NEWSGlobal Health

Spring 2013

CONTEMPLATION • COMPASSION • ADVOCACY

Shane Lloyd (MD/PHD program) was selected as winner of the 2013 Ardeth and Norman Frisbey International Student Award in the student leader category. This award honors and

recognizes outstanding contributions to international under-standing by graduate/undergraduate international students (holding non-immigrant status) enrolled in full-time resident instruction or its equivalent.

Sarah Smith, MSIIIfor receiving the Spirit of Internationalization Award from from Penn State’s Global Programs. Smith was the first student in the Global Health Scholars’ Kenya

site, founder of Global Medical Brigades at Penn State, and has been to Africa several times to share medical services to those in need. According to Smith’s nominator Khanjan Mehta, what really sets her apart from other students is her persistence, her role as a mentor, and a strong spirit that is always determined to be effective and get things done.

Global Health Scholars Ki Chang (MS3) and Kimberly Faldetta (MS3) have been accepted through a competitive application process to the Medical Research Scholars Program (MRSP) at the NIH, a one year research fellowship for medical, dental, and veterinary students on the NIH campus in Bethesda, MD.

Kimberly: “I hope to be involved in a research project involving NTDs [neglected tropical diseases], malaria, or HIV. The NIH has top notch researchers and cutting edge projects, so this will

be a phenomenal experience for Ki and me.”

Ki: “We will be spending the year on the NIH campus performing research in a specific laboratory with an assigned mentor in the field we choose. We will have the opportunity

to take courses as well on the NIH clinical center. I will most likely be in the Neurosurgery branch of the NINDS (national institute of neurological disorders and stroke).”

Congratulations By Catherine Nicka (Class of 2014)

Gordon Kauffman, M.D. (General Surgery) presented a documentary-worthy autobiographical telling of “Surgeon Abroad: Timeless Lessons Learned.” Part Indiana Jones, part William Halstead, part Don Quixote, and a large part Albert Schweitzer and C. S. Lewis, those attending the annual Global Health Night received insights into the quest of a true humanitarian.

PAIRWN The 2013 Global Health Night featured unique presentations and fellowship through engaging personal stories and partnerships.

Dr. Kauffman’s presentation was followed by the stories of members of The Pennslyvania Immigrant and Refugee Network in a reader’s theatre format of “Magnificant Healing”. Told with empathy and humor, as if the women were sitting around the kitchen table, PAIRWN women shared personal experiences that highlighted issues of interpretation barriers, cultural expectations, and differing attitudes toward health and healing. One woman spoke of childhood memories of forced circumcision in Africa. Another reflected on daily challenges such as adapting to foods and new recipes without the ability to read English; grateful for a gift of rice, she prepared the rice as her family for generations only to find out that there is a quick cooking “minute rice” in the United States! Even the rice was not the same. This woman overcame not only the daily challenges of food preparation but also overcame the childhood trauma of separation from family and all things familiar during a war zone rescue mission.

Global Health Night

LionCare’s New Tobacco Cessation Program at Bethesda Mission By Lauren Schmidt

Recently a group of medical students (class of 2015) established a smoking cessation program at Bethesda Mission in Harrisburg as a means of providing personal contact and some social support. Many of the men residing at Bethesda Mission, a homeless shelter, are in the process of changing their lives through building personal relationships, finding jobs, and learning how to emotionally and financially support their families. The students seek to make a positive difference in the lives of these men. A number of the men have successfully stopped using drugs and alcohol, but still struggle with using tobacco. In conjunction with a nurse from Pinnacle Health, medical students lead weekly support groups with those

interested in quitting smoking. Over the last four months students have met with approximately 40 men, ranging in age from 18 to 66 years. Group support sessions enable the men to learn about the effects of smoking and to share their struggles with tobacco. The program also provides men with their approximate lung ages based on spirometer readings conducted on site. With the help of Pinnacle Health, individuals have the option to use nicotine patches or gum without having to worry about insurance coverage. This summer we plan to expand the smoking cessation program to the women’s shelter at Bethesda Mission in hopes of also being able to reduce the effects of second-hand smoking.

Katie Richardson in KenyaBy Katie Richardson (Class of 2014)

I had the opportunity to go to the Kapsowar Mission Hospital in Kapsowar, Kenya with African Inland Mission. Kapsowar is located in the west of Kenya and is 2 hours from the nearest town with a real grocery store. Kapsowar Hospital serves a wide area of the Marakwet people in Kenya.

I spent my first week in surgery. The main surgeon in Kapsowar has been there 15 years, and he is the only surgeon in the area. The first day I worked with him I saw a tonsillectomy, scrubbed in on a prostatectomy and hysterectomy, and then helped with an open reduction and external fixation of a femur fracture. I saw what would typically in the states be four different types of surgical specialties in one day. I also had the opportunity to scrub in on as many as I wanted. There were times when I didn’t because I didn’t want to waste a gown. In Kapsowar they sterilize all their own equipment including the cloth gowns that we wore to scrub in. This was so different from the disposable nature I am used to in the U.S. and made me think about stewardship of resources. One morning there was a trauma when a taxi’s brakes gave out. I spent the day with a woman with a scalp and right hand laceration. I was able to help with things like making sure she got a tetanus shot, antibiotics, and suturing. Later we had to transfer her to the hospital 2 hours away as she started to suffer from ARDS and there are no ventilators at the hospital in Kapsowar.

I spent my second week in the Maternity ward. In Kenya, regular deliveries are done by nurses, and the doctors do the C-sections. Once again they were more than willing to let me jump right in. I got to receive the babies right after delivery and first assist on C-sections. I was also the first doctor that many of these women would see for their prenatal check-ups. I learned how to do dating exams using ultrasound. One day when I was performing the ultrasound to date the baby I had a very hard time finding a good heartbeat. When the attending

came in to look at the ultrasound he confirmed my fears that the baby did not have a heartbeat. This woman had had three previous miscarriages, this made her fourth. At

this time I understood both that it is important to deliver news like this delicately but in a straightforward way. Along with the bad news we also offered her hope that she may still be able to have a baby in the future and that she should come to us again when she first gets pregnant or when trying to get pregnant so that we could perform some tests.

My last two weeks I spent in Pediatrics. I met some of the most adorable and brave kids during those two weeks. Once again things were very different as there are no ventilators. I remember one little boy named Caleb who was 3 months old and came in with pneumonia. When I first saw him he had labored breathing and we put him on oxygen. Later in the day when I came to check on him his breathing was less labored but this was because he was tiring out. The doctor and I had the hard conversation with Caleb’s mother that he was not doing well and that the next couple of hours would be crucial to his survival. We prayed for Caleb and by God’s grace he was doing better the next morning when I came into the hospital. Caleb made a full recovery while I was there and was able to go home. This was just a further testimony to us and Caleb’s family that God does work miracles.

Two more stories I’d like to share are of Purity and Frida. Purity is a 6 year old girl who was burned in a fire that killed her mother and burned her brothers. Her and her brothers had surgery but she needed further surgery and so her father left her at the hospital for weeks in between surgeries. Purity could have been angry at being burned, at losing her mother, at being abandoned at the hospital but she was kind instead. My first day at the hospital she came up to me and introduced herself and asked my name. She gave me her left hand to shake as the right was badly burned. Purity continued to be full of joy and had the sweetest temperament. She had befriended a little baby who had been badly burned in a kitchen fire. This baby’s mother took Purity under her wing and it was great to see how people in the hospital including this mother helped care for Purity even though her own father was often absent.

Frida is a 5 year old girl with AIDS and military tuberculosis. When I first met her she was in with a fever and distended abdomen of unknown origin. She was already on the right HIV and TB medications so we put her on antibiotics for this suspected peritonitis. I could tell there were many times that Frida did not feel well but still she had a gentle spirit and a smile that could light up the room. In Kenya the need is much

greater than in the U.S. and the medical situations much more severe in light of limited resources and yet the people have so much perseverance, hope, and joy which I think in part comes from their faith.

At the Kapsowar Mission Hospital you get the opportunity to work with both doctors from the U.S. and those from Kenya. The rest of the hospital staff is Kenyan. There is a nursing school there and the students are usually very willing to help with translations on morning rounds for those who don’t speak Swahili. This would be a great trip for almost any medical student as it is up to the student how his or her time is structured meaning if you want to spend all your time in one place or see a little bit of everything you can, and they are more than willing to have medical students involved. It is great to experience medicine in a different culture and

see how cultural aspects and spiritual aspects affect health care. To be a good physician I must care about all aspects of a patient’s life, which is why each day when I visited the kids to make them more comfortable with me, I tried to convince them that I was not a scary mzungu (Swahili word for European or white man) but instead their rafiki (Swahili for friend).

Over spring break, a group of 26 medical students, graduate students, and physicians from the Christian Medical Society traveled to the Dominican Republic to work with the organization Meeting God in Missions (MGM). During our week there, we had the opportunity to set up medical clinics in five local villages near the city of Hato Mayor. Our clinics were usually held in the village school or church building, so each day we had a new experience setting up our triage, provider, and pharmacy stations. The medical students worked in pairs with a translator to interview each patient, do whatever physical exam was possible with a patient sitting in a very busy, crowded room, and then present the case to one of the five physicians. Each day we packed pharmacy supplies and gave away all medications free of charge.

While we were excited that we saw over 100 patients each day, we recognize that the medical care we provided was just a small part of what MGM is doing in those villages. In addition to bringing in groups that provide medical care and vacation Bible school and sports activities for the children, MGM works with and trains pastors in each village in the hopes of establishing a lasting connection. The organization aims to use short term mission groups to spark a long term relationship with the villages that will enable community development and spiritual growth. Our group was excited to be a part of this ministry, especially because it allowed us to provide medical care to many individuals who otherwise would not have had access to the healthcare system.

Throughout the week, the group learned a lot of valuable information about providing medical care in an impoverished setting and also about integrating faith and religion into medical practice. In addition to providing medication for common

problems like intestinal parasites or tinea infections, the students had the opportunity to pray with each of their patients before they left the clinic. This act of prayer was a powerful tool in a setting of very limited resources and access to care. While we recognized that the twenty tablets of Tylenol we gave for a patient with back pain was only a temporary fix, our hope was that our prayers and our connection to MGM’s broader mission would leave long-lasting effects on the people we encountered. We left the Dominican Republic with a deeper appreciation for abundance of knowledge and resources that we encounter in our medical education, as well as a better understanding of the power of service in building relationships.

Dominican Republic (Christian Medical Society)

Katie Richardson in Kenya continued

From March 2nd to 9th, Hershey medical students and physicians partnered with University Park undergraduates in the first collaborative spring break service trip. In the Darien province (known in the States as the malaria and yellow fever infested jungle of Panama), we provided medical services under the auspices of the Global Brigades organization. According to a local physician, the near 50,000 Panamanians living in Darien have only five medical specialists and three ambulances to cover an area the size of Connecticut.

After months of preparation and traveling 21 hours, we arrived at 5:30 AM to our compound in Santa Fe. Undeterred by frigid showers, putrid portipotties, and unpredictable electricity, we awoke after 4 hours to sort medical supplies collectively purchased by generous donors and participant contributions. During the next 3 days, we operated a clinic out of a local elementary school. Using the Global Brigades model, we established 5

stations: Triage- to collect vital signs; Consultation- to conduct patient interviews and exams; Dental- to provide oral

care; Laboratory- to perform urine, glucose, and other diagnostic tests; and Pharmacy- to dispense drugs. In total, we provided care to over 300 Panamanians. Many patients came for wellness checks, others for teeth extractions, and several just to receive free anti-worm drugs and vitamins. Yet numerous patients presented with medical issues- skin lesions, labor and nutrition induced disorders, and genetic abnormalities- that astounded all of us.

“Through my first year of medical school, I have endured hours of draining anatomy dissections, monotonous lectures, and stressful exams,” wrote Dan Brill (MSI). “Day-to-day, I am absorbed in the daily medical school rigors and tend to forget why I

entered medicine- to apply my medical knowledge and skills to help others. Whether I was performing a physical exam, teaching undergrads how to collect vital signs, or empathizing with a local resident, I derived an enormous sense of satisfaction at contributing to this philanthropic effort. Ultimately, this medical service trip with Drs. William and Eileen Hennrikus, Syeda Ahmad, Caitlin Armstrong, Amy Du, Alicia Evans, Spencer Johnson, Dana Schirk, Eve Thau, and 32 undergrads, has reinvigorated my passion for medicine and motivated me to seek out other medical service opportunities. I encourage you too to aid similar endeavors with any means you possess.”

Collaborative Hershey and University Park Medical Service TripEl Tirao, Panama By Dan Brill

Health Fair in HarrisburgBy: Mia Mattioli

On April 20, 2013, over 30 medical school students from the 2016, 2015, and 2014 classes hosted the second annual Healthy Harrisburg! health fair. Healthy Harrisburg was originally inspired by a first-year course titled Social Influences in Health. Having learned about health care disparities affecting low-income communities nationwide, Penn State College of Medicine students sought to address some locally. In conjunction with the LionCare clinic and the Central

Pennsylvania Boys and Girls Club, they were able to organize a second fair, following up on the first held last April. Approximately 70 local children and parents attended and were educated about nutrition, emergency safety, exercise, anti-bullying and the benefits of not smoking. They were also taught medical science through presentations teaching comparative anatomy, microbiology, and dermatology.

The Global Health Center provides organization and oversight for the medical center’s educational, service, and community research activities in global health. The Center is responsible for promoting global health issues on campus. If you would like to contribute to the quarterly newsletter, or if you are not receiving this publication, but would like to be added to the list, please send an email to nfredrick@psu.edu.

Director of Penn State College of Medicine’s Global Health Center: N. Benjamin Fredrick, MD, Family and Community Medicine

Student Global Health Newsletter Co-Editors: Catherine Nicka, Lauren Schmidt (Class of 2015)

Global Health Center Advisory Board:Elizabeth Bates, BS DN (Nursing), Dennis Gingrich, MD (Fam Med), Brandt Groh, MD (Pediatrics), Graham Jeffries, M.D. (Medicine), Philip Wilson, PhD (Humanities) Daniel Wolpaw, MD (Internal Medicine)On the Web: http://www.pennstatehershey.org/web/globalhealth Like us on Facebook: http://www.facebook.com/PSUGlobalHealthIf you would like to receive Global Health Center announcements, please notify Thao Danz: tdanz@hmc.psu.edu.

Oliver Wagner spent a month in Zambia at a missions hospital. Oliver will be completing his family medicine residency at Lancaster General Hospital in Lancaster, PA.

Zambia was an amazing exper ience . This trip really did meet all of these expectations, but it was i n c r e d i b l e for so many reasons that I

could not have anticipated before.

I was able to spend a few days sightseeing when I first got there, mostly around Livingstone. Seeing Victoria Falls was really breathtaking, and the safari I went on was amazing as well. The country is very beautiful despite the general lack of green. All of the precipitation generally comes during the rainy season, which lasts from about November to January. Since I was there mostly during September, it was just about as dry as it gets. Seeing brush fires is very common just driving along the highways and dirt roads..

Zimba is a small town located about 50 miles north of Livingstone along the Great North Road, which runs all the way from South Africa to Cairo. The hospital is the main medical provider for about a 20 mile radius, which is quite considerable when most of the patients do not have access to transport. Most patients are managed in

the outpatient clinic, but a few need to be admitted to the small inpatient ward that is divided up into men, women, maternity, pediatric, and TB sections. Some patients, such as complicated obstetric cases, are transferred to Livingstone or the capital Lusaka. In general, all of the inpatient and outpatient patient care is accomplished by a small group of nurses and the 3 doctors that work at the hospital. An estimated 75 patients are seen in the outpatient clinic each day, typically by one or two of the doctors after they are finished with morning rounds. Things certainly get busy.

One of the great things about this site was the variety of quality medical experience it gave me on a day to day basis. Every morning I rounded on a ward, each day getting more used to reading radiographs, ordering medications, and learning how to monitor patient progress. Many afternoons I spent time

in outpatient clinic which challenged me to effectively communicate with patients despite the language barrier. I was in the OR about twice a week where

I was the first assist on many surgeries and eventually became the primary once I was comfortable enough. Other days I spent time helping out in the lab, pharmacy, and physical therapy. In all of these settings I not only learned valuable lessons I will take to residency, but I was genuinely helpful to the staff.

There were only a few negative things I could say about the rotation. Being a small medical center, most of the complicated cases were transferred to either Lusaka or Livingstone. This means that I missed out on some of the more interesting cases that pass through. Also, the hospital is very limited in regards to radiology and lab testing, so many diagnosis were just assumed and treated accordingly. This was very difficult to get used to; in the US we order tests for everything and almost always get some form of confirmation of our suspicions. The language barrier was a good learning experience, but did limit my patient encounters in outpatient when translators were not available. All in all these limitations were far outweighed by all of the positive aspects.

Zambia By Oliver Wagner