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Mount Sinai Global Health ‌committed to closing the unconscionable gap in global health

Photo credit: Š Miki DUISTERHOF. Mikiduisterhof.com

2013 Annual Report


We dedicate this annual report to all the individuals around the world who are in need—of medical care, of compassion, of justice. It is to them we commit our lives. And we are so very grateful to our supporters who make our work possible. We could not carry out our important mission without you. Thank you! - The Mount Sinai Global Health Team


Letter from the Dean I am most pleased to present to you our 2013 Annual Report. This year’s report focuses on the disparities in the healthcare workforce across the globe. Mount Sinai Global Health remains steadfast in our mission to close the gap in global health by educating our physicians and medical students and by training local healthcare workers and building partnerships in underserved communities around the world. We’ve included in this report some stunning world maps that starkly reveal these disparities. The map of the bloated African continent on page 6 representing maternal deaths stands in sharp contrast to its emaciated counterpart on page 7 indicating the extreme shortage of doctors and nurses in the same region. Without sufficient numbers of trained workers, our march into the 21st century will be marred by deepening inequality and increasing vulnerability among the already marginalized. During the past year, we sent more than 50 students, 20 residents, and 30 faculty members on medical and training missions in more than 20 countries around the world. With the support of Dennis Charney, MD, Dean of the Icahn School of Medicine at Mount Sinai, we launched a five-year Dean’s Scholars in Global Health program to support two Mount Sinai incoming medical students each year. These students will earn a master’s degree in public health and devote one additional year of medical school to an advanced field experience. This year, we also awarded four researchers with Innovation Fund seed grants, including a seed grant highlighted on page 13 to make climate change a priority focus of our program. Our Human Rights Program continues to gain momentum. Human Rights Director Holly Atkinson conducted an investigation into a massacre of school children in Myanmar (Burma) in April, spotlighted on page 15, that has received worldwide attention and has significantly informed US foreign policy. Human Rights Deputy Director Annie Sparrow has launched a study, funded by the Global Health Innovation Fund, to quantify the ‘collateral damage’ of war through examination of Syrian refugees’ health outcomes following exposure to multiple human rights violations. Both Dr. Atkinson and Dr. Sparrow were among 55 eminent signatories on an Open Letter published in the prestigious journal The Lancet, calling for an immediate international response to the grave humanitarian crisis in Syria. Dr. Sparrow’s subsequent media appearances about the Syrian situation earned extensive recognition for Mount Sinai Global Health.

“Mount Sinai Global Health remains steadfast in our mission to close the gap in global health by educating our doctors and medical students and by training local healthcare workers and building partnerships in underserved communities around the world.” -Dr. Phil Landrigan, Dean for Global Health; Ethel H. Wise Professor of Preventive Medicine; Chairman, Department of Preventive Medicine; and Director, Children’s Environmental Health Center

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Mount Sinai Global Health We are deeply committed to closing the unconscionable gap in global health. In so doing, we save lives, transform vulnerable communities, and bring about enduring social change.

Mission

Four Pillars We accomplish our mission by: 1.  Producing the next generation of leaders in global health by inspiring and training medical students, public health students, residents and fellows in the discipline of global health, as well as training local healthcare workers through transformative partnerships. 2.  Providing direct patient care to marginalized and underserved people around the globe. 3.  Identifying sustainable solutions to critical global health problems by conducting rigorous research. 4.  Advancing human dignity and social justice by promoting, protecting and fulfilling human rights.

“The Global Health Residency Track (GHRT) is one of the main reasons I chose to train at Mount Sinai. It is also one of the main reasons I chose to stay on as faculty after residency. The GHRT has far exceeded my expectations and provided me with indispensable tools to better understand the nuances of working with culturally diverse underserved populations. I look forward to continued active involvement with the program for years to come.” – Dr. Hiwot Woldu, psychiatric Global Health Residency Track alumna

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Our Worldwide Reach‌

Since its inception in 2006, Mount Sinai Global Health has partnered with communities in 46 countries and touched tens of thousands of lives. At Mount Sinai Global Health, our work is driven by the needs of our partner communities and not by external scientific, political or financial agendas. We strive to build partnerships among people who have — people who have a vision, have wisdom, have determination, have community, have knowledge, have technical skills, have finances, have generosity. In the effort to reduce global suffering and bring about equity in health, everyone’s assets contribute to the shared vision.

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Photo credit: © Miki DUISTERHOF. Mikiduisterhof.com

“I don’t know what your destiny will be, but one thing I know: the only ones among you who will be really happy are those who will have sought and found how to serve.” - Dr. Albert Schweitzer

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The Gap in Global Health It will take a lot to tackle the world’s health issues: cutting-edge biomedical technologies, new drugs and vaccines, innovative delivery strategies for life-saving interventions and, not least, money and political will. But at Mount Sinai Global Health we know that the foundation of any successful global health strategy is people. It will take a generation of dedicated and idealistic scientists, philanthropists, policy makers, engineers, lawyers, activists and, of course, healthcare workers, to reduce the unconscionable gap in global health. At Mount Sinai Global Health, we have embraced the responsibility of preparing a new generation of healthcare workers. Training is an essential component of all our endeavors. And here is why. Below is the world map as we traditionally see it, with the area of each country reflected by its land mass. But there are other ways to look at the map of the world (see next page).

Land Mass

Š Copyright Sasi Group (University of Sheffield) and Mark Newman (University of Michigan)

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Maternal Deaths

© Copyright Sasi Group (University of Sheffield) and Mark Newman (University of Michigan)

Here we see the map distorted to reflect each country’s distribution of maternal deaths — the numbers of women dying as a result of complications during pregnancy or childbirth. It is not difficult to see that Africa and South Asia are swollen to reflect the disproportionate numbers of maternal deaths that occur in these regions. A major reason for the grossly unequal distribution of maternal deaths is shown on the map on the facing page: the grossly unequal distribution of doctors. •T  he World Health Organization (WHO) estimates that 167,000 more physicians are needed in Sub-Saharan Africa to give adequate care to mothers and newborns. •C  ountries in the WHO South-East Asia region suffer 29% of the global burden of disease but have only 11% of the world’s supply of physicians (and just about 1% of world health expenditures). •T  he WHO African Region experiences 24% of the global burden of disease, while having only 2% of the global physician supply (and less than 1% of global expenditures). •I n Liberia, there are only three pediatricians in a country that is home to two million children. • In Uganda, there are 75 surgeons for a population of 30 million people.

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Distribution of Doctors

© Copyright Sasi Group (University of Sheffield) and Mark Newman (University of Michigan)

These realities drive our training program, giving us reason to not only train Mount Sinai trainees, but also to offer our training services to local populations in the most impoverished and under-resourced communities in the world. Mount Sinai Global Health’s dual-training agenda represents a sustainable, practical and long-term approach to the crucial problem of physician availability in the developing world. First, we train global health physicians in the U.S. to become professionals who will take responsibility for the world’s most vulnerable population—both in US, and abroad. Second, we train healthcare workers—doctors, nurses, midwives, lay community health workers—in the very communities across the globe that have the greatest need, the worst health statistics and the least access to health professionals. We help these communities to become independent and empowered to take responsibility for their own health. In so doing, we strive to create a healthier map of the world.

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Training

Photo credit: Anu Anandaraja

Clinical supervisor Mr. Pinho teaches Traditional Birth Attendants in Mozambique.

“My time in Mozambique was one of the most formative experiences during medical school. It challenged me in entirely unique ways and exposed me to things I would never have seen otherwise. The Global Health summer experience allowed me to gain greater insight into medical practices in very rural environments; the contrast this experience provided also shed light upon the specific ways we practice medicine in New York.� - Alina Fomovska, medical student who completed the summer program in Mozambique Since 2009, under the leadership of Dr. Anu Anandaraja, Mount Sinai Global Health has been working in Mozambique’s Gorongosa National Park. The Gorongosa region is very remote and isolated, where women and children are marginalized, where there is one doctor for a population of 250,000, and where communities live many hours from the closest hospital and may have to cross crocodile-infested rivers to get there. This is a population where one in five children will die before they reach the age of five, and where more than 80% of women gives birth alone at home, rather than at a hospital, leading to high rates of death among mothers and newborn babies. Now, partnering with the local government and UNICEF, Mount Sinai Global Health has helped to train 23 community health workers and 30 traditional birth attendants. These women and men are recruited directly from these communities; they are then trained, equipped with medicines and equipment, and return to their communities to educate and care for their own people. All activities of the Mount Sinai Global Health Training Program have been generously supported by John and Jody Arnhold, The Mulago Foundation and the Peter and Carmen Lucia Buck Foundation. A special thank you to Judith and John Hannan and the Recanati family who have made the development of the Mozambique Gorongosa project possible through their generous donations.

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Spotlight: Training in Mozambique Training Outcomes:  Mount Sinai Trainees: 15 students, 3 residents and 3 fellows Local Health Workers: o 32 Traditional Birth Attendants (TBAs) from 6 communities o 23 Community Health Workers (CHWs) from 13 communities

Health Impact: In the first 9 months of the Traditional Birth Attendant program‌ o  More than 3,500 people were reached with educational health messages about family planning, safe birth, domestic violence, nutrition, and HIV/AIDs prevention and treatment o The proportion of births in hospital vs. at home rose from 16% to 49% o 436 pregnant women were reached with antenatal care o There were no maternal deaths

In the first 3 months of the Community Health Worker program‌ o 20,000 individuals were reached by CHWs through home visits o 5,576 patients were treated by CHWs o 1,770 patients were transferred for more advanced care by CHWs

Photo credit: Tal Recanati

Medical student Alina Fomovska interacts with Traditional Birth Attendants in Mozambique.

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Patient Care OUR PATIENT CARE MISSION is to reduce health disparities by providing medical, surgical and preventive services in communities around the world that do not have access to quality healthcare. Building on the ideals that have informed the work of Mount Sinai since its inception over 150 years ago—medical excellence, social responsibility and community service—Mount Sinai Global Health achieves its service mission by partnering with local communities and institutions on the delivery of direct patient care and health promotion programs. Our patient care program, led by Dr. Ramon Murphy, is closely integrated with the other pillars of Mount Sinai Global Health: the education of local healthcare providers builds capacity and independence among our partners, rigorous research informs our standards of practice, and the moral imperative to uphold human rights shapes our programming and sustains our commitment.

Photo credit: Hans Dethlefs

Mount Sinai medical students Ericka Jaramillo, Joseph Leanza, Sonia Jarrett, Benjamin Massenburg enjoyed spending time in the Dominican Republic with local children, who sang traditional song for them.

“I am extremely grateful to the Mount Sinai Global Health for helping me acquire the skills, experience, and extraordinary mentorship to collaborate with a global community and address the health needs of its children in a meaningful and sustainable way. I hope to continue collaborating with Mount Sinai Global Health for many years to come.” - Dr. Alex Leader, 2013 Global Health Residency Track alumna who completed her fieldwork at our site in Santiago, Dominican Republic and is currently chief resident in the Department of Pediatrics

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Spotlight: Patient Care Across the Globe GLOBAL: MENTAL HEALTH Global mental health needs are massive and are too often neglected. Mount Sinai Global Mental Health brought about a major improvement this year by successfully advocating to amend the World Health Organization’s Model List of Essential Medications to include the anti-psychotic medication, risperidone. This list powerfully influences how countries select medications to stock their public health systems’ pharmacies. Thanks to our team, tens of thousands of patients the world over will now have access to risperidone. The inclusion of this critical anti-psychotic medication indicates significant progress in recognizing the importance of meeting the mental health care needs of the world’s population. The consideration of adding risperidone arose from listening to colleagues in our partner countries and observing the shortage of adequate anti-psychotics in so many places. The submission effort was led by Ms. Jasleen Salwan, a rising second year medical student at Mount Sinai, Dr. Hiwot Woldu, who recently completed her psychiatric residency and is now a faculty member at Mount Sinai, and Dr. Anna Rosen, Assistant Clinical Professor in the Department of Psychiatry.

In 2012, thanks to a generous donation from Rhoda Herrick, Mount Sinai Global Health launched a new multi-disciplinary collaboration in the Dominican Republic.

DOMINICAN REPUBLIC: EMERGENCY MEDICINE 12,000: The number of children who have been screened using the new emergency room triage protocol developed and implemented by Mount Sinai pediatric and emergency medicine residents for the Pediatric Emergency Department at Arturo Grullón Children’s Hospital in the Dominican Republic. Photo credit: Suzi Bentley

Pediatric resident Dr. Alexandra Leader monitors a toddler in the Dominican Republic.

NEW YORK CITY: HURRICANE SANDY RELIEF 151: The number of Mount Sinai physicians, nurses, residents and medical students who helped staff five clinics and two mobile clinics in the areas of New York devastated by Hurricane Sandy. Mount Sinai was one of the leaders in providing volunteer medical professionals to address the crisis.

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Research OUR RESEARCH MISSION is to support innovative research projects that yield evidencebased discoveries that have lasting impacts on the most vulnerable populations and marginalized communities both here and abroad. Our research endeavor, led by Dr. Jagat Narula, has four primary goals: to track global patterns in the spread of disease; to identify risk factors that can be targeted for prevention of disease; to train and enable our global partners to effectively carry out research in their own communities; and ultimately, to transform the knowledge gained into sustainable health solutions for at-risk communities. Translating new research findings into health solutions and scaling them up in multiple communities around the world can save hundreds of thousands of lives and contribute to increased well-being globally. In 2012, the Global Health Innovation Fund provided funding for 4 pilot research projects: Development of a new Climate Change and Health Program – Perry Sheffield, MD, MPH    A forward-thinking initiative to create a research-based collaborative program that focuses on the link between climate change and health. Assessment of Human Rights and Health Outcomes in Syrian Refugees, Beirut, Lebanon –   Annie Sparrow, MD  A pilot study examining the longitudinal impact on civilian health following exposure to multiple violations of fundamental human rights and international humanitarian law. Planning of a Collaborative Center in Environmental and Occupational Health for Latin   America, Brazil – Luz Claudio, PhD and Frederico Peres, PhD  A joint program between Mount Sinai and the Oswaldo Cruz Foundation (Fiocruz) to provide expert-level training to the next generation of environmental and occupational health researchers in Latin America. Cooperadora-Administered Surveys to Identify Rural Women in Need of Gynecologic   Surgery, Santiago Dominican Republic – Taraneh Shirazian, MD  A community-based research project to test the feasibility of using an easy-to-administer tool for local healthcare workers to identify women in low-resourced communities who are in need of gynecologic surgery.

“My year at the Chulabhorn Research Institute in Thailand stoked my passion for global health, for collaborative research, for recognizing a problem and conceptualizing the work that may help generate a solution. This energy will fortify me in the future, both in global health endeavors and in my day-to-day work as a physician dedicated to closing gaps in human health.” - Molly Tolins, a fourth year medical student who recently completed a Scholarly Year at the Chulabhorn Research Institute in Thailand where she focused on environmental toxicology research.

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Spotlight: Research on Climate Change

Photo credit: Anthony Berger

Dr. Perry Sheffield leads a focus group discussion with local medical professionals at the “Health Effects of Heat in Relation to Climate Change” workshop in Ahmedabad, Gujarat, India. Climate change has been called the “the biggest global health threat of the 21st century.”* Dr. Perry Sheffield has been working to create a Mount Sinai research portfolio to better understand and reduce the impact of climate change on vulnerable populations. In addition to collaborating with a large team of US and Indian scientists to develop the first heat wave response plan in India, she also mentors medical and public health students examining the relationship between increasing temperature and its potential contribution to an epidemic of kidney disease in agricultural workers in Nicaragua. Dr. Sheffield has been the recipient of a Global Health Innovation Fund award in both 2012 and 2013.

*C  ostello A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. The Lancet, Volume 373, Issue 9676, 16–22 May 2009, Pages 1693-1733.

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Human Rights OUR HUMAN RIGHTS MISSION is to advance health, dignity and justice both locally and globally by inspiring and training health care professionals to protect, promote and fulfill human rights. We carry out this mission through teaching the human rights framework, conducting research on human rights violations, providing clinical service to victims of torture and other human rights violations, and engaging in advocacy to bring about institutional change. We seek to dismantle the “structural violence” that so profoundly contributes to human disease and suffering. The program combines the academic strengths of teaching and research with a strong commitment to engaging in community service and advocacy for the most vulnerable among us. Our work is both inspiring and indispensible. Medicine can help heal the world; medicine in service of human rights can help transform it.

“Being a part of the human rights community and helping build human rights programming at Mount Sinai has truly shaped me as a future physician. It has defined the values that I will strive to embody and practice as a doctor, and it has provided me with a concrete framework with which to think about equity, justice, and access to resources in the broader context of medicine.” -Salina Bakshi, Alpha Omega Alpha, award-winning 4th year medical student

Photo Credit: Heim Aung

A woman fleeing anti-Muslim violence that broke out in March 2013 in the city of Meiktila, located in central Myanmar, takes refugee in an IDP camp outside of town.

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Spotlight: Human Rights Abuses in Myanmar and Syria Dr. Holly Atkinson, Director of the Mount Sinai Global Health Human Rights Program, conducted a human rights investigation in Myanmar (Burma) earlier this year in cooperation with Physicians for Human Rights (PHR). The PHR report Massacre in Central Burma: Muslim Students Terrorized and Killed in Meiktila details the results of the investigation into the March attacks on Muslim students, teachers, and residents in the Mingalar Zayyone quarter of Meiktila, a town in central Myanmar. The boarding school, which housed 120 students as young as 11, was set ablaze and destroyed; the attacks and killings continued after police officers forced children and residents to come out from hiding. Innocent children and adults were humiliated, beaten, and killed with complete impunity. Dr. Atkinson has presented the findings to the State Department, Congressional committees, White House staff, UN bodies and non-government organizations. She and her PHR colleagues are pressing for human rights investigators, journalists, and humanitarian workers to have unfettered access to Myanmar; increased protections for ethnic and religious minority groups; and withholding of security assistance until the Burmese government establishes full accountability for its security forces. Dr. Annie Sparrow, Deputy Director of the Human Rights Program, traveled to Lebanon and Turkey in August and September to launch a population-level study of 2,000 households of Syrian refugees to assess linkages between human rights violations and adverse health outcomes. Her retrospective survey will quantify specific human rights violations and document the health status of Syrian refugees over the period since the

Photo credit: Heim Aung

Former boarding school in Meiktila, where students and teachers were massacred. beginning of the conflict. Survey results are expected to provide evidence of the impact of human rights violations on the health status of refugees and lay the foundation for extensive outreach and advocacy. The findings will be used also to build the legal and moral arguments for humanitarian intervention and to advocate for the opening of cross-country borders to ensure the secure transport of aid workers and peacekeeping forces, food, fuel, medicines, medical supplies, and technical support, and—with more vital support in place—mitigate the flow of refugees. By quantifying the impact of the conflict on health outcomes, this research has the potential to transform common perceptions of refugees and redefine them as “ordinary” people who are the targets of human rights violations (rather than as a targeted, specifically persecuted group), as well as to demonstrate how a middle class country can be plunged into poverty as a result of the systematic abuse of human rights. A special thank you to Don and Georgia Gogel and to Michael and Laura Fisch, who have made the work of the Human Rights Program possible through their generous donations.

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Photo credit: Annie Sparrow

One of the more than one million child refugees driven from Syria by the on-going civil war, this 3-year old sits in a tent in the Bekaa Valley in eastern Lebanon about 20 miles from the Syrian border clutching his UNICEF vaccination record. Since the war began two years ago, he has missed his 1-yearold vaccination and every other one he should have had since that time.

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Mount Sinai Global Health Faculty and Staff Dean for Global Health; Ethel H. Wise Professor of Preventive Medicine; Chair, Department of Preventive Medicine; and Director, Children’s Environmental Health Center Philip Landrigan, MD, MSc Associate Dean for Global Health and Director of Research; Philip J. and Harriet L. Goodhart Professor of Medicine and Cardiology; and the Director of Cardiovascular Imaging Program Jagat Narula, MD, PhD, FACC, FAHA, FRCP Director of Training; Assistant Professor of Pediatrics and Medical Education Anu Anandaraja, MD, MPH Director of Patient Care; Professor of Clinical Pediatrics; Director of Uptown Pediatrics; Vice-Chair of the Department of Pediatrics in Voluntary Affairs; and Director of Off-Site Pediatric Residency Programs Ramon Murphy, MD, MPH Director, Human Rights Program; Assistant Professor of Preventive Medicine and Medicine Holly Atkinson, MD, FACP Associate Directors Sigrid Hahn, MD, MPH Nils Hennig, MD, PhD, MPH Jonathan Ripp, MD, MPH Annie Sparrow, MD, MPH Faculty Suzanne Bentley, MD Craig Katz, MD Global Health Program Manager Elena Rahona, MS Training Program Manager Renee Bischoff, MPH, MSW

Program Administrator Jessica Jade Batista, BA

The Mount Sinai Global Health Team: (back row) Nils Hennig, Phil Landrigan, Jon Ripp, Ben Bristow; (middle row) Jagat Narula, Holly Atkinson, Ramon Murphy; (front row) Jessica Batista, Renee Bischoff, Annie Sparrow, Anu Anandaraja, Sigrid Hahn, Suzanne Bentley, Elena Rahona.

Photo Credit: Kerry Kehoe

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Photo credit: Holly Atkinson

Letter from the Chair of the Advisory Board As I look back over the past year, one of the things I am most proud of is my continued association with Mount Sinai Global Health. It has been my great pleasure to welcome Dr. Cecilia Artacho Oh and Kenney Oh, Yelin Song and Bert Chan, Lori Finkel and Amy Robbins Towers to our group. With their help, the advisory board is even better positioned to offer informed expertise and vision to the flourishing program. The expansion of our advisory board mirrors the growth of the program itself, which is deepening its research, training, patient care, and human rights advocacy in flagship sites of Mozambique, the Dominican Republic and Haiti. As the program continues to expand, I have no doubt that the collected talents and insights of our advisory board members will assist Mount Sinai Global Health’s ability to close the unconscionable gap in health around the world. We would also like to thank all those who have given their time and financial support. We hope you will continue to take an interest and follow the great work being done by the Mount Sinai Global Health team. With your help we can educate the next generation of global health leaders and provide better health care for all.

Tal Recanati

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Thank you to our generous

Advisory Board Sheena and David Danziger Lori B. Finkel Judith and John Hannan Kathy Kivelson Hecht Susan Kasser Andrea and Matthew Lustig Alison Mass and Salvatore Bommarito Cecilia Artacho Oh and Kenney Oh Holly Peterson Tal and Ariel Recanati Yelin Song and Bertrand Chan Elizabeth Stern Amy Robbins Towers Dena K. Weiner and David Rozenholc

Thank you to our Faculty Advisors Ernest Benjamin, MD Paolo Boffetta, MD, MPH Daniel Caplivski, MD Luz Claudio, PhD Ebrahim Elahi, MD Stephanie Factor, PhD, MPH Jeffrey Freed, MD Valentin Fuster, MD Adolfo Garcia-Sastre, PhD Braden Hexom, MD Jennifer Jao, MD David Muller, MD Peter Palese, PhD Lise Rehwaldt, MD Ram Roth, MD Michail Shafir, MD Perry Sheffield, MD Taraneh Shirazian, MD Lester Silver, MD Rajesh Vedanthan, MD Christina Wyatt, MD

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The Importance of Philanthropy Thanks to the generous founding support of The Mulago Foundation and our other philanthropic partners, Mount Sinai Global Health continues to powerfully address the global gap in health by bringing the finest in training, patient care, research and advocacy to the world’s most impoverished populations. With your help, our goal is to ultimately make ourselves obsolete in these communities by empowering individuals and populations to care for themselves. Since 2007, the generosity of our supporters has helped us affect the lives of tens of thousands of people around the globe. We have trained over 500 students, residents and fellows who have made an enduring commitment to global health. We have quadrupled the number of international sites at which we conduct fieldwork. We have trained more than 850 local healthcare workers at sites around the world and granted hundreds of thousands of research dollars to innovative research on five continents. In the short time since our founding, Mount Sinai Global Health has become a beacon in the field and positioned Mount Sinai as a leader in worldwide health improvement. And yet, so much more remains to be done. The realities of the enduring disparities in health across the world are unconscionable. By investing in people — trainees, researchers and local health workers worldwide — as well as by conducting research, providing direct care, and advocating for human rights, we magnify our impact on a global scale and work towards sustainable solutions. Join us in securing a healthy and hopeful future for our globe’s most vulnerable communities.

Photo credit: Molly Tolins

A group of children in Thailand provided saliva samples for analysis of arsenic levels, DNA repair enzyme levels, RNA extraction and DNA extraction as part of a Mount Sinai research study on environmental toxins and child health.

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Financials July 1, 2012 – June 30, 2013 Contributions July 1, 2012 - June 30, 2013 Institutional Support 20%

Individuals/ Family Foundations 53% Foundations/ Corporations 27%

Total Contributions $1,297,128

Expenses July 1, 2012 - June 30, 2013 Research Grants 4% Operational 4%

Educational Programs 21%

Partner Site Development 10%

Faculty and Researchers 61%

Total Expenses* $1,393,543

* The difference between contributions and expenses was covered by unspent funds from the previous year.

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Below are examples of how your generosity can make a difference in the lives of people worldwide! $50,000 Support the Mozambique Community Health Worker Project for one year In a country where one in five children dies before the age
of five, Mount Sinai Global Health’s community health worker project is dedicated to training Mozambican women and men to prevent, diagnose, and manage the major childhood killers—malaria, diarrhea, and pneumonia—in their remote villages. Mount Sinai faculty, students, and residents support the training of dozens of local community health workers annually, who in turn serve the local region of more than 50,000 people. $25,000 Sponsor Mount Sinai Global Mental Health’s activities for one year Mount Sinai Global Mental Health serves populations where access to mental health care is highly underdeveloped, including Liberia, India, Belize, St. Vincent and the Grenadines, and Haiti. The program has established psychiatric consultation services
in a Liberian hospital with no prior psychiatric care, started Alcoholics Anonymous groups where there was no support for substance abuse, and is now working to provide access to mental health services in rural villages in India and in a Haitian orphanage. $10,000 Purchase a portable ultrasound machine for use at maternal health sites across Africa and Latin America
 A gift of $10,000 will purchase a portable ultrasound machine, used in obstetric care and gynecological surgery, to improve womens health at Mount Sinai Global Health sites around the world. Our work focuses on vulnerable populations, particularly women and children, where access to hospitals and equipment is extremely limited or nonexistent, making portable equipment indispensable. $5,000 Support a resident or student completing clinical work and research around the globe Few of the more than 16,000 doctors graduating annually from US medical schools are trained to address the special needs of populations living in poverty. However, Mount Sinai Global Health believes that every medical school graduate has a responsibility to advocate for these populations. Our global health curriculum identifies idealistic and committed trainees and prepares them to become global health leaders in the countries and communities that need them most. $1,000 Purchase simulation equipment for use in the Dominican Republic The core of Mount Sinai Global Health’s work in the Dominican Republic is building local healthcare capacity through partnerships with hospitals, clinics, schools and community centers. A gift
of $1,000 will purchase simulation equipment, namely a mannequin or torso, to be used for teaching critical CPR skills and running mock patient cases with local healthcare workers in the Santiago region. To learn more about these options or to discuss your interests, please visit philanthropy.mountsinai.org/globalhealth or contact Lauren Merkley, Associate Director of Development at 212-731-7442 or lauren.merkley@mountsinai.org.

Our Wish List

Photo credit: Allison Devia

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Selected Publications by the Global Health Team Bansilal S, Vedanthan R, Woodward M, Iyengar RL, Hunn M, Lewis M, Francis L, Charney A, Graves C, Farkouh ME, Fuster V. Cardiovascular Risk Surveillance to Develop a Nationwide Cardiovascular Health Promotion Strategy: The Grenada Heart Project. Global Heart 2012; 7(2):87-94. The Grenada Heart Project aims to study the clinical, biological, and psychosocial determinants of the cardiovascular health in Grenada in order to develop and implement a nationwide cardiovascular health promotion program. We conducted a survey of cardiovascular risk factors among a nationally representative sample of adult Grenadians. Prevalence of cardiovascular disease risk factors were: overweight and obesity–57.7% of the population, hypertension–29.7%, physical inactivity–23.4%, diabetes–13.3%, hypercholesterolemia–8.6%, and smoking–7%. This randomly selected adult sample in Grenada reveals prevalence rates of obesity, hypertension, and diabetes significantly exceeding those seen in the United States.

Blanas DA, Ndiaye Y, Nichols K, Jensen A, Siddiqui A, Hennig N. Barriers to community case management of malaria in Saraya, Senegal: training, and supply-chains. Malaria Journal 2013;12(95):1-7. This article examines communities’ perceptions of a new community case management of malaria program in Senegal that uses lay healthcare workers to deliver rapid diagnostic tests and new antimalarial medications to rural villagers. The paper describes how early problems with shortages were resolved, although there is an ongoing need for training among the community health workers.

Jao J, Wong M, Van Dyke RB, Geffner M, Nshom E, Palmer D, Muffih PT, Abrams EJ, Sperling RS, LeRoith D. Gestational Diabetes in HIV-infected and -uninfected Pregnant Women in Cameroon. Diabetes Care. September 2013, Vol. 36, No. 9, e141-e142. This article highlighting a largely ignored disease—gestational diabetes, or diabetes in pregnancy— and its increasing prevalence Africa has been published in Diabetes Care. This study was conducted in Cameroon at Mount Sinai Global Health’s partner site, the Cameroon Baptist Convention Health Services consortium, and found that the prevalence of gestational diabetes in Cameroon is similar to that found in advanced economies.

Sollom R. and Atkinson H. Massacre in Central Burma: Muslim Students Terrorized and Killed in Meiktila. Physicians for Human Rights, May 2013. This report documents the anti-Muslim violence that took place in Central Burma in late March 2013. At least 20 children and four teachers were killed during organized attacks against a school, mosque and residential area. The investigative team conducted interviews with eyewitnesses as well as other key community members with intimate knowledge of the attacks. The report provides policy recommendations for the Burmese government and the international community for addressing on going human rights violations against the Burmese Muslim community.

Winer RA, Morris-Patterson A, Smart Y, Bijan I, Katz CL. Knowledge of and attitudes toward mental illness among primary care providers in Saint Vincent and the Grenadines. Psychiatric Quarterly. 2013 Feb 3 (Epub ahead of print). The article examined the knowledge of and attitudes toward mental illness among primary care providers in Saint Vincent and the Grenadines (SVG). Results demonstrated that healthcare providers did think mental illness should be a healthcare priority and had a number of ideas for strengthening the attention given to mental illness in their district health clinics, including additional staff training and scheduling designating mental health clinic days. These findings will provide a basis for future development efforts in SVG as part of the Mount Sinai collaboration with their Ministry of Health.

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First Place Winner Global Health Student Essay Contest Old Neighbors: Exchanging Values on the Reservation by Eric Bressman

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he dust kicked up behind me in the late afternoon of another North Dakota summer day. I’d ventured further west than on any of my previous rides, and I happened upon the pow-wow grounds just past the outskirts of a small neighborhood. My comically undersized bike rattled along as I admired the backdrop: rolling green hills meandering down toward glistening ponds and back up toward tree-lined plateaus. Up along the hilltops chirping meadowlarks fluttered to and fro. I was struck by the contrast to my expectations. The road west of Fargo on my drive to the Spirit Lake Nation reservation had yielded two truths about eastern North Dakota: topography is in short supply, and Jesus remains a powerful muse on the North Dakotan airwaves, second only to pickup trucks. These were no Alps, to be sure, but it felt like a veritable oasis in the middle of an endless ocean of ho-hum amber waves of grain. I thought I’d seen another one of the radiantly yellow birds I’d been catching in small glimpses when I was snapped out of my peaceful daze by the distant sound of a rez dog barking. I looked ahead, and sure enough there was one of the beasts, about which I’d been warned, standing at the edge of its owner’s backyard, chest puffed out, protecting its territory. Doubling back was clearly the safer bet, but the way ahead was far more convenient. I convinced myself that a creature a quarter my size wouldn’t be able to keep up with me once I really kicked it into high gear. As I continued forward I tried not to seem too threatening, but as soon as I got within a hundred feet the dog gave chase. I immediately abandoned all pretenses and started pedaling like a mad man. The road curved left and I came out of the turn

“I do know that at the core of our own project’s success were the relationships we formed…”

with every ounce of strength I had, while the dog easily kept pace, barking at my heels the entire way. We were in front of a row of houses now, and some of the residents looked on, laughing as I pedaled ferociously by like a helpless antelope on the discovery channel making it’s futile, last ditch effort just before the cheetah drags it down. It occurred to me at that moment that I was probably in less danger than I originally thought, and I came to a stop, only to have the dog begin licking my leg. I started to walk my bike, and it trotted alongside me for a bit. Finally someone let out a whistle calling it back, and I continued on home. In the weeks leading up to my time on the reservation, I was often asked if the people still live in tepees, and in the weeks afterward people wanted to know if I had been given an Indian name. The answer to both questions seemed to disappoint most people, although I’m grateful I was spared the moniker Soils Himself on Tiny Bike. But what struck me most was that after the few fun, dated facts that most of us picked up in elementary school or summer camp, just about everyone’s knowledge ran dry. Most people were aware that alcoholism was a problem on many reservations, but many of those same people were only half kidding when they asked about the teepees. And I don’t fault them for their ignorance, either. Until I started reading about Spirit Lake and the Dakota people a few months prior to my departure, I was equally unaware. I eventually learned a great deal about the present day state of affairs in Indian Country, but what resonated with me more than anything was how little I had known before. I began to wonder whether the final, and perhaps greatest, injustice committed against the American Indians

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was simply their relegation to anonymity. Our job on the reservation was to first teach a class in public health and health careers at the tribal college (the reservation’s community college), and then to run a camp for middle school aged kids with a health care and health careers theme. The goal of both projects was to encourage members of the tribe to eventually pursue careers in health. Though it’s not easy to find an appropriate measure for such a goal, the ambitions our students and campers expressed to us at the conclusion of each project indicated that our message had hit home for many of them. But the appreciation expressed by the people we met and worked with seemed to transcend the project in which we were involved. They thanked us graciously and profusely for coming, almost as if the greatest service we had done for them was the simple act of showing up. They brought us into their homes, they invited us to break bread with them, and they welcomed us into their spiritual community. They shared with us their Dakota way of life, and regularly asked us questions about our own families’ traditions. I thought about how little the issues that plagued their community, or any other tribe, factored into mainstream American discourse, and it began to make sense. From the moment the native tribes first encountered our forebears some four hundred years ago, they’d had their basic humanity ignored time and again. And for all the progress we’ve made as a society in the arena of civil rights, Native Americans have so rarely factored into the discussion. Talking with the people on the reservation, it seemed that, from their perspective, the disrespect and brutality with which they had been treated for centuries was an outgrowth of the same fundamental injustice that engendered their sense of anonymity today. They simply wanted to be known and understood, and if people could just see the beauty of their way of life they might finally appreciate the common humanity that connected them. After telling people a bit about the reality of life on the reservation, they’ve asked me if it’s a depressing place. Unemployment in Spirit Lake is close to sixty percent, many small, three bedroom homes are occupied by ten to fifteen

people, and methamphetamines are increasingly becoming a problem. Not to mention the old mainstays of obesity, diabetes, and alcoholism, or the domestic violence that often come along with pervasive substance abuse. I think the question misses the point, though, because the atmosphere of a place is rooted in the people that inhabit it. If they want to know about the people, I’ll tell them that there are certainly some bad people on the reservation, as well as many individuals whose difficult lot in life is the unfortunate byproduct of their tribe’s tortured history and a century and a half of mistreatment. But there are also many beautiful people on the reservation, people whose spirit and capacity to love shine brighter than the sun over the great plains on a summer afternoon. Some of them may become nurses or doctors or politicians, while others may never earn a college degree. The last question I’ve commonly received is what can be done to help improve the situation on many reservations. The answer, in short, is that I have no idea, and having spent one summer on one reservation makes me severely under-qualified to answer such a question. I do know that at the core of our own project’s success were the relationships we formed, and if any of the people we met walked away with an appreciation for the value we see in a career in health, it is only because we engaged in a mutual exchange of values that ought to form the foundation of any meaningful friendship. For a century our forebears chased down the native tribes until they had the land they wanted, and we’ve spent the century and a half since running away, trying to forget the fate to which we consigned them. If our hope is to right the wrongs that have been done, our first step must be to stop running, and simply connect to them as friends and brothers. Only when we establish a clear understanding of mutual respect and learn how to learn from them, can we hope to finally share some of our own values in a meaningful way.

-ÔThe Global Health Student Essay Award is supported by a gift from Dr. Holly Atkinson, Director of the Human Rights Program, Mount Sinai Global Health.

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