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The Bridge

Public Health Newsletter

Fall 2013, Volume 3

The Bridge is a public health newsletter written and produced by Hofstra University students and faculty devoted to bridging the gaps in our health care system and improving the health of our communities.

Public Health Response to Chemical Warfare in Syria By Pascale Frederique, MPH Student For two years now, Syria has been trapped in a seemingly endless civil war. President Bashar al-Assad’s military regime has been ruthlessly fighting back the opposition rebels in what seems to be a longstanding political and military stalemate. Thus far, 1,400 people are estimated dead, with numbers soaring into the 3000s for injured. Each land advancement or occupation is met with shell fire, flying bullets, and fierce aggression from both sides. But on August 21, 2013, the deadliest attacks occurred along the outskirts of Damascus; a new component had been added to the fighting, alarming global, political and public health leaders alike: chemical weaponry.

Sarin is a colorless and odorless chemical. “A class of nerve agents developed in World War I by the Germans, it is akin to weaponized forms of pesticides,” according to Dr. Kenneth Spaeth, director of environmental medicine at North Shore University Hospital, biological weapons expert, and professor in Hofstra University’s Master of Public Health program and at the Hofstra North Shore-LIJ School of Medicine.

Dubbed the “Ghouta attack,” after the densely populated suburb surrounding Damascus, the area is accustomed to fighting that started at the inception of the civil war. Both the regime and rebels maintained strongholds in the area and were constantly finding ways to advance into either camp. Multiple intelligence sources, most notably the French, have reports of a premeditated bombardment by the al-Assad regime to capture rebel lands. It was further reported that rocket missiles filled with Sarin gas agents were launched against the opposition. Not surprisingly, Syria is the third largest holder of chemical weapons in the world, making the accessibility to chemical agents an arm’s length away.

Hospitals in Ghouta and other regions of Damascus sent reports of patients exhibiting neurotoxic symptoms, most within hours of the attack. Military personnel, rebels, and civilians showed symptoms of violent coughing, contracted pupils, blurred vision, vomiting, loss of consciousness, foaming at the mouth, impaired speech and hearing, and rapid heart activity. Those heavily exposed to the agent, with remains caught in clothes or hair, died within hours. Health care workers, having seen the effects firsthand, are convinced that Sarin gas is being used in combat. Physicians treating patients do not doubt the presence of toxic agents, considering the troubling evidence in their wards. “The reported symptoms are consistent with nerve gas use,” states Dr. Spaeth. continued on page 7

“Essentially it poisons the nerve cells in the brain and body, disrupting nerve cell communication with uncontrollable nerve signaling … and depending on the amount of exposure to Sarin, the symptoms could be wide ranging,” Dr. Spaeth continues.

Inside

Global Health Goals in Our Backyard By Johanna Andrews, MPH, ’14; and Martine Hackett, PhD, Assistant Professor, Health Professions, Hofstra University In 2010 the United Nations and all countries of the world agreed on eight bold Millennium Development Goals. The focus for the next five years is on issues that range from eradicating extreme poverty and hunger to combating HIV/AIDS, malaria and other diseases that would improve the health and well-being of the world’s population. Despite the ambitious agenda, as of 2013 there has been positive progress on achieving these goals. According to the U.N., enrollment in primary education in developing countries is now at 90 percent; continued on page 7

From the Director.........................................................2 The Killer Gap............................................................3 Leadership Retreat....................................................4 One on One With Dr. Uwemedimo...........................5 Nassau County Health and Wellness Fair.................6 Hofstra’s Center for Civic Engagement....................6 We Are Public Health.................................................6 Preparing for a Disaster.............................................8 MPH Students in the Dominican Republic................8 Universal Lead Screening in India...........................10 Children With Developmental Disabilities..............10 Health Promotion in Panama.....................back cover Helping to Heal in Muzaffarpur, India.......back cover For More Information................................back cover

From the Director

Corinne Kyriacou, PhD, MPH Associate Professor and Director MPH and MSCH Programs Department of Health Professions Hofstra University Since the May 2013 issue of The Bridge, many exciting developments have transpired here in Hofstra’s graduate public health programs, and across our county, state and country. As you will read in this issue, our growing community of public and community health scholar-practitioners has spearheaded extraordinary health programming, participated in critical training, and taken action to improve the health of vulnerable communities locally and abroad. A diverse new cohort of MPH and MSCH students started this fall, bringing a different set of backgrounds, experiences and interests to the student body (see article by Maria Akhondzadeh and Anu Anish). Additionally, we further expanded academic, research and practice opportunities for students by bringing on five new adjunct faculty with expertise in community organizing, emergency preparedness, nutrition and global health (learn about one of these new faculty members in the interview by Maria Akhondzadeh) and by developing our community-based partnerships (see article by Nuzhat Quaderi). Enriched and engaged, our students and faculty interact often with the larger community to discuss, identify and implement solutions to critical public health challenges. Over the summer we developed or participated in a number of exciting events. In July faculty members Dr. Martine Hackett (Hofstra’s Department of Health Professions) and Dr. Larry Eisenstein (Nassau County health commissioner) presented at a summer series exploring public health issues in the suburbs, discussing the Wisconsin Public Health Rankings and Contemporary Suburban Public Health Inequities, respectively. 2

On August 3, our students were invited to attend The Aspen Institute’s “Excellence in State Public Health Law Leadership Retreat,” where several observed closeddoor meetings about state efforts at health care reform (see article by Amy Singh and Nuzhat Quaderi). On August 6, new faculty member Dr. Josh Moskovitz hosted several of our students at a disaster drill at North Shore University Hospital, providing an insider’s view of how health care organizations develop, test and modify plans to protect patients and the community (see article by Amanda Dugan). On August 18, our public health students successfully led the development and implementation of Nassau County’s first Health and Wellness Fair (see Alicia Colangelo’s article). In an effort to share our excitement about the field of public health with college-bound high school students, I presented in late summer as part of the Hofstra North Shore-LIJ School of Medicine Pipeline Program. Inspired by the momentum spreading across the country to reshape how care is organized and delivered, and particularly energized by the historic launch of the health insurance exchanges, our community is ramping up efforts to increase awareness and understanding about the purpose and benefits of health reform for individuals and the community at large. Soon after the semester got underway, our student Society of Public Health Advocates (SOPHA) partnered with faculty to hold a screening of the nationally acclaimed documentary film Escape Fire. In late September, faculty member Dr. Ken Spaeth held a riveting special field report on his role in the investigation of tainted vitamins on Long Island. On October 8, the MPH program partnered with North Shore-LIJ’s Zucker Hillside Hospital to present a panel discussion titled “Breaking the Silence: Stop the Stigma of Mental Illness.” On October 16, MPH faculty member and Hofstra Law Professor Dr. Janet Dolgin, together with Hofstra’s Maurice A. Deane School of Law and the new Gitenstein Institute for Health Law and Policy (of which Dr. Dolgin is director) hosted a full-day symposium titled “Affordable Healthcare’s Next Act,” bringing together practitioners, academics, policymakers and health care administrators to examine issues related to the impact and future of the landmark Affordable Care Act (ACA). A number of other MPH faculty served as panelists during this symposium.

Finally, to educate Nassau County residents about the online marketplace and connect them with essential community-based service organizations, SOPHA worked hard to organize the inaugural Service Fair, which was held at Nassau University Medical Center on November 21, 2013. Our collective momentum has been further charged by this year’s theme for the American Public Health Association Annual Conference: “Think Global, Act Local.” Many of our students and faculty are interested in applying best practices from the United States to troubled communities abroad, and in learning about international best practices and finding ways to apply successful strategies to improve population health among communities suffering right here on Long Island. Some students and faculty are traveling abroad to participate in learning visits, conduct needs assessments, or develop and implement programs (see articles by Nathalie Jean-Baptise, Ronald Sanchez, Sophia Noel, Hope Zewou; Akshat Jain; Rahul Sinha; and, Bakhtawar Bajwa). Indeed, our first graduate from Hofstra’s MPH program, Shaanan Meyerstein, is now working in Botswana with HIV-infected children as part of a Pediatric Global Health Corps run by Baylor University and Texas Children’s Hospital. Other students and faculty are attending this year’s APHA conference in Boston or studying new data on global challenges as a means to identify priority areas for future initiatives (see articles: “Public Health Response to Chemical Warfare in Syria” by Pascale Frederique; “Global Health Goals in Our Backyard” by Johanna Andrews and Dr. Martine Hackett; and “The Killer Gap” by Akshat Jain). To bring some of this global health work to a larger audience, Dr. Omolara Thomas Uwemedimo, MPH faculty member and pediatric attending at Cohen’s Children’s Hospital, presented her work at an MPH webinar over the summer called “Clinical Mentorships: A Public Health Approach to Improving Pediatric HIV Care in Africa” (link available at hofstra.edu/publichealth), and we will focus on global health issues during Hofstra’s Second Annual National Public Health Week in April 2014. Students and faculty working in partnership with the community to study pressing public health challenges and implement solutions describes what you’ll find in this issue of The Bridge, and essentially defines who we are.

THE KILLER GAP: Global Health Inequalities for Children (Review of the World Vision Report on International Pediatric Health) By Akshat Jain, MD; MPH, ’15

The inadequacies of programming, implementation and reporting health programs across the globe have led to the unmet needs of the Millennium Development Goals. New parameters are being used to access and report the overall health status of a region/country, phasing out the age-old markers of infant mortality rate and life expectancy. The need has arisen to look at the problem through the perspectives of “distributive care.” The Global Health Gap Index grades the health status of the country on the basis of four parameters: 1) life expectancy; 2) personal cost of using health services; 3) adolescent fertility rate; and 4) coverage of health services. People are also categorized into “health rich” or “health poor.” People with the most access to the best health education, awareness, prevention and treatment are

health rich. People who face the most barriers to accessing health education, awareness prevention and treatment are health poor. Health poor people seem to do

worse, as one would expect, but a complex interplay of factors leads to poor health care delivery, leading to shockingly low scores even in the developed world.

• High out-of-pocket health care spending.

the toddler with the HIV treatment she needs to stay alive.” It is stories like these that keep the health professionals working in these devastated areas plugging away. Wherever there is a child in need, there is a public health professional working to meet those needs. And clearly, the needs are deep, complex and pressing.

The gap exposes the “actual” health of the country effectively and brings out the following few factors that affect the score most adversely:

• Social infrastructure – conditions provided for a community to be born into, grow, live, work and age. • Lack of equal investment in the early years of life, which is the period that holds the greatest potential for lifelong good health. • Policies and practices that have prioritized urban growth, leaving rural communities to suffer from chronic underinvestment in infrastructure and amenities.

It is stories like these that keep the health professionals working in these devastated areas plugging away. • Unequal employment and working conditions. • Lack of social security: globally, four out of five people lack the backup of basic Social Security coverage.

• Lack of investment in national health workforces: imbalance between rural and urban health worker density within countries. • Gender disparities – the position of women in society is associated with child health and survival. The stories that hound local health workers are soul stirring: “For an entire day, 13-yearold Matseleng travels by foot with her 2-yearold sister, Makhotso, strapped to her back. Their destination is the clinic that provides

To read the report in its entirety, please visit http://www.worldvision.ca/ ABOUTUS/Media-Centre/Documents/ KillerGapreport.pdf.

Excellence in State Public Health Law Leadership Retreat By Amy Singh, MPH, ’14; and Nuzhat Quaderi, MSCH, ‘14 The Aspen Institute, an education and policy studies organization based in Washington, D.C., strives to foster leadership and provide a nonpartisan venue to improve health outcomes. In the efforts to solve critical public health issues in the United States, The Aspen Institute’s Justice and Society Program created a new initiative that brings together teams of policymakers across governmental agencies among eight states. This one-year program was funded by the Robert Wood Johnson Foundation and was designed to allow each stakeholder to work together within their state, share perspectives and experience the other states’ health issues. Through the Excellence in State Public Health Law Program, each state’s health office or high-level designee, governor’s staff and high-level officials from agencies gathered for a retreat in Glen Cove, New York, from August 2 to 4, 2013. The goal of the Excellence in State Public Health Law program was to strengthen public health law collaborations among state officials and state-level policymakers while each team focused on each state’s respective health priorities. The Ten Essential Public Health Services include the following: monitor health status; diagnose and investigate health problems; inform, educate and empower people about health issues; mobilize community partnerships; develop policies; enforce laws and regulations; link people to needed personal health services; assure a competent workforce; evaluate effectiveness; and research for new insights. By following the Ten Essential Public Health Services, each state targeted efforts on emerging and ongoing issues affecting the entire community as opposed to a selective group of individuals. As regulated by the American Public Health Association, the ultimate goal of the project seeks to strengthen partnerships that are essential to maintaining health improvement in communities at large. Two graduate students in public health/ community health, Amy Singh and Nuzhat Quaderi, and a recent graduate from the health sciences program, Aaqil Ali, attended this August retreat to act as rapporteurs during group breakout sessions. With the topic of the conference pertaining to public health laws, policies and regulations, members of a cohort gathered to share their experiences with colleagues from other states. Through a series 4

Nuzhat Quaderi, MSCH, ‘14 (left); Amy SIngh, MPH, ‘14; and Aaqil Ali, BSHS, ‘13 in front of the Glen Cove Mansion where the Aspen Institute Retreat was held.

“One thing that struck me is that the CDC’s greatest successes are ongoing issues in public health today.” — Amy Singh of panel discussions and small group work, the students were able to learn from the project plans and the relevance of legislative bills in public health. The conference also focused on the role of newspapers, reporters, and even social media on effective implementation of public health initiatives. Given the chance to sit in on the lectures, the students were given an exclusive sneak peek into the challenges that public health officials face when looking to promote community health programs and legislation. The students were fascinated to be able to correlate issues that they’ve learned about in their classes to actual emerging public health threats. Amy Singh, an MPH student, said, “One thing that struck me is that the CDC’s greatest successes are ongoing issues in

public health today. This leadership retreat allowed me to gain an appreciation for such public health laws, policies and regulations as needed in order for a change to occur, but most important, for quality improvement. In the long run, the public health approach to exposing risk factors of chronic health problems and other consequences will not only emphasize healthier choices, but also build a strong governmental infrastructure. That alone exceeds our goal to utilize cost, access and quality of care as public health advocates.” Nuzhat Quaderi, an MSCH student, said, “I never really considered the impact that social media had on being able to effectively promote and implement public health programming. The challenges in being able to promote community health are vast, but it was exciting to see executive public health officials from different states come together to learn from each other and brainstorm how to address these challenges head on. “The opportunity to be a part of this conference gave us a chance to see real-life applications of our course work, meet some great minds in the field of public health, and broaden our horizons.”

One on One with Dr. Omolara Thomas Uwemedimo By Maria Akhondzadeh, MPH, ’15 Dr. Omolara Thomas Uwemedimo earned the MPH from from Columbia University in 2011 and the MD from New York University School of Medicine in 2004. She did her residency in pediatrics at Boston’s combined residency program, which consisted of Boston Medical Center and Children’s Hospital of Boston, and completed it in 2007. She also did a general academic pediatric fellowship at Columbia University. In addition to Dr. Uwemedimo’s extensive background, she did postdoctoral work in urban community health in 2011.

Q A

What made you decide to join the faculty at Hofstra?

Well, when I first got to North ShoreLIJ, I was very interested in trying to put to use my public health degree. Specifically, I have an affinity toward global health, which has been the main focus of most of my work. I liked the idea of being able to teach not only medical residents and physicians, but also public health students in the area of global health, which relies on population health initiatives.

Q A

Who do you think should consider a degree in public health?

Everyone! However, to be realistic, I do think that those working in global health really should have some public health courses under their belt. Most of the work we do clinically tends to be very limited in the sense of the efforts and the results once you’ve performed these clinical care initiatives. The bigger thing to think about is actually how we can make a difference on a global scale for the children for whom we are providing care. And so the idea for me is thinking not only what kind of impact am I going to make for this child in front of me, but also what kind of impact can I have in the community that I’m serving. And because of the need for more cost-effective health care, it is really important that we focus on population health initiatives. One initiative that I’m really interested in is the use of community health workers in resource-limited countries. And that’s an example where it’s not really focused specifically on how we provide the care (the specific protocol guidelines) but how we teach community health workers to reach a larger community.

You have history working in an urban setting. What has drawn you to doing work in the local area surrounding Hofstra?

Even though my focus has been on global health, America is just so diverse. New York City and Queens are two of the most diverse regions in the world. One of the things that most people don’t realize is that medically underserved communities here in the United States and communities in resource-limited countries have many similarities. And I think that we can use some of those initiatives that have been used in other countries to reach those who are very difficult to access here. One of the big things that I am interested in doing is trying to focus on how to get our immigrant populations here – specifically undocumented immigrants – to access health care better. Some of the work that I have done in my research fellowship was focused on the issues of insurance and how to provide health care that doesn’t rely on insurance. I think that it is really important and something that we are working on in the global health training program at North Shore-LIJ (in terms of the immigrant populations that we serve in Queens and on Long Island).

Q A

What are some of your global health experiences?

I would have to start from very young, in the sense of coming from a Nigerian background. So my parents are immigrants from Nigeria (born in Nigeria). I was born here; however, my mother and father felt that it was very important for me to be exposed to Nigeria from a very early age. I think my first trip back to Nigeria was when I was 7 months. The first trip that I remember was when I was 7 years old, and from that time on, I felt an affinity toward the issues and the need to help others, specifically in other countries, because of what I had witnessed from family members. It started with trips when I was an undergraduate. During that time period (in 2000), I went to Kenya and that was my first trip. A program called Operation Crossroads of Africa sent us for three months to Kenya with one backpack; I was in the medical group and we worked with a private hospital there. We really got a chance not only to work with the physicians there, but also to get a better look at the community outreach programs provided through the hospital and to get an idea of the health concerns that plague people in resource-limited countries. This was at the peak of HIV in that country. It was very alarming to see how HIV had devastated

Kenya. From that experience, I got “the bug.” In medical school I was able to go to Nigeria and Cuba and during residency I was able to go to Lesotho and Nigeria again. And from that point in residency, I realized that I wanted global health to be not an adjunct portion of my career but the focus of my career. So when I finished residency, I decided to go to Africa for a year and I worked with Baylor International Pediatrics AIDS Initiative (known as BiPai) in Malawi. I lived in Malawi for a year to really get the idea of not just doing short-term missions but seeing how it would be to work and live in a country outside of the United States for a prolonged period of time. And during that time, the importance of and need for public health became very apparent to me. I would split my time between providing one-on-one care in the HIV clinic and going to Northern Malawi (a rural area in Malawi) in a UNICEF van to teach the health care workers in small clinics how to provide HIV care to children. I felt that that was a more long-lasting experience where you were leaving skills with providers and developing a program that would now be able to address the HIV treatment and care needs of a population of a whole region. During that time we were able to train about 300 health professionals and I believe we had 14 clinics in the northern region that were functioning pediatric HIV centers. That was when I decided I needed to go to Columbia University to get some public health training … so I would know what I was doing!

What is the global health training program that you started at North Shore-LIJ?

The global health training program is an amazing program that we’re hoping will create partnerships in resource-limited countries and medically underserved areas and have long-lasting effects. It focuses specifically on both physicians and resident physicians in pediatrics and the family medicine department. In addition, we have now included the MPH program at Hofstra to be able to rotate at the sites. The focus of the program is to allow residents (as soon as they enter into their pediatric residency) and those who have an interest in global health to be able to run through a global health track. During their three years, they are exposed to a curriculum that’s focused on global health. They are also exposed to evening seminars that include speakers and topics related to more in-depth issues regarding continued on page 11

Inaugural Nassau County Health and Wellness Fair By Alicia Colangelo, MPH, ’14

… more than 100 local vendors came out to provide Nassau County residents with information and resources to help them live a healthier lifestyle. The first Nassau County Health and Wellness Fair, held August 18, 2013, was a great success. There were more than 600 people in attendance, more than

North Shore-LIJ and Winthrop-University Hospital. It took place at the Mitchel Field Athletic Complex in Uniondale; more than 100 local vendors came out to provide Nassau County residents with information and resources to help them live a healthier lifestyle.

50 doctors and nurses, and 30 volunteers. Approximately 300 residents participated in free glucose, cholesterol, blood pressure, heart disease, breast cancer and dental screenings. In addition, 31 pints of blood were donated to the New York Blood Center. The event was hosted by Nassau County Executive Ed Mangano, in conjunction with

At the event, attendees had direct access to multiple health and wellness resources, as well as private consultations and health screenings. Attendees with abnormal screening results were advised for followup care at the exit interview. The fair also offered an array of workshops and exercise classes, in addition to children’s activities such as carnival games, a mobile gaming truck, interactive photo booths and free backto-school supplies. It truly was a fun-filled day for families to get healthy together.

Hofstra’s Center for Civic Engagement By Nuzhat Quaderi, MSCH, ’14

The Center for Civic Engagement (CCE) was founded on the premise that individuals who are equipped with civic engagement experiences and skills are better able to move from awareness to action. Since its inception, the CCE has aimed to educate students about the current and historical issues that affect both our local and global communities, and has worked to empower students to make changes by developing and strengthening leadership, team-building, organizing, and advocacy skills. The CCE believes in the importance of creating a community of active citizens

and works with all interested members in building long-term relationships with community-based organizations to make lasting and meaningful changes within our community. To that end, the CCE offers internship and volunteer opportunities with community-based organizations, on-campus event planning opportunities, opportunities to build skills through committee membership, and more. Students may work with the Grants Committee, in which they learn grant-writing skills; the Community-Based Research Committee, which offers opportunities to work with community organizations to identify and

pursue customized research needs; and the Community Partnerships Committee, which works with CCE’s strategic partners. The ability to build long-term relationships, appropriately use advocacy skills, and build coalitions often leads to success in the field of public health. Therefore, it is important for all public health students and professionals to be civically engaged within the communities they serve. If you are interested in finding out more about the Center for Civic Engagement, please visit hofstra.edu/cce or email CCE@hofstra.edu.

We Are Public Health: Meet the New MPH and MSCH Students Maria Akhondzadeh, MPH, ’15; and Anu Anish, MPH, ’14 People spend the majority of their lives trying to define themselves. If asked the question “Who are you?” a noun may suffice: I am a student, I am a son or daughter, I am an employee, I am a father or mother. People spend their lives creating a name for themselves. A person hopes to leave a legacy of sorts. As our Class of 2015 embarks on its new academic journey, we asked our new 6

students the following questions: “What brought you to the starting line of this point in your life?” and “What do you want to be known for?” Pascal Frederique, a new MPH student, said, “Public health encompasses my interests and it speaks to who I am as a person.” Her decision to start the MPH program grew

from both a desire for higher education and a passion to improve our health system, our community and our nation. Maria Akhondzadeh (MPH, ’15) is part of the quality assurance/quality improvement team in her fire department and loves Hofstra University’s “hands-on approach to public health and the intimacy the program has to offer.” Coming from Stony Brook continued on page 11

Global Health Goals in Our Backyard extreme poverty rates have been cut in half since 1990; and since 2000, 1.1 million malaria deaths have been averted. Though there is still much work to be done to reach the Millennium Development Goals by 2015, the success so far can be attributed to focused efforts by governments, the private sector, charitable foundations, and civil society. One of the Millennium Development Goals is to reduce by two-thirds the mortality rate for children under 5. Newborns account for almost half of these deaths due to preterm birth complications, pneumonia and diarrhea. Infant mortality has long been a leading public health indicator to determine the health of a nation, since it measures the health of the most vulnerable members of society. Reports from the United Nations show some significant improvements in reducing mortality rates in countries with very high death rates – Bangladesh, Ethiopia, and Liberia. But what about the United States? There is no mention of the United States as an area of focus for reducing infant mortality in the Global Millennium Goals. You might think that in comparison to developing nations, the need

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in the United States seems insignificant. However, according to the Centers for Disease Control and Prevention, in 2010 the United States ranked 130th out of 184 countries for preterm births, and has the highest first day infant death rate of all industrialized nations. Although there is advanced technology, medical care, and knowledge about caring for infants in the United States, the infant mortality rate tells a different story about how we care for the most vulnerable members of our society. A closer look at the numbers shows that much of the high rate of infant mortality nationally can be explained by the disproportionately high rates of deaths for black non-Hispanic infants — twice as high as white non-Hispanic infants (12.7 deaths per 1,000 live births vs. 5.5 in 2008). Though black non-Hispanics account for only 16 percent of births, they represent more than 30 percent of infant deaths in the United States. These disparities or differences by race/ ethnicity in infant mortality are even more severe in our own suburban Nassau County. In 2010 the infant mortality rate for black

Public Health Response to Chemical Warfare in Syria Exactly a year and a day prior to the Ghouta attack, U.S. President Barak Obama gave a speech pertaining to the Syrian conflict. He sent a warning to al-Assad and “the guys on the ground” (rebels), that the use of chemical weapons was unjustifiable and would require an American response, if “red-line” was crossed. This “red-lining” has caused contention in Washington and within the international community, considering no definitive action has been taken since the attack. Sans international interventions or government aid, the opposition rebels have still found ways to protect themselves through preventive measures. Rebel leaders increasingly urge their fighters to wear as much protective clothing as possible. This includes wearing wet rags on faces and distributing gas masks, albeit available only on a limited basis, for those in direct combat. Many leaders have rallied together to implement regular eye-washing sessions at various ground checkpoints. Despite the fact that such measures do little to counter the direct effects of a Sarin gas attack, these preventive steps could attenuate resulting symptoms. Hospitals have also taken part in the prevention effort by distributing syringes of atropine, the only known treatment to counteract nerve degeneration, to rebel forces and civilians caught in the crossfire. One hospital has set up a special shower system to be used when exposed patients are admitted. Those exposed to chemical agents go through a system of washing and changing their clothes

non-Hispanics was 14.5 infant deaths per 1,000 births, compared to 3.2 infant deaths per 1,000 births for white non-Hispanics. The causes for these differences are complex, but strongly reflect the social and environmental differences among communities in Nassau County. The communities with higher rates of infant mortality have lower median incomes, poor school systems, and fewer resources for family support. These social determinants of health do not explain all of the differences; however, as in other countries around the world, social conditions must be identified as a significant contributing factor to health outcomes. Approaching solutions on a societal level to reduce inequalities in jobs, education and housing here in Nassau County and across the United States is imperative. We need to create outlets for dialogue on these critical issues, so that we may be able to devise action plans to tackle these health disparities. It is only then that public health professionals can begin to address unacceptable differences, and a global focus on the health of vulnerable populations can begin much closer to home.

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before entering the hospital, thus limiting contamination of health care workers and already vulnerable patients. Without any past experience with chemical warfare, the collective efforts of rebel leaders and hospitals should be applauded. However, with suffering and deaths increasing as a direct result of the Ghouta chemical attack, a comprehensive response from the global public health community is essential. Hospitals in the outlying Damascus area are not fully equipped to manage the high influx of patients and their wide-ranging symptoms; meanwhile, populations are being displaced because of combat and death, claiming refugee status in droves. Very clearly, a public health infrastructure is needed to deal with the mounting health, social, and environmental problems facing the Syrian population. It must be noted that the conflict is rife with politics within Syrian borders and internationally, making it very difficult to assess and address properly. Recent reports of seven Red Cross workers being kidnapped at gunpoint compound this issue, but must not be a deterrent to continued international response and action. “Public health should always be concerned with any widespread event of horrific acts,” says Dr. Spaeth, “because there is no wellness in war.”

Ken Spaeth, MD, who is on the faculty of the Hofstra North Shore-LIJ School of Medicine and the MPH program, gave a talk in September about the ongoing investigation of tainted vitamins on Long Island.

Preparing for a Disaster: Thinking Outside the Box By Amanda Dugan, MPH, ’14 Disasters, unpredictable by nature, can make preparation difficult. On August 6, 2013, Dr. Josh Moskovitz, MD, MPH, Emergency Medical Services liaison, invited Hofstra MPH students to observe a disaster drill/ hospital evacuation exercise at North Shore University Hospital (NSUH), Manhasset. Students who attended the exercise were able to participate in the summation and afteraction reporting of the drill.

… to really be prepared during a disaster, everyone needs to think outside the box and utilize all available resources.

Disaster drills attempt to simulate circumstances of crisis so that individuals have the opportunity to practice responses. These drills identify weaknesses in disaster response plans, and help give people an understanding of how to operate outside their normal framework.

floor of the hospital. This room would serve as the command center for the drill. All communication with receiving facilities would happen from this room. The evacuation exercise took place on an unutilized hospital floor. All were instructed to remain calm and wait for the overhead announcement.

As Long Islanders, we have not had to worry much about “disasters.” Long Island is not known for earthquakes or tsunamis; and until last fall, we even made out pretty well during hurricane season. The effects of Superstorm Sandy and the untimely evacuations of many New York hospitals have served as a real eye opener. Disaster response plans are essential to standard operating procedures, not only for hospitals, but for schools, residential facilities and any other large public domains.

Health system volunteers served as “patients” for the exercise, and various members of the hospital staff were used as clinical actors and transporters. Critical patients were evacuated first; they were placed on sleds and transported down the nearest staircase to the Emergency Department (ED). Upon arrival in the ED, a registrar was waiting with a scanner to scan each patient’s hospital ID bracelet to ensure all were accounted for. Patients were then loaded on to North Shore-LIJ ambulances and sent on their way to the receiving facility. For the purpose of

The drill attendees were asked to meet in the Tower Conference Room on the first

this drill, Long Island Jewish Medical Center, in New Hyde Park, was the receiving facility, where a similar (receiving) drill was taking place. All ambulatory “patients” were walked down the stairs after critical patients were accounted for. During a true disaster, these ambulatory patients would be instructed to report to the command center for further instruction. This was the first drill Dr. Moskovitz held at NSUH. For the most part, it went very smoothly. Staff remained calm, messages were conveyed to patients in a way that kept everyone at ease, and all patients were transported safely and without incident. After the drill, there was a “debriefing session” held at the command center. During this session, opportunities for improvement were identified, related mostly to communication and logistics. Dr. Moskovitz explained that to really be prepared during a disaster, everyone needs to think outside the box and utilize all available resources. Much of the preparedness stems from practicing techniques that are not used every day and brainstorming potential obstacles so that in the advent of an actual emergency, participants are better prepared to overcome these obstacles.

Hofstra’s MPH Students Travel to the Dominican Republic to Assess Availability of Health Care for Migrant Haitian Sugarcane Workers By Nathalie Jean-Baptise, MPH, ’14; Sophia Noel, MPH, ’14; Ronald Sanchez, MPH, ’14; and Hope Zewou, MPH, ’14 After much anticipation, excitement and planning, Hofstra University’s first group of MPH students – Ronald Sanchez, Nathalie Jean-Baptise, Hope Zewou and Sophia Noel – arrived in the Dominican Republic on June 24, 2013, for their global health internship. Our home for the two-week stay was Casa Pastoral, a mission house located in La Romana in the southeastern portion of the island. The accommodations at Casa Pastoral were basic and included all our meals, which were served family style by a friendly staff. We shared large open dorm rooms and bathrooms with various mission 8

MPH students (starting fourth from left) Hope Zewou, Sophia Noel, Ronald Sanchez and Nathalie Jean-Baptiste with workers from Casa Pastoral where the students stayed during their trip.

groups from the United States. The city of La Romana is unique in that most of the land is owned by Central Romana Corporation and has been one of the largest employers since the early 1900s. The city’s distinctiveness is also evident in the blend of Dominicans, Haitians and Dominicans with Haitian descent who reside there. Spanish and Kreyol are spoken on the street, which is also characteristic of La Romana. On this global health trip, our goal was to evaluate the access to care given to mothers, newborns, children and infants (MNC) within the city of La Romana and the workers in the sugarcane villages – called “batey” or “bateyes.” Our task was to objectively conduct interviews and observational analyses of a series of city hospitals, village clinics, community health workers, community members and the community. Ultimately, we are to produce a thorough qualitative analysis of the gathered knowledge and the factors affecting MNC health care to determine the feasibility of establishing, implementing or enhancing delivery of care through the Care Group Model (CGM). The CGM is a system of community health workers working within the bateyes to establish strong connections with other community leaders, disseminate health education, provide acute care, and serve as the lifeline of the community. Although we were each responsible for different aspects of the assessment, we collaborated and observed each other in our data collection processes, giving each the opportunity to see how all parts of the system function. During the first week, we visited several hospitals, private and public, where Hope and Ronald conducted facility assessments and key informant interviews. For the second week, we went into the bateyes and met with our target population. Nathalie conducted interviews with mothers with newborns and infants, and Sophia interviewed community health workers and community leaders.

of obtaining Dominican citizenship, even though they were born on Dominican soil. In fact, just recently a law was passed in the Dominican court to strip Dominicans of Haitian descent of their citizenship. The bateyes are located in the midst of the sugarcane fields, quite isolated from the closest town, which could be several miles away with little more than dirt tracks for roads. The most popular form of transportation around La Romana is the motorcycle. It is used for family travel as well as public transportation like “moto” taxis. Transporting a sick mother or child out of the batey to the nearest clinic or hospital can be a difficult and dangerous task. This makes the presence of the community health worker with knowledge of basic illness treatment a necessity.

spent on the beautiful Bayahibe Beach, and we took a catamaran boat to Isla Saona, a beautifully serene island off the coast. We took a speed boat on the return trip from Isla Saona and stopped midway at a natural pool in the middle of the ocean. All the passengers were invited to play volleyball and relax in the center on the ocean surrounded by crystal clear water. It was yet another unique and memorable experience in the Dominican Republic. We will never forget the people we met, especially the families in the bateyes and the helpful guides who took us around to each of our destinations. It is our hope that future cohorts from the MPH program who visit La Romana will build on the foundation we had the privilege of laying there and make meaningful the work we initiated through our needs assessment. Ron Sanchez summed it up perfectly in his personal reflection on this trip:

When we had the opportunity, we dined at several different restaurants for a taste of the local flavors. One of our highbrow dining experiences was at La Casita, which was recommended to us by one the doctors we interviewed. We spent our free time exploring La Romana, visiting the Latino Baseball Hall of Fame and an ice cream shop, and shopping for souvenirs, of course. Our first weekend was

My hope is that the region comes together in a unified voice representing all social and economic classes and begins a steadfast battle to improve their access to health care and standard of living, despite the overwhelming control of the sugarcane empire and the government’s lethargic approach to the region. The struggle must come from within the residents of the area in coordination with the various outside organizations that are mobilizing to create sustainable change. As our project continues to grow, we will look to make significant changes in the lives of the people we touched and whose lives have touched us.

Bateyes are where the sugarcane workers from Haiti migrate to live with their families during cutting season; some reside all year long and/or rarely return to Haiti. The bateyes are composed of impoverished housing units clustered around the sugarcane fields and lack the most basic resources such as clean running water, electricity, sanitation, and access to adequate food sources. Among myriad problems, the batey residents are also marginalized and discriminated against. Some migrant workers lack documentation, which in turn can limit access to services such as health care. Furthermore, generations of children born in the bateyes are hindered in the process 9

Findings From the First Universal Lead Screening Program in Jaipur, India By Akshat Jain, MPH, ’15 In fall 2011, together with a group of New York-based physician colleagues, I established the first lead screening program in Jaipur, India. The initiative, called Project AGNI (Anterograde Growth Normalization Initiative), brings together the knowledge of the West with the street smarts of the East to create a safe and a healthy environment for children in India. Lead is a heavy metal that acts as a neurotoxin to which the developing brain is particularly vulnerable. Lead poisoning in children is known to negatively affect brain systems implicated in cognitive, communication and social functioning. Each microgram of lead in the blood reduces the IQ by 1.5 points, and an average level of 8 in a child makes him/her underperform by close to 12 IQ points. Project AGNI took the heavy metal poisoning screening, which is a common practice for children in the developed world, to Jaipur. Scientific analysis of lead levels in the blood (BLL) of children in the city revealed shocking results. The average lead level of more than 40 percent of the children in the growing age group was found to be above the CDC “harmful” or toxic level

Figure 1. Blood Lead Frequency Distribution (Jaipur, 0-18 years)

The average lead level of more than 40 percent of the children [of Jaipur, India] in the growing age group was found to be above the CDC “harmful” or toxic level ...

(Normal <2 , Toxic Level >5). Approximately 54 percent of children had BLL levels of more than 5 micrograms/dl, and 36 percent had BLL of more than 9 micrograms/dl, which is the CDC guideline for harmful lead levels (see Figure 1). These results were found by others around the world during the “gasoline era,” but are uncommon today. In-depth analysis of potential environmental factors revealed culprits ranging from drinking ground water to chemical paints to Ayurveda medications. Efforts are underway to educate the population and raise awareness of the dangers of lead poisoning and sources of contamination.

Improving Access to Care for Children With Developmental Disabilities in India By Akshat Jain, MPH, ’15 Recognizing that there was a tremendous need to improve quality and access to care for Indian children with developmental disabilities, I partnered with local pediatricians and other stakeholders in Jaipur, India, to establish the first comprehensive care center for this population in 2010. Children with developmental disabilities living in rural India were previously mislabeled as “mentally retarded” or “behind” and were subjected to constant criticism from family and peers. With participation from academicians from the local medical school (via Skype), we introduced diagnostic tools such as

the “Indian Autism Score,” diagnostic evaluation, and neurocognitive testing, designed specifically for Indian children with autism and attention deficit hyperactivity disorder. Local stakeholders were involved and empowered to get engaged and sustain efforts in raising awareness about working with children with developmental disabilities. Seminars and teaching sessions for parents, school principals, teachers, pediatricians and pediatric residents were organized across the city to explain the pathology of mental cognitive developmental disorders so as to reduce stigma and inappropriate labeling, and to improve diagnosis and care.

Once every month a Skype consultation is provided to the families that are screened at the Child Development Center – the nodal referral center for a catchment area of more than 200,000 children. Developmental assessment and examination are performed in conjunction with a pediatrician at the other end of the webcam consultation, to provide a diagnosis and chart out a comprehensive care plan for the patient. Once every six months, I conduct training modules for the pediatric house staff – the future workforce of the community – to ascertain that these critical conditions are not missed, once in practice.

One on One with Dr. Omolara Thomas Uwemedimo continued from page 5 global health. And during both their second and third years, they have opportunities to work and apply their skills in a practical way in one of our country sites (Dominican Republic, Kenya, and India). We had four MPH students go this past summer and conduct a needs assessment in the Dominican Republic; they really enjoyed the experience. In addition we’re using the information from the needs assessment to help us with creating a long-term quality improvement project with our partner site hospitals in the Dominican Republic. It’s been a great experience. We’re starting up a Kenya site in January 2014, and India should be ready in July 2014.

What satisfies you the most about your career path, and what motivates you to work in the field of public health?

I think what satisfies me most is being able not only to be a clinician but to think a little broader. However, I think they complement each other. I would say working with children and just being able to have children be an entry point to changing families is an exciting, rewarding, and amazing feeling. Being able to change the direction of a morbidly ill child’s life, as well as the lives of family members, by that child growing, thriving, and possibly being well enough to go to school is exciting. These are things that we as physicians don’t take for granted when we enter and treat illnesses. But I think the other thing is working with local NGOs through public health initiatives to focus on the social determinants of health (encouraging education and youth empowerment). These are the things that I really love about working specifically with children and definitely in global health because the changes you see are so dramatic. Many times we make changes here in the United States that you don’t really see. There you can see a child who is extremely malnourished turn around and be able to thrive and have enough health so that they can go to school – just with a little inpatient

We Are Public Health

hospitalization. These are things that drive me to continue these programs.

What strengths and attributes do you believe Hofstra has to assist students in their development as engaged and influential public health professionals?

I think exactly where Hofstra is located is a great place because there is a need there. There is a medically underserved population right there in the midst, and so having a university there and being committed to working in programs that will benefit the community is one of the biggest strengths of Hofstra. There is such diversity in the student body, and diversity among those who are actually going to make the changes is extremely important to the programs that are created. I think also in terms of learning for Hofstra students and during their classes, they are able to exchange cultural influences and differences and how that affects their health sciences and the ways they deliver programs is beneficial. It’s really important for public health students to think about and to reflect on the fact that we’re not treating a homogenous population; we’re treating an extensively diverse population here in the United States. Specifically in New York, I think that is a major strength of Hofstra and the student body. Also the alliance with North Shore-LIJ makes it a much stronger experience for Hofstra students in terms of being more embedded in a health system that serves such a widely distributed area with such a diverse population.

What characteristics do you believe a student pursing public health should have?

Passion! I think public health is not the sexiest career that people hear about. I say that jokingly, but I also say it because it’s not a career a lot of people think about. I think it’s really important to have passion and a drive even though the pay may not be that

great and the working conditions may not be great. I also think there needs to be a specific interest in getting out into the community and working with people. Being a people person is extremely important in public health. We have our biostatisticians and epidemiologists, but definitely it’s strengthened so much by the ability to use experiences with the population and work with the community. I think it’s extremely important to have that ability and have that strength. I would say the last thing is being able to have a creative mind. The creativity piece is the fact that most public health interventions that have been wildly successful are those that stood out from the norm. Having the ability to see the problem and think creatively about a wide array of different ways that that problem can be addressed are extremely important skills for a public health professional.

In the coming years, what global health issues do you think are going to be of predominant concern?

I would definitely say being able to address access to health care for a diverse population. I think we’re seeing more of a gap between the extremely rich and the extremely poor. We are seeing less and less of the middle class. Due to that gap, we are seeing many more people who are not able to access health care effectively. I think ultimately a big issue is going to be finding the populations that are medically underserved and figuring out the best way that we can bring them care. I think the other big issue, in the sense of children’s health and education, is how to integrate health into school. Education is probably one of the best ways that we can get children into public health interventions. Specifically, obesity is a big issue, and we need to figure out how we can work with educational institutions to address child health issues. In addition, trying to figure out how to address immunizations, or lack of vaccinations, is a persistent problem, in terms of parents refusing to vaccinate their children.

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University with a strong background in leadership, she feels that Hofstra will allow her to grow and explore her interests in epidemiology and biostatistics. Taleen Bolbolian (MPH, ’15) hopes to become a physician and has a desire to gain knowledge and skills about how to care for both individuals and populations. Her main interest is in improving access to mental health care. A physician by profession, Julie Krystal (MPH, ’15) is looking to develop

skills that will help her understand health care on a broader scale. She hopes to contribute to a greater quality of care for patients. Debra Choinski (MSCH, ’15) wants to improve the health of diverse local communities in the tri-state area by creating education and disease prevention programs. These students, together with their peers, comprise the 36 students new to the MPH (19 students) and MSCH (14 students)

programs this year. The new cohort is quite diverse in terms of experience, discipline, interests and backgrounds; our international students from China, Pakistan and India bring a strong global health focus to the program. The Class of 2015 is an exciting, passionate group who will help to redefine health and health care during this time of great change in the United States. Clearly, the group’s collective answer to the question “Who are you?” is “We are public health.” 11

Global Brigades: Health Promotion in Panama By Bakhtawar Bajwa, MPH, ‘15 On the morning of May 25, 2013, 36 students traveled to Darien, Panama, as part of the Stony Brook Global Medical Brigades team. Our brigade was to last for seven days, providing basic health care for the communities of Nicanor and Embera Purú. Global Brigades is a student-based organization with chapters based all over the United States, Canada, U.K., Ireland, Germany and Switzerland. Its initiatives are widespread – from medical, dental, and public health to brigades that focus on microfinance, architecture and business. Currently, Global Brigades works in Ghana, Honduras, Nicaragua and Panama. The preparation for our brigade to Panama had been going on for the entire school year. Students had gathered enough resources to collect medical donations to provide for all of the patients that would be seen on the brigade. In addition to the one U.S. doctor going with us, we had two Panamanian physicians, one dentist, two pharmacists and an EMT. Split up into five days, the brigade started off with the sorting of all the medical supplies, including dental supplies, vitamins, anesthetics, painkillers and a variety of other medicines. With the help of the pharmacists, we prepackaged all medications for use at the clinics in our communities. One standard dental package containing toothpaste and a toothbrush was made for every member of both communities. In addition to the dental supplies, every member of the community was given a small supply of vitamins to be incorporated into their diets.

Image credit: Renjith Krishnan

As our brigade finally took off – after some long, strenuous hours of medicine sorting – the students were assigned to different stations of the clinic ranging from triage, consultation, dental, pharmacy and data informatics, which is important in keeping records of all the patients seen on the brigades. In addition to the clinic, a separate public health effort was being implemented, which involved the construction of five latrines throughout the community of Embera Purú. Building of the latrines was a public health effort that went further than simply educating the communities about their health. It provided a step toward sustainability, which is difficult to achieve in volunteer trips that last only a few days and provide medications that won’t go beyond the time frame of six months at a time. Split into five groups for this public health initiative, we were able to build five latrines from the base up with the help of the Panamanian engineers provided to us

by Global Brigades. The work was labor intensive and dirty and lasted for long hours under the scorching sun. However, the effort of building these latrines had an impact on both the volunteers and the community members that goes far beyond our imaginations. There is the evident result of having proper sanitation provided via the compost latrine that is above ground, feasible for any waterlogged area. In addition to the sustainability factor of building compost latrines, the building effort by volunteers was a way to interact with the families in the community. From morning until evening, we spent our time with the families, just outside of their wall-less houses, building the latrines not just for them, but with them. In the process, most family members, including children of all ages, joined us in our efforts and helped with tasks such as mixing cement. This is where the true connection happened. Even with the language barriers, we were able to observe the lifestyle of this small community thousands of miles away from the city life, the food they ate, and their social activities. How a community runs, how the people interact with one another, and how they care for each other are all aspects that lie at the root of all public health efforts. Building a latrine for one family turned into building a relationship with the entire community, essentially opening doors for future health care efforts.

Helping to Heal in Muzaffarpur, India By Rahul Sinha, MD; MPH, ’14 Waking up every morning and finding out that there is someone in poor health waiting outside the house to be seen by you, someone who is hoping to get some free medication to relieve their suffering, had become routine for me. Soon I realized that most of them needed specialized care, which was available in the far away regional referral center, but was inaccessible to many because of limited information and lack of proper public transportation and roadways. One morning, I met an old man who reached my house after traveling a few miles on bicycle with someone’s help. He had

elephantiasis with severe secondary skin infection, requiring intensive wound care and medications. He had been suffering from this illness for a long time, but he could not afford the medical care. Slowly, his immediate family members had distanced themselves from him, as they perceived his illness as a communicable disease.

strong commitment to help people in need, which started at my house and slowly spread into the community. Ultimately, I decided to take a few ill patients with me each day and bring them back and forth to the hospital. This simple intervention at the individual level changed many lives, including that of the old man with elephantiasis.

At that time I was working at the regional government referral hospital, where the co-payment was approximately 10 cents (USA $ equivalent) and all services, including medications, were free. Every day, I commuted from my village house with

Having a good transport system is important for delivering quality care. Improving the overall infrastructure in a developing economy like India is important for better access to health care and thus improving health and quality of life!

To learn more about Hofstra’s MPH and MS in Community Health programs and to find out about upcoming events and view archived webinars, please visit hofstra.edu/Academics/Colleges/healthscienceshumanservices. You can also email Corinne Kyriacou, PhD, MPH, associate professor and director, MPH and MS in Community Health programs, at corinne.m.kyriacou@hofstra.edu.

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