondary prevention could be achieved with proper and immediate first aid to prevent burn wound sepsis and other complications; Tertiary prevention is lacking and physiotherapy is unavailable locally. Preliminary KAP data suggests further that many patients do not believe that burn injuries are preventable, and believe their congested living environments make burn injuries inevitable. Yet other community members believe burns are preventable with diligent child supervision and forethought during cooking. These data suggest that targeting such Attitudes could improve burn prevention. Conclusions: While there are several problematic and often daunting causes to burn injuries in Kibera, many Kibera residents do not get burned, or they deal with their burns in a beneficial way. A belief in the preventability of burn injuries seems to be a central theme in success. Future systematic research is warranted 14
and underway. Additionally, this experience has helped me understand the role for surgeons in global health, the need for surgeons to operate within a team managing a patient’s continuum of care, and the complexities of patient care in resource-limited settings.
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Abstract 11: Prevention of Malaria in Children Under Age 5: A Public Health Project in Namagabi, Uganda Blair Dina Malaria is an infectious disease transmitted from person to person through infected mosquitoes. Though curable, it causes an estimated 1-3 million deaths per year. In hyperendemic regions, like Uganda, immunity against disease is difficult to achieve, so the burden of disease is much higher in children under 5 than in the rest of the population. According to USAID, malaria kills one in seven Ugandan children before their fifth birthday. I worked for four and a half weeks in Namagabi A village, located in Kayunga District in central Uganda. Because malaria is the largest burden on villagers in Kayunga district, and morbidity and mortailty is highest in children under 5, our project aimed to teach mothers of children under 5 about malaria prevention. I worked with a community health worker to develop a questionnaire that would help us assess existing knowledge about malaria. We first conducted home visits, interviewing a total of 20 mothers of small children. We then educated women on the cause of malaria, the risks, signs, and symptoms, and discussed prevention strategies. Women were asked to: • • • •
Regularly cut back the bush on their property and to ask their neighbors to do the same Stay vigilant and be sure to empty any stagnant water that gathers on their property, especially after rain Build bathroom soak pits and keep them covered Have all children sleep under mosquito nets. Women were also advised how to use nets properly
The community health worker and I gave assignments to each mother as to how she might make sustainable changes to her property to prevent malaria. We re-visited each home one to three times to offer assistance with the assignments. To reward the participants for their hard work and to thank them for recognizing malaria as a danger, we conducted a repeated education session and distributed insecticide-treated mosquito nets with instructions on how to use them properly. The questionnaire results revealed that most women had some understanding of malaria and how they could prevent mosquito breeding grounds. The assignments for each woman were chosen because they were lowcost, sustainable, and simple to complete; they were assignments the women suggested themselves; and they were proven methods to reduce mosquito breeding grounds. During our re-visits, we evaluated whether an assignment had been completed by comparing the property to how it had looked on our previous visit. Because this project was short in duration, further projects will be needed to evaluate the long-term efficacy of the intervention. Makerere University students travel from Kampala to Kayunga every year to conduct community health projects. In the summer of 2012, these students will be able to evaluate whether the project was indeed sustainable, and they will be able to scale it up to include a larger body of participants. My field experience in Kayunga District was a learning experience in public health, in teaching, in culture, and in project development. Though small, I feel that it serves as a nice pilot for future malaria prevention interventions in the villages of Kayunga District.
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Abstract 12: Primary Care Experience in the Himalayas Eric Farmer India has the second highest population in the world, and has some staggering healthcare discrepancies. For those with money and living in the cities, the care provided is some of the finest available. But much of the country cannot afford healthcare, and about seventy percent of the population (nearly 716 million people) lives in rural areas where healthcare access is a problem on top of affordability – half of those people fall below the poverty line as well. In the United States, the physician density is four times higher than India, the nurse density is seven times greater, and the dentist density is an overwhelming twenty-two times greater! In the rural portions of the inner Himalayas, the inequalities are much larger. Getting affordable, reliable healthcare to the people of the inner Himalayas has proven to be a challenge. For three weeks, I volunteered with a traveling clinic that served the people of the inner Himalayas, providing free medical care and drugs. The clinic moved often in order to serve as many of the individual villages as possible. As often as possible, this organization worked with local healthcare providers for a further understanding of the immediate local need. Over the course of the trip, over 800 patients were treated, including several house visits to bed ridden patients. The Himalayan Health Exchange was able to stay in each village until all patients that had come for the day were seen and given proper care. This was one of eight trips to India that the Himalayan Health Exchange has facilitated each year, each trip seeing a similar number of patients, depending on the need. I found that the methods used by the Himalayan Health Exchange to serve the locals were to their benefit of both the patients and the students volunteering on the trip. In the long run, this method of healthcare delivery cannot be used as a dependable source of care to this population. However, the Himalayan Health Center Foundation has been working to solve this problem, and is in the process of developing a permanent clinic site that can base future trips, allowing for more trips into the area, and for further expansion of the service net.
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Abstract 13: Providing for the Public: Healthcare in South Africa Doug Curphey, Caroline Minkus, Vanessa Stubbs, & Mimi Wu As a nation building itself after 46 years of Apartheid ended in 1994, South Africa is still organizing its healthcare system to best serve its people. Currently, this system is divided into public and private sectors, providing firstworld Western medicine to a diverse and oftentimes underserved population. While the private sector is organized similarly to that of the US, the public sector is hierarchical. Beginning with local clinics and day hospitals, it rises through three levels of hospital care, primary through tertiary, with increasing numbers of specialists on staff and more equipment to perform more complex procedures. Although 80% of the population is served by the public system, the top fifteen percent of the nation is footing the bill. These same paying citizens are among the 20% of the population paying out-of-pocket for private healthcare. Additionally, 80% of South African doctors work in the private sector, necessitating a two-year community service requirement in the public sector as part of medical training. We, a group of first year Feinberg medical students, spent six weeks working at primary (Stellenbosch Hospital) and secondary (Karl Bremer) public hospitals in the Western Cape. Much of what we learned went beyond the physical and diagnostic aspects of medicine and into the public health and social sectors. Observing and participating in this system, we compared its strengths and weaknesses with those existing in the United States. While free health care, from well-child visits to organ transplants, is provided to everyone regardless of the cost, patients still face a myriad of barriers to care. As compared to the United States, where there are 26.7 physicians per 10,000 persons, South Africa only has 7.7. Moreover, these few physicians must attend to eight times as many beds, meaning little to no preventative care and rushed, goal-oriented patient visits. Long wait times at the hospital, inconvenient commutes to the nearest facility, and lack of sophisticated equipment and medications were also frequent observations. These struggles are likely generalizable to the South African public healthcare system as a whole. We set out to gain experience with diseases rarely seen in the United States and work with patients from a culture different than our own. Not only were we able to do this, but we also learned about how social and political issues play into the practice of medicine. Some of the challenges we faced were specific to our location, like the Afrikaans language barrier. But many were truly global in nature and our summer experience will shape our future practice in the United States. Our poster aims to shed light on the South African healthcare system and its strengths and weaknesses in order to better understand our own. The topics highlighted here were selected from directly observed clinical examples after discussion in routine debriefing sessions amongst the traveling students and local physicians. We hope to raise awareness with other students and illustrate how what we have taken away will help us in the future.
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Abstract 14: Psychosocial Challenges of Immigrant Patients Living with HIV in France Joan Tankou People living with HIV/AIDS in this current day and age are regrettably still neglected, stigmatized and sometimes persecuted in certain parts of the world. These people, mostly from underdeveloped countries come to France seeking refuge and treatment. Upon their arrival however, they encounter numerous new challenges. Similar to the United States, minority groups in France face disparities in their health statuses. Statistics show that in 2009, 25% of all new HIV infections in France were among people from Sub-Saharan Africa and North Africa. These numbers tell us that, despite France Universal healthcare system that provides care to all residents, there are still many challenges in providing care for the immigrant population. This is perhaps evidence that cultural and language barriers impede the successful delivery of healthcare and contribute to the discrepancy illustrated by the statistics. During my six-week clinical rotation in the infectious disease department at the Hopital Avicenne in Paris, I observed some of these challenges and the programs designed to overcome them. In the United States, HIV is also more prevalent among minority groups and African American alone account for nearly 50% of new infections each year. The infectious disease department at Hopital Avicenne consisted of a patient population that is 80% recent immigrants (50% West African, 25% North Africa, 25% Asia). In recent years, there has been shown an increased risk of Highly Active Antiretroviral Treatment (HAART) treatment failure, in this population, due to the lack of medication adherence. In order to gain greater insight into this current trend, I conducted a survey identifying some of the issues faced by the physicians and the immigrant patients with HIV. Some contributing factors to the problem of medication adherence I came across were illiteracy, mistrust of health system, fear of stigmatization and illegal statuses to name a few. One patient I interviewed told me that he lacked a refrigerator to keep his medication at the proper temperature thus interfering with their effectiveness. For two weeks, I worked with l’Equipe d’Accompagnement et d’Observation (i.e the Management and Observational Team). Professor Bouchaud, the head of the department, created this program for the management of patients with HIV. The team addresses most psychosocial concerns such as social/cultural differences, medication side effects, HIV status disclosure, family support, and financial burden using a translation service and visual tools to ensure efficient communication. Another program, L’hopital du Jour, was created to allow patients with HIV to visit the hospital for their annual check up and have all their exams, laboratory work and physical done in just a few hours. The clinic was designed to limit conflicts with patients ‘ activities and increase compliance. These programs were key in overcoming some of the shortcomings of the system. Medication compliance is essential to the successful treatment of HIV and the prevention of HAART treatment failure. Numerous factors can impede on adherence, notably fear of stigmatization and poverty. Could the programs adopted by the Hopital Avicenne prove beneficial in providing solutions for these challenges in the United States?
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Abstract 15: 16 and Pregnant: Reproductive Health in Quito, Ecuador Laura Banks My aim is to explain my experiences related to reproductive health and family planning in a socially conservative country and demonstrate how this opportunity led to my interest in adolescent health and pregnancy prevention. I participated in a four week Child Family International program in Quito, Ecuador that focused on reproductive health in an urban setting. I shadowed an Ecuadorian physician daily for six hours and completed patient histories and exams. I visited the public maternity hospital, a pediatric office, a specialty hospital and the military hospital. During these rotations, I interacted with physicians, residents, medial students and patients, learned about the Ecuadorian healthcare system and participated in discussions about public health concerns. The most prevalent public health challenges pertaining to reproductive health include maternal and infant mortality rates, malnutrition, infectious disease and adolescent pregnancy rates. I was most impacted by the adolescent pregnancy rate. At the public maternity hospital in Quito, one in four babies is born to a mother between the ages of 10 and 17 and these mothers are less likely to finish their education and more likely to be living in poverty. Despite this problem, I expected reproductive health to be a difficult topic for patients and physicians to discuss because of the conservative values promoted by the Catholic religion and the continued subordination of women. The physicians I worked with, however, were committed to pregnancy prevention through empowering their young patients to make their own reproductive health decisions and providing access to family planning and contraceptives. The hospital offered these preventative services under a law that guarantees access to healthcare and family planning for women of reproductive age and children up to age 5. This law is not universal, however, because of a shortage or resources and social and cultural barriers to its complete implementation. The government recognizes these shortcomings and there is a new initiative to promote this law, improve access to sexual education and change cultural attitudes surrounding reproductive health. Despite these laws, physicians still struggle to prevent future pregnancies in their patients because many adolescent females are uneducated, live in poverty, lack access to contraceptives, do not realize the impact of a pregnancy on their future or are victims of domestic abuse. Teenage pregnancy is a complex issue and decreasing the birth rates will take dedication, patience and more family and religious centered interventions. Adolescent pregnancy rates are also high in Chicago and this year I will be working on the newly formed Adolescent Health Access Committee to design and implement interventions in Chicago communities aimed at lowering pregnancy and STD rates. Overall, my time in Ecuador demonstrates the importance of international rotations because they provide great potential for future healthcare workers to gain perspective on public health issues, increase cultural competency, improve language skills and use these skills and knowledge to combat healthcare inequities and provide better care for patients.
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Abstract 16: Rotation Experience in Hospital Dalinde in Mexico City and Public Health Experience in Malinalco, Mexico Mania Kupershtok This past summer I spent a month in Mexico City working in Hospital Dalinde, a private hospital in Mexico City. I was able to observe the private medical system through working with fifth-year medical students doing their internship year. Similar to the US, health insurance is spread across a number of systems. The two main sources of insurance are the Institute of Social Services and Security for Civil Servants (ISSSTE), which covers public employees, and the Mexican Social Security Institute (IMSS), which covers private employees. Insurance is also provided through the navy, and companies such as PEMEX. There is also private health insurance that may be purchased. For those unemployed, self employed or unable to afford insurance there is a program called Seguro Popular, which provides services for a fee based on income level. If you are below a certain income level you receive free care with Seguro Popular but the services covered are limited. In addition, in order to foster an environment of preventative care, especially in severely underserved populations there is a program called Oportunidades, which financially incentivizes good health practices. Every patient at Hospital Dalinde has quality health insurance and the care I witnessed was of high quality with short wait times, private rooms, and great patient care During one week of my time in Mexico City I received the opportunity to participate in a service project to Malinalco, a rural community about an hour outside of Mexico City. An aspect that is unique about Mexico is that all students across all disciplines need to provide a certain amount of time to social service. The project in Malinalco was a pilot public health project bringing students together from a variety of different career paths including medicine, nursing, communications, finance, philosophy, engineering and administration in order to provide a multidisciplinary approach to service in an under-resourced setting. It is necessary to have a multidisciplinary approach when working with a community because healthcare is compromised of much more than just having access to physicians and services. During this week we stayed in a middle school classroom and working with nuns to provide educational talks to the community. The talks and activities included topics such as hygiene, first aid, lactation, homemaking/cleaning, financial planning, and bullying. In the afternoons we would provide activities for the children in the community. Some days the medical students would make home visits to patients. In addition to these talks, I was able to observe the students begin to form a long-term relationship with this community. They went door to door to every household and surveyed the population on types of programs and services that may be missing in the community that they could slowly work to increase. It became obvious that one week is not sufficient to see a true impact on this particular society. However, this project is in the right direction to form a lasting, sustainable relationship with the people of Malinalco. My hope is that Northwestern students can have a relationship with Universidad Panamericana students on this project in the future.
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Abstract 17: Preliminary Chagas Treatment Protocol for Centro Medico Humberto Parra Gabriel Heiber Centro Medico Humberto Parra (CMHP) is a free clinic located in Palacios, a small town 70 miles away from Santa Cruz, Bolivia’s biggest city. In this very poor rural area, CMHP provides free primary care, medication, health education and other services to a population that otherwise would lack access to healthcare. A patient population with such serious need and a solidly set-up institution that provided with resources for learning and contributing to the community, presented me with a very compelling opportunity to volunteer as a medical student in Bolivia. In addition to the diseases common in the U.S, CMHP patients also presented with illnesses typical of a tropical developing country. Among these is Chagas, a particularly relevant disease in Palacios, as over half of its population has tested positive. Chagas is caused by the parasite Trypanosoma cruzi, a protozoan which is mainly transmitted to humans by blood-sucking insects of the Triatominae family. This lifelong infection includes symptoms that are rare but potentially fatal. Since at the time of my stay at CMHP there were no established guidelines for the treatment of Chagas, and because of the clinic’s pressing necessity for optimal resource allocation and health-care planning of the large Chagas-positive patient population, it was my project to learn from local authorities how Chagas was being treated by public institutions and establishing a preliminary protocol for attention at the clinic. With the guidance of the head of infectious disease at Hospital Japones, Santa Cruz’s largest public hospital, a previous literature review, and considering the WHO’s recommendations, a preliminary protocol which includes patient education, chemotherapy, fumigation etc. was established for fighting Chagas at CMHP. Pending a thorough review and approval by the directors of CMHP along with a funding award, this preliminary protocol can potentially serve as a sketch for the actual implementation of treatment protocol for Chagas.
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Abstract 18: Tropical Medicine and Community-Based Care in Puerto Escondido, Mexico Mitra Afshari, Eric Ahlstrom, Josh Knapp, Mania Kupershtok, Silvia McClandish, Jasmine Rassiwala, Muthiah Vaduganathan, & Staci Vanderjack Motivation Northwestern University Alliance for International Development (NU-AID) is a student-run public health organization on the Feinberg campus. This year, 10 students participated in an away rotation in Puerto Escondido, Oaxaca, Mexico. Puerto Escondido is a small coastal town with a high prevalence of vector-borne infectious disease and maternal mortality rates infrequently witnessed in the United States. Though malaria has been nearly eradicated, incidence rates for Dengue fever in Oaxaca have been increasing from 147 cases per 100,000 inhabitants in 2004 to 2,836 in 2006. In 2008, the average maternal mortality rate throughout Mexico was 52 deaths/100,000 live births. Oaxaca had double this rate. The United States in 2005, by comparison, had 11 deaths/100,000 live births. Approach The month-long trip was divided into two parts: clinical experience and public health work. During the first two weeks, students were divided into pairs consisting of one first-year student and one fourth-year student in order to facilitate a vertical learning model. Clinics were located outside of Puerto Escondido, in rural, under-resourced settings. Each clinic was staffer by at least one local physician and nurse who were able to not only oversee all clinical interactions, but also teach about prevalent community health problems. These family medicine clinics saw approximately 15-35 patients each day. Each pair was able to directly participate in clinical care, derive patient histories and refine physical exam skills. The fourth year student was also responsible for conveying important clinical facts and integrating basic science principles for the first year medical student during the course of the day. The second half of the trip was dedicated to organizing and delivering public health talks to the local communities. Results During the first of these two weeks, our students worked to disseminate information about maternal health issues, family planning and sexually transmitted infections. After conducting further research on the cultural traditions and local population demographics, all students prepared and delivered a two-hour “pláctica” or lecture to 40 women from the community. Under Mexico’s anti-poverty program, “Oportunidades,” community members are incented to attend classes on various health topics including maternal care, vector control, family planning, etc. through monetary stipends. The clinical teams graciously extended us an offer to deliver one of these weekly health talks. During the final week, the students participated in infectious disease brigades, focusing on Chagas, Dengue and Malaria (the three most common infectious diseases in the region). The first few days of this week were dedicated to surveying various sites around the community, learning about mosquito life cycles and identifying potential breeding grounds. Working closely with local public health officials, the students prepared a one hour lecture to present to the community.
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Conclusion Overall, this month-long trip integrated clinical medicine and public health in an experience that is difficult to come across in the United States. During our time in Puerto Escondido, students gained exposure to tropical diseases rarely encountered in the United States. Furthermore, students learned how to effectively partner with existing health education infrastructure to provide accurate and engaging talks to the community about pertinent health issues. However, as visitors to a foreign country, we were met with the challenge of assimilating to a new culture and adapting our medical education to better suit a resource-limited setting. We learned that in order to be effective in international public health work, it is not only important to understand health infrastructure but to also study the cultural nuances present within the local community.
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Abstract 19: Unite for Sight, Ghana Allison Ramsey Cataracts is the leading cause of blindness worldwide. The leading cause of blindness has a cure, yet many people - particularly in developing countries - do not have the access or resources necessary to lift the burden of their disease. In fact, the barriers to eye care in developing nations is innumerable. Unite for Sight is one organization designed to provide sustainable high quality eye care to those living in extreme poverty. Through fundraising they are able to subsidize thousands of surgeries each year performed by the local ophthalmologists, and tens of thousands of bottles of medications. They provide sustainable access by building the organization on a foundation of local ophthalmologists and clinics. They recruit international volunteers, whose numbers and enthusiasm allow the local clinics to conduct outreach to hundreds of additional rural communities with otherwise limited access to health care. Methods Fundraising and training are required by (and tools provided by) the organization before participating. Volunteers submit two letters of recommendation. Once accepted, a deposit is required and the student sets up a fundraising website with the goal of raising $1700 and 500 pairs of glasses. Online training is provided to familiarize volunteers with the program, the culture, and preparations for travel before departure. In Ghana each outreach consisted of traveling to the outreach site and introducing ourselves to the patients who had gathered for eye screening. We set up stations to registrar patients, check visual acuity, have them examined by the ophthalmologist, and dispense medications/glasses. We refer for surgery when applicable. Thursdays I spent at the Crystal Eye Clinic in Accra observing surgeries. The weekends were free, with optional organized trips. Results In 10 days I personally performed visual acuity screening on approximately 400 patients, and fitted another 100+ for eye-glasses. No volunteer delivers medical care beyond his/her level of training. I observed 20 cataract surgeries in a single day at the eye clinic in Accra. I never once felt unsafe, and everyone was welcoming and friendly. Conclusion/Implications Unite for Sight’s results include treating over 1.2 million patients since the organization’s inception in 2000. This includes over 44,000 sight-restoring surgeries. The impact on the rural these patients living in extreme poverty is tremendous: they have the ability to receive sight-restoring treatments and surgeries, access to follow-up care, and education regarding eye health. As the organization continues to grow, even more communities will be reached. Volunteering abroad is a tremendous experience for medical students, and this program is a great choice for those students interested in participating in a high-impact, sustainable health care delivery organization in a developing country. It attracts volunteers of all backgrounds (journalism, public health, etc) and as such creates a multi-disciplinary environment. Unite for Sight can work with medical schools to provide elective credit (programs in Ghana, India, and Honduras). 25