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Global Health

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Preparing tomorrow’s healers to act with compassion and justice.


University of Texas (UT) Health Science Center San Antonio More than 3,000 students per year train for health careers within our schools of biomedical science, dentistry, health professions, medicine, and nursing. Established in 1959, the Health Science Center’s purpose is to provide the best health careers education, biomedical research, patient care and community service to San Antonio and the South Texas region. It extends to campuses in the metropolitan border communities of Laredo and the Rio Grande Valley. The Center for Medical Humanities & Ethics The Center’s vision is to provide a unique program that will make a significant difference in the quality of medical education in the United States. The program emphasizes ethics and professionalism and encourages service-based learning in organizations and clinics in San Antonio and South Texas, in the colonias of Laredo and Corpus Christi, and in missions abroad, where students experience medicine as it is practiced in different cultures, often with very limited resources. The Center works to assure that students are knowledgeable about the principles of medical ethics related to their professional activities. They are expected to be able to identify, analyze and resolve moral conflicts that arise in the care of a patient. The program helps heighten students’ sensitivity to the patient’s experience and preserve their innate empathy. Mission We strive to be a leading center educating medical students and health professionals in ethics and professionalism while nurturing empathy and humanitarian values. We fulfill our mission by: • Preparing students to identify, analyze and resolve moral conflicts in patient care and medical research; • Deepening the attentiveness to patients that will persist throughout students’ medical careers through exposure to arts and letters; and • Developing a distinguished interdisciplinary community service learning program that focuses on ethics in action and serves as a bridge between ethics education and development of empathy and humanitarian values.


Contents Introduction...................................................................................................... 5

The Global Health Program............................................................................... 7 7 Definition of Global Health 8 Global Health Curriculum Electives in Global Health................................................................................. 10 11 ELEC 5047: Global Health Enrichment Elective (MSI and MSII) 12 ELEC 5057: Leadership in Global Health (MSII) 13 INTD 3001: International Medicine Elective (MSIII) 14 MEDI 4151: Poverty, Health and Disease (MSIV) 15 INTD 4030: Preparing for Global Health Work (MSIV) 17 INTD 7003: International Medicine (MSIV) Global Health Service Learning Sites............................................................... Student Groups Ethiopia Outreach Project Hispaniola Students Going Global - Panama ¡Vamos Guatemala! New Site Approval Process

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Global Health Funding..................................................................................... Paul Brand International Scholarship Dean’s Scholarship External Opportunities Student Reflections..........................................................................................

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How to become a Mentor.................................................................................. 31 Global Health Faculty and Staff........................................................................ 32


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A medical student takes the vital signs of a young girl in the Dominican Republic.


Dear students, Welcome to Global Health! Under the nurturing umbrella of the Center for Medical Humanities & Ethics, our program is fueled by the idealism and humanitarian values of our students. This program owes its very existence to the empathy and passion you bring to studying our profession. Despite rapid growth in the last five years, we have labored to honor these core values, remaining mindful of our co-existing mission to teach ethics and professionalism. What is Global Health? For years, “international health” described health work in resource-limited settings with an emphasis on tropical diseases and illness due to poor nutrition, inadequate access to water, sanitation, and maternal care. More recently, “global health” emphasizes mutual sharing of knowledge, in a bilateral exchange between industrialized nations and resource-limited countries, and the term includes non-communicable diseases and chronic illness. One definition of global health is “an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide.” Students are drawn to global health for reasons ranging from enhanced cultural understanding and language skills, to a mission to alleviate suffering, or the drive to broaden medical experience beyond geographic boundaries. Whatever your motivation, if you can maintain an attitude of humility, respect, and flexibility you will learn more than you ever thought possible. Our courses introduce global health through a community service-learning model: we first inform ourselves about local priorities. Community 5


engagement is followed by preparation, mentorship, monitoring and evaluation of project outcomes, guided reflection, and finally, reporting of metrics. One cannot overstate the need to prioritize a community’s expressed needs over your own agenda. Study in advance about locally prevalent diseases and take protective measures for your own health. Lack of personal and professional preparation easily turns the tide from net benefit to burdens for host countries. Ethical dilemmas abound when professionals from resource rich settings impose their norms in a severely resource limited setting. National protocols differ depending on resource availability. Please take care not to undermine trust in local health providers, but do learn as much as you can from them about how to maximize your history and physical exam skills, absent the technology of excess in our own system. I conclude with the words of Martin Luther King: that “of all the forms of inequality, injustice in health care is perhaps the most shocking and inhumane”. This applies to all countries around the world, including our own. Our global health students find life-long inspiration for their careers in reflecting on the power of the healing professions to profoundly improve quality of life for all people. With warm good wishes for your transformational journey, Ruth E. Berggren, MD Director, Center for Medical Humanities & Ethics Professor, Medicine 6 Marvin Forland, MD, Distinguished Professor of Medical Ethics

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Definition of Global Health • Health: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. - World Health Organization, 1948 • Global Health: Global Health is the area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. - Consortium of Universities for Global Health Education, 2009

7 Dr. Ted Wu and a student take a family’s history in Guatemala.


The Mission of our Global Health Curriculum • To provide community service learning opportunities in

international settings which deepen students’ knowledge about global health issues, develop skills in healthcare service delivery, and help to address community expressed needs together with host organizations and local leadership. • To offer a global health curriculum that lays a foundation of practical knowledge, appropriate skills, and critical thinking that prepares students for overseas work and encourages leadership, ultimately empowering and improving the health of underrepresented populations worldwide. • To bring global health home by encouraging scholarly activities and promoting awareness of global health issues on our University Health Science Center campus and beyond. • To emphasize ethics in global health delivery and research through classroom discussions and guided reflection at international community service learning sites. 8


Two medical students set-up a pharmacy station during a mobile 9 clinic in Ethiopia.


Medical students and Jason Rosenfeld, MPH work on a public health research and water, sanitation and hygiene education program in the Dominican Republic.

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ELEC 5047 Global Health Enrichment Elective This elective for first- and second-year medical students serves as an introduction that prepares students to successfully participate at a global health community service learning site. This course provides a foundation of knowledge in global health programs and ethics, while increasing cultural competency and maximizing travel safety. Students will learn to make a postivite impact through their participation in a community service learning project.

Eligibility • First- or second-year medical student in good academic standing Requirements • Completion of 12 hour-long sessions, either online or in-person, including several mandatory sessions • Successful participation at a Global Health Community Service Learning site • Completion of a Book Seminar - Read and discuss the selected book • Completion of the Johns Hopkins Berman Institute of Bioethics course, “Ethical Challenges in Short-Term Global Health Training” at http://ethicsandglobalhealth.org • Completion of a reflection exercise, either written, oral, or photograph • Completion of a Student Site Evaluation 11


ELEC 5057 Leadership in Global Health Elective for second-year medical students who have previously completed the Global Health Enrichment Elective. Students will play an important role on subsequent trips as they serve as peer mentors and trip coordinators, improving the overall quality of the services the teams provide.

Eligibility • Second-year medical student who has completed ELEC 5047 Requirements • Completion of 12 hour-long sessions • Successful participation at a Global Health Community Service Learning site • Maintain accurate and complete clinical records, develop and maintain a longitudinal database, and conduct basic analyses of data • Completion of a Trip Report • Completion of a Book Seminar • Completion of the Johns Hopkins Berman Institute of Bioethics course, “Ethical Challenges in Short-Term Global Health Training” • Read Laurie Garrett’s article, The Challenge of Global Health • Report your experience at the “Global Health in Action: Notes from the Field” presentation series • Completion of a Student Site Evaluation 12


INTD 3001 International Medicine Elective A 4-week rotation at an international site where students participate in patient care, clinical or public health research, and/or public health service delivery.

Eligibility • Third year medical student in good academic standing • Successful completion of the Global Health Enrichment Elective (ELEC 5047) • Dual degree students (MD/MPH) may substitute the Global Health seminar offered by the School of Public Health. OR • Previous international experience in health care or public health setting as determined by the course director Requirements • Submit a detailed description of the rotation or project, including clinical hours and/or project objectives with measurable outcomes • Reflection Essay • Student Site Evaluation • Preceptor/Mentor Evaluation • Patient log (Clinical students) • History & Physical with Extended Discussion (Clinical students) 13 • Written or oral report (Non-clinical students)


Fouth-year medical students hold a group book seminar. MEDI 4151 Poverty, Health & Disease A four week elective offered in March-April for fourth-year medical students who wish to gain insight into the complex interplay between poverty and health, in resource-limited settings both at home and abroad.

Eligibility • Fourth-year medical student Requirements • Class participation • Read one book from the class list of approved books • Oral presentation: Group book seminar 14


INTD 4030 Preparing for Global Health Work A two-week multidisciplinary course for students who are planning future global health experiences, using three learning based methods to enhance knowledge, skills, and critical thinking.

Eligibility • Fourth-year medical student Requirements • Class participation • Student-led “Charla” or 10-minute presentation to peers • Take-home final exam Fouth-year medical students conduct a laboratory workshop on Malaria smears during Preparing for Global Health Work.

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A fouth-year medical student practices draining an abcess during Preparing for Global Health Work.


INTD 7003 International Medicine A four week rotation at an approved international site where students participate in patient care, clinical or public health research, and/or public health service delivery.

Eligibility • Fourth-year medical student in good academic standing Requirements • Submit a detailed description of the rotation or project, including clinical exposure/hours and/or project objectives with measurable outcomes. • Reflection essay • Patient Log • Extended History and Physical with discussion (including 2 scholarly references) • Student site evaluation • Mentor evaluation • Written Project Report (Non-clinical students) 17


Global Health Service Learning Sites Argentina - Buenos Aires: Academia Buenos Aires Dominican Republic - Santo Domingo: Universidad Iberoamericana (UNIBE) - Santo Domingo: Dr. Taylor HIV Research - La Romana: Clinica de Familia la Romana - Barahona: WASH Promotion Partnership - Independencia: Project Hispaniola Ecuador - Quito: Andean Global Studies - Riobamba: Cachamsi

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Ethiopia - Aleta Wondo: Ethiopia Outreach Guatemala - Guatemala City: La Clínica Familiar de Luis Angel Garcia (CFLAG) - San Juan Sacatepéquez: Universidad Francisco Marroquín (UFM), Clinica Barbara - Quetzaltenango: ¡Vamos Guatemala! - Uspantan: San Antonio Guatemalan Endeavor (SAGE) India - Vellore: Christian Medical College (CMC) - Bangalore: Kempegowda Institute of Medical Science (KIMS) - Chennai: The Banyan Panama - Canazas: Students Going Global - Panama Peru - Cusco: Institute of Field Research and Expedition (IFRE) Volunteers - Yantalo: Yantalo Foundation South Africa - Johannesburg (Soweto): University of Witwatersrand 19


Student Groups

Medical students work with translators on a public health research project at Common River. Ethiopia Outreach Medical students and Health Science Center faculty mentors travel to Ethiopia to provide free medical care and conduct public health research in the underserved, rural community of Aleta Wondo.

Site(s) name, country Aleta Wondo, Ethiopia Type of work • Mobile medical clinics, include Family and Internal Medicine and Pediatrics • Public Health research Partner(s) • Common River Students involved Eight first-year medical students Month(s) of travel and length of trip Summer 3 - 4 weeks 20


Medical students organize the clinic set-up for Project Hispaniola in a Dominican Batey. Project Hispaniola Interdisciplinary team of students, Health Science Center faculty mentors, and Haitian physicians and translators dedicated to providing medical care to underserved populations in the border regions of Haiti and the Dominican Republic.

Site(s) name, country Barahona and Independencia Provinces, Dominican Republic Type of work • Mobile medical clinics, include Family and Internal Medicine, Pediatrics and OBGYN • Adult Health Education • Community-Based Water, Sanitation and Hygiene education program Partner(s) • Children of the Nations Students involved Ten to twelve first- and second-year medical students, physician assistant students and pharmacy students Month(s) of travel and length of trip Winter and Spring; 1 week

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Two medical students take a patient’s medical history in Panama. Students Going Global - Panama Medical students and Health Science Center faculty who travel to rural Panama in order to provide free medical services to underprivileged populations living far from available healthcare.

Site(s) name, country Canazas, Panama Type of work • Mobile medical clinics • Clinical Observations Partner(s) • Canazas Hospital Students involved Eight first- and second-year medical students Month(s) of travel and length of trip Spring; 1 week 22


A medical student takes a patient’s vital signs in Quetzaltenango, Guatemala. ¡Vamos Guatemala! Medical students, Health Science Center faculty mentors and supporting physicians travel to Guatemala to provide free health care in rural communities, sexual health education to teenage girls. Some students also stay in Guatemala City to observe health care delivery in an HIV/AIDS clinic.

Site(s) name, country Quetzaltenango & Guatemala City, Guatemala Type of work • Pediatrics (school health screenings) • Sexual Health Education • Clinical Observations Partner(s) • La Clinica Familiar de Luis Angel Garcia (CFLAG) • Hogar Luis Amigo orphanage • Woodland Baptist Church Students involved Six to eight first- and second-year medical students Month(s) of travel and length of trip Winter & Summer; 2 - 4 weeks

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How to get a new international site approved

Students 1. The process for approving new sites can be lengthy. The following steps should be started a minimum of 4 months prior to planned departure. 2. Review Global Health opportunities offered by External Agencies (http://www.texashumanities.org/gh-resources/electives) and/or seek out additional opportunities as they pertain to your skills, interests and goals. 3. Ensure that the site is not located in a US Department of State Travel Warning country. This information can be found at http://travel.state.gov. 4. Identify and contact the site/program manager for your site to obtain as much detail as possible. Details must include professional information about the Site Mentor, cost, housing, and local safety. Students must provide the Assistant Director of Global Health the following information for the Site Mentor: • Credentials/Training • Curriculum Vitae (CV) • Written acceptance of mentorship 5. Complete and submit the Site Approval Form along with estimated budget and the above supporting information to the Center Director for review and approval. 24

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A fourth-year medical student teaches a young child to listen to her heart during a rotation in India, as part of INTD 7003.

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Program Partners If you have a site/program that you would like the Health Science Center to consider as one of our Global Health Service Learning sites, please contact the Assistant Director for Global Health at globalhealth@uthscsa.edu and provide the following information: • Site Location: country, town/city, hospital/clinic/organization/ community • Mission • Program Goals • Point of Contact 25


Global Health Funding

A Paul Brand Scholar works with a pediatric patient at the Clinica Barbara in Guatemala.

Paul Brand Scholarship This competetive scholarship is made available by the CMHE for rising fourth-year medical students in April of each academic year. Students apply for $2,500 to fund an experiential learning opportunity in global health. Recipients will participate in a one-month (including travel time) rotation, as part of the International Medicine (INTD 7003) elective. These scholarships represent an opportunity to learn about the culture and practice of medicine in a resource-poor country. The student will experience medicine in an environment greatly different from what they have seen in the U.S. and will learn about the role of technology vs. the necessity 26 for astute history taking and physical diagnosis skills.


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Eligibility 1. Fourth year medical student in good academic standing Application process 1. Fill out the scholarship application form found at http://texashumanities.org/paulbrandscholarship 2. Have two mentors, at least one physician, write recommendation letters 3. Submit both to globalhealth@uthscsa.edu by deadline listed The applications are reviewed by a panel of physicians and community members, using a rubric to rate each applicant. Up to 5 individuals will be awarded a scholarship each year.

Requirements 1. Enroll in INTD 4030 Preparing for Global Health Work elective in the fall prior to completing an international rotation 2. Work with the Assistant Director of Global Health to decide on an international elective site 3. Enroll in INTD 7003 International Medicine elective during desired foruth-year period. All Brand scholars are strongly encouraged to report experiences at

the “Global Health in Action: Notes from the Field� presentation series. 27


School of Medicine Dean’s Office Scholarship This scholarship is for medical students in all four years, who are enrolled in a global health elective. The amount awarded is determined by the need of each individual student and the continued availability of funds. Students are only eligible to receive one scholarship per academic year and applications are accepted on a rolling basis, at least two months prior to travel.

Application Process 1. Enroll in a Global Health elective. 2. Meet with the CMHE Assistant Director of Global Health to identify and develop an international elective. 3. Have the site approved by the Director of the CMHE. 4. Complete pre-departure orientation and obtain Health Science Center approval. 5. The Office of Student Affairs will be notified of the approval and will foward the Dean’s Scholarship Application. 6. The Application should be filled out by each individual student and returned to the Office of Student Affairs for review. 7. Within 48 hours a decision will be made and the funds will be released as a pre-departure stipend.

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A fourth-year medical student and Paul Brand Scholar takes a patient’s vital signs in India. External Funding • American Medical Student Association’s Global Health Committee: a website dedicated to providing useful information about funding sources, elective opportunities, planning for your trip, reading lists, publications and other useful information. • National Institutes of Health Fogarty International Center: Provides international grants and fellowships in biomedical and behavioral research. Its goal is to provide information about additional funding opportunities in global health research. • Medical Women’s International Association: Offers fellowships and scholarships to suppport women interested in working in Global Health. • Minority Health and Health Disparities International Research Training Program: International training opportunities in health disparities research for students in the health professions who are from health disparity populations and/or are underrepresented in basic science, biomedical, clinical or behavioral health research career fields. 29

For more external sources, go to http://texashumanities.org/gh-resources/electives


Student Reflections

Fourth-year medical students practice obstetrical skills during Preparing for Global Health Work. Working alongside various doctors from around the world with different work styles and different methods of teaching opened my eyes not only to the versatility of medicine, but also the common focus of medicine: to heal. - First year medical student I went to the border of the Dominican Republic and Haiti expecting to provide medical care and medication to patients who have no access to healthcare, and we did just that . I did not expect, however, that what I would gain from the people we met would far exceed any medical care and assistance that I could provide for them. - Second year medical student This rotation was in many ways a capstone to my journey as a medical student, combining my passions and talents into one experience. - Fourth year medical student Other student and site reflections can be reviewed online at 30 http://texashumanities.org/ghdirectory or at the CMHE office.


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How to Become a Mentor

Dr. Richard Usatine mentors students in the Ethiopia Outreach team during a clinic at Common River. To become a mentor for one of the student international experiences: • Contact the Assistant Director of Global Health at globalhealth@uthscsa.edu with the following information: • Credentials/Training • Curriculum Vitae (CV) • Previous experience • Areas of interest • Language skills • Meet with the Center Director to discuss the different types of mentorship available 31


Global Health Faculty Ruth E. Berggren, MD Course Director, INTD 3001, MEDI 4151, INTD 7003 Co-Course Director, ELEC 5047, INTD 4030 Mentor, Project Hispaniola berggrenr@uthscsa.edu Tyler Curiel, MD Mentor, Project Hispaniola curielt@uthscsa.edu Byron Alexander Foster, MD, MPH Mentor, Ethiopia Outreach fosterba@uthscsa.edu Andrew Muck, MD Mentor, ยกVamos Guatemala! Summer muck@uthscsa.edu Barbara Taylor, MD, MS Epi Co-Course Director, INTD 4030 taylorb4@uthscsa.edu


Richard Usatine, MD Co-Course Director, ELEC 5047 Mentor, ยกVamos Guatemala! Winter Mentor, Panama usatine@uthscsa.edu Theodore Wu, MD Mentor, ยกVamos Guatemala! Summer wut@uthscsa.edu Christine Zink, MD Mentor, Ethiopia Outreach zink@uthscsa.edu Global Health Staff Jason Rosenfeld, MPH Assistant Director of Global Health rosenfeldj@uthscsa.edu Stephanie Gutierrez Academic Programs and Global Health Coordinator gutierrezsr@uthscsa.edu


A Lesson By Lee Robinson Until now we were afraid of each other the child afraid of our strange medicine and we of failing her until this moment when we took out the guitar and the song taught us again what we’d almost forgotten: that what we practice is an art as much as any music, made by us and between us, human to human, heart to heart. 6

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Ethiopia 2010 “Medicine for the Soul”

Photo Credit: Tsegaye

Preparing tomorrow’s healers to act with compassion and justice.

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Briscoe Library, room 4.042 7703 Floyd Curl Drive, MC 7730 San Antonio, TX 78229 p (210) 567-0795 | f (210) 567-0805 globalhealth@uthscsa.edu www.texashumanities.org/global-health Facebook.com/GlobalCMHE


Center for Medical Humanities & Ethics Global Health Program