Friday, October 6

Friday, October 6

8:00–8:45 a.m.

The Global Movement Toward Integrated, People-Centered Health Services: The Role of Family Medicine

Shannon Barkley, MD


Despite making substantial progress in people’s health across their lifetimes over past decades, relative improvements have been unequal among and within countries.  Globally, one in twenty people still lack access to even basic health care services.  Where health care is accessible, it is often fragmented and of poor quality. In 2016 the World Health Assembly adopted the Framework on Integrated people-centred health services (IPCHS), giving the World Health Organization the official mandate to work with governments and other key stakeholders to support implementation of the Framework, including building strong primary care-based systems that prioritize community and family-oriented models of care
as a mainstay of practice with a focus on disease prevention and health promotion.  Several recent global partnerships provide an opportunity to better understand the performance of primary care in low and middle income countries, including those in various stages of implementation of Family Medicine programs.

9:00–10:00 a.m.

A Revolutionary Integrative Approach to the Management of Chronic Pain and Depression

Gary Kaplan, DO


During this session, we will explore the proposal that accepted medical practices often fail to help chronic pain sufferers because they have been based on a fundamental misunderstanding of the illness itself. “Chronic pain” and “depression” are not actionable diagnoses; they are, instead, symptoms of a neuroinflammatory disease of multiple and compounding etiologies known as Central Sensitization Syndrome (CSS) . CSS is a new concept that redefines chronic pain as an immunologically-mediated neuro-inflammatory disease that is only one manifestation of the neuro-inflammatory process. Recently, novel research has identified other triggers involved in the pathophysiology of chronic pain and depression that are overlooked in the current treatments. This new understanding has led to the creation of a new map of neuroinflammation and a new treatment strategy. We will introduce a new revolutionary approach for these conditions including innovative pharmacologic treatments, nutritional therapies, mind-body techniques and physical medicine modalities.

Developing Workforce and Enhancing Services through Global Health Collaborations/Partnerships

Sarah Jones, MD; Javier Sevilla-Martir, MD; Tessa S Stecker, MD


Timely access to care, improving quality of services, and work force development are important domains to be considered by all partners in global health collaborations. Community health professionals identified the need to improve outcomes in the area of safe maternity care. We are currently in the process of enhancing these medical services by expanding prenatal care to include both vaginal and cesarean deliveries. Additionally, we are addressing workforce development by offering the first regional Advanced Life Support in Obstetrics (ALSO®) course as an effective means to disseminate knowledge and skills to maternity care providers. In partnership with our in-country colleagues, we will establish a program to maintain skills and assess the impact of interventions. Our partnership establishment and growth will be summarized, and a description of our vision to expand services and invest in the betterment of the community will be shared, highlighting lessons we are learning along the way.

Rethinking Global Health Training - Combining Short Term Exposures with Longitudinal Training

Tochi Iroku-Malize, MD; Neubert Philippe, MD


The Hofstra Northwell School of Medicine's Department of Family Medicine recently decided to explore the value of short term global health experiences (sometimes known as "mission trips") to supplement the global health educational opportunities offered to the students, residents and faculty. The original method of training required 2-4 week rotations at fixed sites in four countries. Those participating in electives did any number of rotations while those pursuing the track certification completed the full 12 weeks over the course of a two year period. The training did not, however, allow for the learners to experience the concept of short term bursts with an interdisciplinary team afforded by short term visits. In October 2016, we piloted the program and as of 2017 we have incorporated it into our curriculum. We will review the pros and cons of embarking on this process.

2 in 1:

Am I Home?

Sara Foster Fabiano, MD


The terminal was alive with light and color while everything surrounding was dark with the occasional flash of lightning in the distance. I wanted to do something cliche like kiss the tarmac. I was in Namibia - as close to home as I'd been in almost 3 years. Having grown up in Angola, Africa with a Canadian-American mother and Angolan father, I was ready to begin my elective back in Angola as a third year resident confident that my background would allow me to be even more effective. On the flight the next day, everything looked and sounded familiar but slightly altered - like trying to look through glasses with the wrong prescription. I had begun a journey which I had dreamed about throughout my medical education - being able to return ‘home’ however, I immediately felt out of context. What did being home and trying to contribute actually mean?

Global Public Health Diplomacy

Bruce Cohen, MD


There are four key objectives of global health diplomacy. 1. Support achievement of international and national goals for the acceleration of control, and the elimination of diseases. 2. Develop sustainable, coordinated public health capacity among partner organizations and governments globally. 3. Prevent maternal morbidity and mortality globally. 4. Improve response to natural and manmade disasters, including complex humanitarian emergencies globally. Global Public Health Diplomacy (GPHD) crosses over disciplines to include elements of human rights and social justice; foreign policy; National Security; development economics; cultural and social determinants of health, and bioethics.

Human Trafficking: An Overview

Ranit Mishori, MD


Human trafficking is a widespread problem with estimates ranging from 14,000 to 50,000 individuals trafficked into the United States annually. This hidden population involves the commercial sex industry, agriculture, factories, hotel and restaurant businesses, domestic workers, marriage brokers, and some adoption firms. Health care professionals may be one of the few professions likely to interact with victims while enslaved. About 30% of trafficked individuals will be exposed to the healthcare system at some point during their captivity, yet they are seldom recognized as victims. Lack of awareness due to sub-optimal educational opportunities plays a key role in why clinicians are not equipped to screen, identify or care for victims of trafficking.

Piloting an International Clinical and Public Health Training Site in Ecuador: Initial Steps and Lessons Learned

Peter Baum, DO; Marianne McKennett, MD; Jose Suarez, PhD; Regina Wang, MD; Akbar Rahman, MD


As the United States’ population is becoming increasingly diverse, it is important to develop global health curriculum and international clinical training opportunities. International rotations can enrich the medical training of residents and students through exposure to new cultures, medical systems, socioeconomic realities, and disease pathology. Such training reinforces physical examination skills, while fostering the desire to practice medicine among underserved and multicultural populations. This presentation will focus on initial steps taken and lessons learned in planning and implementing an international clinical and public health training site in rural Ecuador. We will discuss the development of partnerships, identification of opportunities, curriculum development and pilot testing, experiences and lessons learned, and future directions. This initiative is a result of strategic partnerships between two U.S. Family Medicine residency programs and their affiliated medical university located on the U.S. Border with Mexico, the Ecuadorian Ministry of Public Health, and an Ecuadorian non-profit organization.

Timmy Global Health: 20 Years of Service and Learning

Mercy Obeime; Chuck Dietzen, MD


Medical service abroad offers critical care to underserved populations. There is a long tradition of volunteer medical providers engaging in short-term international service
in order to "give back" to communities in need. As the global health field evolves, a more critical lens has
been applied to short-term medical service, prompting questions of whether this is the most effective mechanism for addressing global inequities in access to care.
Timmy Global Health is an Indianapolis-based nonprofit organization that began as an avenue for medical service abroad. Over the past 20 years it has evolved to include long-term partnerships, public health and prevention activities, education and advocacy objectives, and a move towards community-owned solutions to health care access challenges. Throughout these changes, it has retained
a priority focus on cross-cultural connectedness, mutual respect, and ethical engagement. This presentation will highlight challenges and opportunities in evolving amidst a shifting global health volunteerism landscape.

10:15–11:15 a.m.

Clinical Challenges

Karen W. Lin, MD


Rutgers university has hosted Mandela Washington Fellowship Program for Young African Leaders in the
past years. Every summer, 25 to 50 Fellows of diverse professional and academics background participate in seminars related to areas such as civic engagement, civil society, community building, nonprofit management, political organizing, advocacy, fundraising, ethics and volunteerism to build upon their leadership capacity. These fellows from Sub-Saharah countries of diverse religion, diet, culture and health beliefs. When they felt ill, management of chronic disease and diagnosis of acute infection are challenging at American healthcare system. It usually involved batteries of testing, longer turn-around time from reference laboratory. Patient would have presumptive treatment with multiple antibiotics, and their dorm-mates would have public health concerns. Presenter will propose a systematic approach to these true global health concerns at hosting campuses and local hospitals in USA.

Family Medicine's Contiued Growth and Development in Ethiopia

John Halvorsen, MD; Weyinshet Gossa, MD; Andrew Janssen, MD; Andrea Janssen, MD; Meseret Zerihun, MD; Elnathon Kebebew, MD; Rachel Nunn, MD


Concordant with the Ethiopian government's plan to extend health care to its growing population, Addis Ababa University (AAU) initiated a family medicine residency in 2013. Gossa, et. al., previously summarized family medicine's development in Ethiopia (Advances in Medical Education and Practice 2016;7:261-269), describing family medicine's history and noting its developmental strengths, challenges, opportunities, and threats. Substantial development has occurred since that report, including:

  • A Ministry of Health (MoH) defined curriculum and defined scope of practice for family medicine
  • A national professional society -- The Ethiopian Society of Family Physicians
  • Two classes have graduated from the AAU residency, and two graduates now serve as AAU family medicine faculty, one as the residency program director
  • The MoH remains committed to expanding family medicine training nationally

Many strengths, challenges, opportunities and threats previously identified remain, many that were anticipated failed to materialize, and many new ones have emerged.

Developing Structural Competence in Family Medicine Residents Through Migrant Farmworker Health

Jonathan Fricke, MD; Gayle Thomas, MD; Cheryl Seymour, MD; Carrie Griffin, DO


Migrant farmworkers are a largely invisible global population (Summers 2015). Training clinicians to work with vulnerable migrants has been identified as a priority (Pottie 2014). However, while family physicians are trained to elicit individuals' stories, they are rarely trained in identifying the structural inequities affecting their patients’ health (Metzl 2014). By providing care for migrant farmworkers in labor camps, family medicine residents experience first-hand structural determinants of health likely to be missed within the walls of the usual healthcare facility. We describe two models for utilizing migrant farmworker experiences in family medicine residencies to teach the importance of structural determinants of health. Qualitative data from resident interviews show the ability for these rotations to develop learners' structural competence and humility in a way that traditional curricula do not. Challenges have included competing residency priorities and providing year-round experiences for learners given the seasonal nature of farm work.

Ethics Considerations for Global Health: Do Multiple Interests Necessarily Create Conflicts of Interest?

David McRay, MD; Douglas Brown, MD


Health care professionals participate in global health efforts for multiple reasons. Many do so from a humanitarian commitment to serve and others as an expression of deeply held religious faith. Some participate to advance their academic/research interests (including the opportunity to publish). Most also enjoy encountering new places and new cultures. Such multiple interests can lead to conflicts of interest. If so, how should they be navigated? Do they need to be publicly declared (in a manner similar to the “Conflict of Interest Form” the speakers were required to complete for this presentation)? How might the core obligations of medical ethics guide us in these considerations? When we work in the arena of global health, we are inviting our patients, our partnering organizations, our colleagues,
our trainees, and our host countries and cultures to trust certain things about us. Are we transparent enough with our motivations to allow their trust to be well-placed and secure? What risks do we take – for ourselves and our US institutions – by asking these questions?

Recognizing the Rise of Informatics in Global Health, a New Frontier

Ruben Hernandez, MD; Theresa Cullen MD, MS; Arjun Singh, MD


In a world where disease has no borders and access to Health information is crucial, the integration of patient data, information science applications, and the experties of health professionals has created a global move towards providing higher quality patient care througth better management and acess to information .As a result, global public health informatics has become key to health security, providing healthcare practioners and decision makers access to critical health information by using best practices and princicples in informatics science to improve global public health practice, research and learning.(1) The Center for Biomedical Informatics, Regenstrief Institute at Indiana University, supports a Global Health Informatics program, works with colleagues around the word to supports the development and implementation of principles and open technologies designed for use in resource-limited settings. It has been instrumental empowering communities to embrace appropriate IT technologies to support care delivery cycle as well as health equity (2).

Family Medicine Cares International: Patient Care, Service, Medical Education and Faculty Development in Haiti

Donald Briscoe, MD; Mary Jo Welker, MD; Neubert Philippe, MD; Anna Doubeni, MD, MPH


The AAFP Foundation’s signature program, Family Medicine Cares International, has a long-term commitment to the country of Haiti. The FMCI Program’s volunteers provide patient care, service and medical education each year during a week-long delegation trip. The medical education mission of the program includes both direct teaching to physicians, residents and students and an ongoing faculty development program for the two Haitian family medicine residencies. This workshop will present information about the entire FMCI program but will emphasize the faculty development mission. Specifically, the design, organization, implementation and evaluation of the faculty development program will be discussed. We will also discuss faculty development as a sustainable, capacity building activity in a resource limited area. Lessons learned from our 4 year experience, future plans and potential for exportability to other developing countries will be reviewed.

Parasitology II: Gastrointestinal Parasites

Mark Huntington, MD


Although global health involves more than exotic infections, infectious diseases remain common in much of the world. Gastrointestinal parasites are among the most common infections world-wide. Recognizing that memories your parasitology course in medical school may be distant, this session is the second part of a concise overview of the field of parasitology. Focusing on important worms and germs that infest the gut, this session will dust off those neurons used to describe the clinical symptoms, transmission and prevention, and treatment of parasites of the digestive track. In addition to a significant yuck-factor, these parasites are responsible for significant morbidity. Simplified and amply illustrated with plenty of graphic images that will spoil the appetite of even the most stoic, you’ll walk away from this presentation remembering far more about parasites than you probably desired.

11:20 a.m.–12:00 p.m.

Chronic Mountain Sickness: A Brief Clinical Review and Genetics Update

Emilio Russo, MD; Seth Vignes, MD; Christie Caceres, MD; Anh-Linh Bui, MD


High altitude populations are located in two densities,
80 million people in Asia and 35 million in the Andes mountain ranges. Chronic Mountain Sickness (CMS) or Monge’s disease is a high altitude pathological syndrome characterized by long term exposure to a hypoxic environment. Disease burden is under-reported likely representing under estimation of disability adjusted life years (DALYs) compared to controls. The diagnosis of CMS is considered a clinical with scoring systems designed to stratify severity. In the ideal setting, migration to lower elevation is curative for CMS patients. However, the majority of those affected are financially and personally restrained. Alternative treatments are available. In particular, the Tibetan and Andean natives are often compared. Both populations lack access to care due to topographical and resource constraints, however, the contrasting adaptations to high altitude suggest an evolutionary process. Recent genomic differences found in oxygen delivery physiology support this hypothesis.

Implementing a Family Medicine Residency Program in a Low-income Country Through Collaborative Work

Emmanuel Fabrice Julceus, MD; Rodney Destine, MD; Kerling Israel, MD


Health care systems in limited-resource settings face numerous challenges, including inequity in geographic coverage access, cost, limited qualified healthcare providers, and poor coordination of primary care. An expansion of family medicine residency (FMR) programs
in such countries could result in the improvement of the delivery of health care. The NGO Zanmi Lasante/ Partners in Health and the public sector have developed an FMR program at the Hospital Saint Nicolas of Saint Marc, Haiti. The goal of this indigenous program is to train high quality family physicians who are capable of transforming the health system through their practice and by taking leadership roles in their communities. In this workshop, the Saint Marc, Haiti, experience will be presented and used for discussion. Through brain storming and small group activities, participants will learn tips on building collaborations and working with partners to design and implement a FMR program in low-income countries.

Big Difference, Little Time: Impact of the Modified Horatio Alger Exercise

Varun Shetty, MD; Ronald Magliola, MD; Adam Perzynski, PhD; Bode Adebambo, MD


The Horatio Alger exercise, originally meant to evoke racial and class disparities hidden in society, was adapted to a global health context and successfully conducted at the AAFP Global Health Workshop in 2016 and other venues. Pre- and post-workshop surveys done revealed surprisingly positive results. Prior to the workshop 44% of respondents agreed that they were well aware of privilege, bias and oppression in any population. 73.52% agreed to this post-workshop.16.67% agreed to feeling comfortable about teaching others about unearned privilege, bias and oppression in the pre-workshop survey and 73.48% agreed post-workshop. These educators have gone on to conduct the exercise with other delegates. We discuss the impact of the workshop by presenting survey data, guided by a panel discussion of educators who attended the workshop, then have conducted this exercise themselves, discuss their style of using the exercise, common pitfalls and troubleshooting techniques.

LSUHSC New Orleans - Developing an Interprofessional Global Health Education Program

Nicholas Seeliger, MD; Kelsey Phelps, MD; Emilio Russo, MD; Jeff Mohr


In times of increasing global challenges to health, it is crucial to create a healthcare workforce capable of tackling these complex issues. At LSUHSC New Orleans, we
are integrating "Healing Peru", a grassroots humanitarian mission in the Peruvian Andes into LSUHSC Global Health education. This effort began in 2015 as part of LSU’s Rural Family Medicine Residency program and has now expanded into LSUHSC Schools of Medicine, Dentistry, Nursing, and Public Health. Our goal is to demonstrate high standards of ethical conduct and quality of care in one’s contributions to team-based care. Further, use the full scope of knowledge, skills, and abilities of professionals from health and other fields to provide care that is safe, timely, efficient, effective and equitable. Finally, we believe that healthcare professionals must be able to perform effectively on teams and in different team roles ina a variety of setting. Specifically, in country global health endeavors naturally lend themselves to IPE engagement and facilitate a concentrated IPE learning opportunity.

Evaluation of Education and Training Programs in Global Health: Challenges, Successes and Pitfalls

Laura Goldman, MD; Jeff Markuns, MD; Kristin Shaw, MPH


In a data driven world, it has become increasingly important to demonstrate that global health programs have met desired outcomes. Yet outcomes in Family Medicine training and education programs are exceeding difficult to measure. In our programs, we have strived to change the undergraduate training environment by instituting a competency-based curriculum, and the learning environment to include more active participation by the learner. In post-graduate programs, we have worked to instill the core principles of Family Medicine in trainees, and many of the concepts, such as continuity, are new
to the healthcare system. We have also retrained rural doctors in remote areas. In 4 different types of programs in Cambodia, Laos, Myanmar and Vietnam we have designed evaluations to demonstrate progress toward goals. We have used multiple methodologies including direct observation, surveys, focus groups, 360 evaluations and interviews. We will share our methods and outcomes, and discuss challenges and pitfalls.

Coming Back: Culture Shock for the Returning Global Health Physician

Jerry Koleski, MD; Esther Johnston, MD; Travis G. Bias, DO, MPH, DTM&H


Most global travelers have experienced culture shock when going to their host country. A similar culture shock can occur when the traveler comes back home. This reverse culture shock can be unexpected and potentially more isolating. Often there is a community of expatriates overseas ready to help the newcomer adjust. Coming back can lead to feelings of, isolation, loss and even disloyalty to the home country. Family dynamics can make reentry more difficult. Each family member often has a different time line and a different attitude to the transition. Each member of the panel will share their story and the story of their family. Each member of the audience will also have the opportunity to share their story by n breaking into small groups of eight to ten. The audience members will hear from other returnees successes and failures in their readjustment process.

Health Through a Culturally Sensitive Lens: Characterizing the Patient Dynamics of Colonia Margarita Moran, Mexico

Sarah Brown, Allison Ong; Sheridan Bowers; Margarita Loeza, MD


Flying Samaritans at the University of California, Los Angeles (UCLA) is an undergraduate student-run organization that serves the community of Colonia Margarita Moran in Tijuana, Mexico through a monthly clinic. In partnership with licensed health care providers, our clinic provides primary care for men, women, and children who face barriers to affordable healthcare due to structural violence, immigration status, financial burdens, or difficulties securing transportation. Undergraduates learn about global health and cultural sensitivity through patient intake, health education programs, community-based research, and physician shadowing. With the help of student volunteers and our public health committee, we collected two years of data on our patient population, including demographics and vital signs, to characterize the needs of Colonia Margarita Moran and improve our health services. We
also implemented post-visit surveys to learn more about the community’s available resources and launch a growing database of local healthcare providers and clinics.

1:15 p.m. – 2:15 p.m.

Tackling Adverse Social Determinants of Health as a Global Community: The Role of FM as a Lever of Transformation

Katherine Rouleau, MDCM, CCFP, MHSc


It can be argued that if equity is at the core of global health, transformation is at the core of global health engagement. Both equity and transformation are prevalent themes in the report of the WHO Commission on Social Determinants of Health (SDOH), a defining document shaping current global health efforts. What does this mean for family medicine locally and abroad? What particular role should family medicine play and what contribution could it make to respond to the challenges laid out by the global community through the work of the Commission? This presentation will explore the privileged interface between SDOH and family practice and will consider how the recommendations set out in the report can/should be translated into concrete actions and constructive transformation by and through family medicine. Using examples from Canada, we will propose potential ways forward. Looking at the recently launched discipline of family medicine in Ethiopia, we will consider if and how the interface between family medicine and the social determinants of health might differ in the Ethiopian context.

2:30–3:15 p.m.

Model of a Resident-Led Refugee and Immigrant Primary Care Clinic in an Urban Academic Medical Center

Jamie Robinson, MD; William Buoni, MD


Columbus, Ohio, is home to 15-20,000 Bhutanse Nepali refugees who were the victims of ethnic cleansing in Bhutan. Due to decades in refugee camps, this population suffers from high rates of mental health disorders and complicated medical conditions. Among primary care clinics at our large academic medical center (AMC), our resident clinic serves the highest number of Bhutanese Nepali patients. And although these patients comprise a small percentage of the total patient population, their care takes a disproportionate amount of time. In response, residents designed a one-half day a week clinic specifically for these patients with the goal of sensitivity to each refugee's psychological, social and economic barriers to healthcare. There are many obstacles related to coordinating the logistics of clinic flow and assessing patient needs. However, as part of an AMC, we have the privilege of accessing many resources, a small internal grant, and eager to learn resident physicians.

Global Expansion of Primary Care via Asynchronous Remote Teleconsultation: A Case Illustration

Steven Fox, MD; Michelle Turner; Chelsea Clarke, MPH; Megan Cahill, MD; Stephen Y Chan, MD, PhD


There is a severe shortage of primary care physicians worldwide, especially in low and middle income countries. Clinicians, especially those with less experience, may feel uncomfortable managing certain situations independently, and benefit from the available support of a physician with more experience. Advancement and availability of telecommunications technology has enabled this support to be accessible not just in person but also remotely from across the globe. We describe a case of a 45 year old female presenting to a clinic in Kenya with unilateral leg swelling. Diagnosis and management of deep vein thrombosis was conducted by a local provider with support of a U.S.-based primary care provider volunteering within a telemedicine organization, The Addis Clinic. In presenting this case, we illustrate how asynchronous remote teleconsultation promotes capacity to provide primary care globally. We also discuss challenges to providing quality care with asynchronous remote teleconsultation and ways to overcome these challenges.

Health Promotion in a Rural, Agricultural Community of Baja California Using a Promotora Model

Marianne McKennett, MD; Mary Moya Richards, MD; John Prucha, MD; Claire Ojima, MD


The UCSD-affiliated Scripps Family Medicine Residency Program (SFMRP) is a community-based training program with core teaching sites located just nine miles from the U.S. Border with Mexico. The Scripps FMRP uses a community-driven approach that emphasizes community medicine and border health throughout the curriculum, including a hands-on application of the Community Oriented Primary Care (COPC) model. Founded in 1998, the Viajes Interinstitucional de Integración Docente, Asistencial y
de Investigación (VIIDAI) is a collaborative international public health field project for students and faculty from San Diego State University (SDSU) School of Public Health, Universidad Autónoma de Baja California (UABC), and the School of Medicine at University of California at San Diego (UCSD). FM residents from the SFMRP partnered with the VIIDAI program to enhance health promotion in the rural community of San Quintin. Through focus groups and key informant interviews, workshops are developed and evaluated in response to community needs.

Struggling in Your Work Abroad? You’re Not Alone! Recognizing the Challenges of Maintaining Personal Wellness in the Setting of Global Health Work

Andrew Smith, MD; Brent Burket, MD; Leanne Marcotrigiano, MD


Global health work can be intellectually challenging, personally meaningful and practically helpful. But it can also be incredibly difficulty. As foreigners immersed in low resource and underserved communities, we witness the tragedies of social and economic inequality in the patients we care for. In focusing much of our energy on the needs of the people we serve, we often forget to care for ourselves. In this session we will reflect on the importance of self-care while doing global health work. The presenters will discuss common themes of wellness as they pertain to the global health worker, including: loneliness, cultural exclusion, family challenges, physical illness, acuity of disease, exposure to violence, financial stressors, and the pressure to feel that one’s work is valuable and impactful. Through active audience participation, the presenters will facilitate a conversation with the group to develop and share practical approaches to maintaining personal wellness in our work.

Global Medical Education: There’s an App for That

Jason Kroening-Roche, MD; Janelle Billig, MD; Elise Duggan, MD; Emmanuel M. Sindato, MD, MMed; John Robson Meda, MD, MMed; Warles Charles, MD


Tanzania is addressing healthcare workforce shortages by rapidly expanding medical school class sizes. A key challenge is limited teacher and resource capacity. As mobile technology tools become more available globally, they offer promise to address these challenges. A team of American and Tanzanian faculty explored the student experience using Google Classroom at two medical schools in Tanzania. Students were surveyed about baseline technology access, skills, and perceptions, as well as post-implementation attitudes regarding the benefits and challenges of Google Classroom. We found that mobile technology access and skills were readily available. Students had favorable opinions of the Google Classroom tool. They identified easy access to information, the sharing of resources, and improved feedback and communication with faculty as benefits. Key challenges were lack of reliable internet access and speed. Future steps include ongoing data collection to measure the impact of Google Classroom and exploring educational quality outcomes.

Cracking the Code: Developing Global Health Research Opportunities for Underrepresented Minority College Students

Tessa Stecker, MD; Juleon Rabbani, MPH; Javier Sevilla-Martir, MD


Over the last 10 years, the number of underrepresented minorities (URMs) in medicine and URMs in the general population has disproportionately increased. Pipeline programs have been developed to increase the representation of these groups in health-related fields. As part of a pipeline initiative, eight Napa Valley Community College students participated in a Research Methods Workshop. This workshop was designed to teach the students basic research methods while increasing their knowledge of global health opportunities. Students completed identical pre- and post-training surveys to assess change in knowledge of epidemiological research, data entry, database management, and health issues in Honduras. Knowledge statistically significantly improved across 60% of the measured items. In spring 2017, students will work with residency faculty to extract and analyze patient chart data from three trips to Honduras and will present their findings at a research forum. We will discuss the implementation of the workshop and student experiences.

Glocal Health: Think Globally and Implement Locally

Jayashree Paknikar, MD

Room locaiton: Grand Ballroom

70,000 refugee arrive in the United States per year from various countries with diverse religious, cultural and educational background. It is therefore imperative for current and future generations of family physicians to develop and/or equip themselves with tools to effectively treat this rapidly growing sect of patient population. At our clinic more than 80 % patients are recently migrated refugees. therefore we embarked on studying different observations and its causal relations. Salient amongst them are birthweight patterns in refugee population and increase perinatal complications ; challenges faced with management of diabetes as well as immunization rates in refugee populations with different backgrounds. We have presented some of this initial work at Mayo clinic first delivery of science summit and now I plan to expand and make it interactive brainstorming workshop for the attendees to expand the horizons in understanding this wildly unknown portion of healthcare!

4:15–5:15 p.m.

2 in 1:

The Medical Evaluation of Asylum Seekers

Ranit Mishori, MD


Each year, thousands of people who have suffered torture and ill treatment at the hands of governments and due to ethnic and religious persecution, flee their countries of origin and seek asylum in the United States. Clinicians can provide expert opinion and critical documentation of torture and ill treatment in asylum proceedings. Family Physicians, in particular, can leverage the unique, interdisciplinary lens of Family Medicine to fully evaluate the complex biopsychosocial impacts of torture and ill treatments. Beyond the provision of clinical expertise, the experience of conducting asylum evaluations can be very meaningful and can broaden the scope and impact of family physicians as patient, community and human rights advocates. The presentation will describe important considerations in conducting a medical asylum evaluation and review common physical and psychological findings of torture and ill treatment.

Best Practices Caring for Recently Arrived Arab and Muslim Women

Fatin Sahhar, MD; Shahla Namak, MD; Ammar Charestan, MD; Fadya El Rayess, MD, MPH


Syrian, Iraqi and Somali refugees are some of the most recent refugees being resettled in the US at a time when the political and social environment in the US is increasingly threatening to those who are perceived as Muslim or Arab. Much of the bias is fueled by the fact that most US citizens have little knowledge of Arab and Muslim cultural values and traditions. The knowledge gap is particularly evident in the care of Arab and Muslim women. This session will provide participants with a quick review of best practices for care of these underserved, understudied women minority, who pose challenges for health providers unfamiliar with their health influences. The included strategies aim to increase healthcare seeking(1). Topics to be covered using a case based format include how to approach such issues as family planning (2), screening for cancer (3), domestic violence, parenting, and mental health among these women.

Lessons and Opportunities: Employing Telemedicine to Support Primary Care in a Global Rural Setting

Steve Ko, MD; Julieta Gabiola, MD; Dale Rai, MD


Recent advancements in information and communication technologies have elevated telemedicine as a promising tool for serving health needs in isolated and underserved populations. While telemedicine has been successful at increasing access to certain subspecialty care in the global setting, its role in enhancing primary and general healthcare has been limited. The research team hypothesized that using a novel simple-to-use, cost-effective telemedicine technology, and training community health workers who can facilitate its use, could enhance the delivery of primary care in a resource-poor community. Given this hypothesis, the research team proceeded to: (1) conduct a health needs and assets assessment among a medically isolated population, (2) conduct an acceptability and feasibility testing of an intervention involving telemedicine technology and community health workers, and (3) evaluate the intervention via assessing effects on the study population’s rate of health care utilization and self-reported barriers to health care.

Procedural Training for Family Medicine Residents Interested in Global Health

Sara Foster Fabiano, MD; Daniel Kortsch, MD


Question What procedures should be emphasized in FM residencies to prepare for medical practice in a global health setting? Background While global health education for Family Medicine residents has developed extensively, there have been few publications describing which procedures are appropriate for individuals who plan to work in low-resource settings. This paper proposes a list of procedures to guide FM residents in their GH goals and can help residencies in their educational offerings. Methods A literature review was conducted to identify prior publications in this area. Databases searched included PubMed, Cochrane, Google Scholar, and MedEdPortal. Conclusion Apart from general knowledge-based competencies, there exist no formal recommendations for global health procedural training for FM residents. This paper proposes procedures which can serve as a guide for residents interested in international work. Further analyses are warranted on which procedures are used most often in low-resource settings and ways to standardize training.

2 in 1:

History Giving: Narrative Writing and Global Health

Martha Carlough, MD


Experiences living and learning globally often deeply affect learners and physicians and despite important opportunities for presenting about experiences and group debriefing, many of us are left with complex emotions and processing about who and what we encountered and how that may have changed us. This experiential workshop on narrative writing will offer practical exercises for incorporating the reading of literature and narrative writing (poems, short stories, songs) into our global health work. This practice of “history giving” instead of “history taking” is intended preserve and honor what we learn from others’ lives (while maintaining appropriate confidentiality), be a creative outlet for connecting with others and develop resilience to prevent burn out and cynicism.

Using Narrative in Global Health: Lessons from the Field

Leo Lopez, III MD


Telling stories is a powerful way to educate, advocate for a cause, and build compassion and empathy. Global health is an epicenter for narrative. Global health students, residents, and physicians frequently encounter challenging clinical cases, ethical conundrums, and divisive conflicts. The goal of this workshop is to teach and empower global health physicians in listening to patient stories, develop a thoughtful narrative, and learn the basics of story telling. After the introduction, the session breaks out into groups. Groups collaborate and discuss their previous global health experiences. They choose a story worth-telling from their previous experiences. They identify themes and motivation. They select character or narrative based plot. They outline three act structure and build a dramatic arc. The groups will then share their narrative with the group.

A Model to Evaluate Global Health Training in Graduate Medical Education Using Standardized Patient Encounters

Courtney Birchall, Olga Valdman, MD; Malina Filkins; Satu Salonen, MD, MPH


There is an increasing interest towards global health training at all levels of medical education. According to AAFP, there currently are 100 family medicine residencies with GH training and 6 with GH fellowships. These global health experiences vary in their content and depth making it difficult to compare quality and impact on learners. The benefits of GH training reported in publications have been largely based on subjective measures. Although improved cultural competency is a presumed outcome of GH education, little objective, quantifiable data exists. Over the past 5 years University of Massachusetts has developed a model to evaluate global health education in an objective way using standardized patient experiences designed for cross-cultural communication skill assessment. In our presentation we will provide information on trends in global health education and the information gap that exists. We will then describe our unique evaluations methods, standardized patient encounters, and preliminary data.

Meena Apa: Addressing the Impact of Menstruation on Productivity and the Health of Women in Bangladesh Through Medical Student Entrepreneurship, Scholarship and Public Outreach

Sara Chowdhury; Sarah Moerschel, MD


Worldwide, menstruation is a taboo. During menstruation women lack access to hygiene products, are shunned, miss school and work, and are at increased health risk. Meena Apa created an anonymous online market to sell pads to urban women. Profits were then used to provide hygiene products to female factory workers. A 2017 survey of these workers showed the number of days missed from work each month due to menstruation decreased from 3 to 0.5 days. This project shows how a program can address a global health issue, how it can be funded and how its impact can be studied. It can contribute to research in global health and the education of students including navigating IRB approval. Future aspects of the project will include development of an education program for youth of both genders on menstruation and development of an online market to provide easy access to hygiene products.

The Cuban Model of the "Patient-Centered Medical Home" Three Decades in the Making: How Cuba's Neighborhood "Consultorio" Truly Integrates Family into Medicine

Laravic Flores, MD; Jade Bito-Onon, DO; Shraddha Shah, MD; Vanesa Avila, MD


In 1984, Cuba implemented the Family Doctor & Nurse Program into its national health care system to ensure primary care services in every neighborhood. This gave birth to the "consultorio," which literally epitomizes the patient-centered medical home (PCMH), as a local house/apartment in the neighborhood is converted into a clinic where the family doctor sees patients almost every day. Nearly thirty years later, Cuba’s PCMH model continues to thrive, with a “consultorio” in every neighborhood and each physician responsible for a designated set of families. Within Cuba’s holistic and integrated primary health care system, the family doctor plays a vital role in disease prevention and health maintenance. Despite its limited resources, Cuba’s excellent health outcomes belie the myth that equates resource-poor countries with poor health. On the contrary, it exemplifies how a system committed to equity, accessibility, and that embodies the essence of family medicine ultimately leads to healthier communities.