Saturday, October 7

Saturday, October 7

8:00–8:45 a.m.

Faith Based Global Health

Warren Heffron, MD


This plenary session on faith based global health work will reflect on global health activities of some of my personal heroes. I will share some stories of their accomplishments, motivations and methodologies. As a group, we will then turn to a review of global health work by faith based religious groups and secular organizations which might also be called faith based. I will then discuss attitudes of co-operation that will maximize and legitimize the efforts of all groups. My hypothesis is that we all do global health work based on some sort of faith.

9:00–10:00 a.m.

Descriptive Statistics of Adult Patients with Hypertension Seeking Care from Short-term Services Trips in Santo Domingo, Ecuador Over a Two-year Period

Christine George, MD; Sam Waling, MD; Maria Gabriela Castro, MD; Samuel Matheny, MD; Rameeza Sheriff, MD


Considering the volume of resources committed to short-term medical service trips, the current literature on clinical or patient-oriented outcomes MSTs is scarce. Shoulder
to Shoulder Global provides a blended program of short and long term care through MSTs and a permanent clinic in Santo Domingo, Ecuador. Using data extracted from the TimmyCare electronic health record collected over
the last three years, we share our initial experience with a health impact assessment based on preliminary measures of hypertension management. We will focus on descriptive statistics for a population of adult patients with hypertension and discuss the challenges of measuring clinical quality in the setting of intermittent care.

2 in 1:

The Progress of Family Medicine Residency Education in the People’s Republic of China: A Personal Perspective from Central China

Cheryl deMena, MD


During the past 2 decades the Chinese medical system has expanded rapidly with technological advances and specialization. In the wake of this progress is an inadequate primary health care system served by less qualified and poorly trained doctors. Over the past decade the central government has made great efforts to improve the quantity and quality of community medical centers and the general practice doctors who staff them. Though government initiatives have been well researched, publicized, and funded, there remain significant challenges in providing primary care to the Chinese people. Having lived and worked in Wuhan, China for the past 17 years, I have personally seen the changes in the medical system and witnessed the challenges faced by leaders tasked with facilitating change. Over the past 5 years I have participated in both faculty development and training of family medicine (general practice) residents. I can attest to both the determination and the challenges involved.

Filling the Void: Developing Local Leaders in the Southeast Asia Family Medicine Academy

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


Like much of the world, development of the Family Medicine Academy lags behind other specialties in Southeast Asia. As the region embraces the WHO sustainable development goal of “health for all at all ages” and universal health coverage, we have seen a re-alignment of government priorities to reconsider Family Medicine. It is essential that local leaders in Family Medicine are prepared to influence the Ministry of Health in the formation of primary care regulations, and the development of programs to train the healthcare workforce of primary care doctors. We have developed a 3-pronged approach to the development of local leaders in Vietnam, Myanmar and Cambodia, involving faculty development, clinical service delivery and policy development, with varying results. In each setting, the context varies, but our strategy has resulted in palpable change in line with our goals. We will share our approach and our successes and set-backs in each country.

Global Health Fellowships: Multidisciplinary Database Development and Program Survey

Ann Evensen, MD; Sean Duffy, MD; Russell Dawe, MD; Andrea Pike, MSc; Brett Nelson, MD


Interest in global health (GH) work among medical trainees has increased greatly over the last 3 decades, with approximately 30% of medical students now participating in GH experiences and many residency programs now offering such experiences. Residency graduates may choose to pursue GH fellowship training now available in many specialties. The only database of available fellowships in all specialties is now more than 5 years old. We are updating this database to include current US and Canadian fellowships programs in all disciplines. We are also surveying fellowship program directors to understand the scope of available programs, partners, fellowship graduate activities, challenges and unique aspects of programs. The administration of GH fellowships presents unique challenges, including financing, finding faculty, and vetting international partnerships..

A Conversation We Must Have: Safety and Security Protocols in Global Health Programs

Ranit Mishori, MD


Thousands of health profession students, residents
and faculty participate in global health activities around the world, many through established organizations and universities with rigorous safety and security protocols. But many students, staff and faculty do not have the backing of major organizations for their security planning. Global health work may expose individuals to various risks, including violence: from petty robbery to sexual violence, to car jacking, political, terrorism and conflict-related violence. As we continue to promote learners’ global health engagement we should promote a serious dialogue on this topic, exchange ideas and best-practices, conduct joint research and learn from each other and from organizations with a proven track-record of ensuring the safety and security of their staff. This presentation will review some common barriers to safety/security planning, discuss what prospective travellers should consider in choosing safety-conscious programs, and propose a road map to design safety processes and protocols.

Leveraging Support for the Design of Interdisciplinary Global Health Programs for Residents

Shay Slifko; Martha Carlough, MD, MPH


The Office of International Activities (OIA) at University of North Carolina was founded to provide support to students and residents in the area of global health. In order to more fully understand resident physicians’ educational needs, the OIA surveyed incoming first-year residents of all specialties in July 2012. The residents identified significant barriers impeding their involvement in global health opportunities during residency including time constraints, finances and mentorship. In response to the survey results, an interdisciplinary educational initiative was developed at our school. This included obtaining buy-in from core residency leadership, establishing a pathway to arrange experiences, competitive scholarships for travel, and initiation of interdisciplinary educational opportunities. Since integrating the programmatic, academic, and leadership endeavors in 2012, we now aim to revisit our residency global health support and assess lessons learned and creative methods for leveraging university-wide resources to robustly support and alleviate barriers for residency participation in global health.

Global Health in the Era of Medical Voluntourism: Service Learning from the Host Organization's Perspective

Kathy Chang, MD; Brooke Lamparello, MD


We provide a practice model that aims to be integrative and sustainable in addressing the multifactorial problem of healthcare quality and equity at a small primary care clinic in rural Uganda. Exposure to practice gaps can be frustrating and demoralizing for those participating in “service learning” if not partnered with tangible ways to close those practice gaps and lead to improvement in the health of
the population served. We describe a framework that may serve as a template for collaboration with organizations who partner with international medical volunteers on a regular basis. Our intention is to foster a consistent learning experience for visiting medical students/residents while growing local human resource capacity in low- and middle-income countries (LMIC).

Parasitology III: Vector-borne Parasites

Mark Huntington, MD


This is Part III of a concise overview of the field of parasitology Zika virus has captured the news lately, but what of other insect-borne infections?  In Part I of this series, we reviewed malaria; here, we’ll look at the rest of vector-borne parasites (but leaving the bacteria and viruses for another time!). The majority of these worms and germs infest the body outside of the digestive system, and tend to be more malignant than the gut-dwelling ones. Don’t worry if your memory of prior parasitology courses is rusty. Simplified and amply illustrated with plenty of images that will make even the most stoic cringe, you’ll walk away from this presentation with a recharged knowledge base, along with a remarkably persistent creeping sensation.

10:15–11:15 a.m.

Cross-cultural Navigational Skills

Michael Miller, DO; Travis Johnson, MD


A Family Physician working globally often works with colleagues and learners from different countries and cultures. Many of the decisions we make and the conflicts that arise in this context are greatly influenced by these cultural contrasts, whether we are aware of the fact or not. Competent navigation of this tension requires that we are sensitive to the core values that underlie the differing perspective in a specific situation and possess the skills required to lead from this vantage point. This session will use case-based scenarios to identify cultural disparities and start discussion of principles that might be used in these situations.

2 in 1:

Building A Central and North American Collaboration to Develop Family Medicine Training and Practice

Jennifer Hoock, MD; Rachel Bramson, MD; Ruben Hernandez-Mondragon, MD; Sean Duffy, MD; Sofia Blanco, MD; Alejandra Cascante, MD


Primary care is essential to improving health in all, but especially low resource countries, however few in Central America recognize or train Family Physicians. Through a series of meetings starting with STFM 2016, blossoming at WONCA/PAHO in San Jose, Costa Rica, and solidifying further at AAFP Global Health (Atlanta), a group of family physician faculty from North America and Costa Rica joined with interested Guatemalans, Hondurans and Nicaraguans to share resources for the purpose of developing Family Medicine across Central America. With the support
of this collaboration, we are taking steps to introduce family medicine and develop residency training with
host countries. We will share our progress in Guatemala and Honduras, and outline opportunities for furthering development of family medicine while inviting participation in the planning and execution of a 2018 Central and North American Conference on Family Medicine sponsored by the Universidad Rafael Landivar of Guatemala.

Family Medicine in Honduras: A Consultation Progress Report

Ruben Hernandez Mondragon, MD; Javier Sevilla Martir, MD ROOM


After one year in the consultation process for the development of a Family Medicine Residency Program in Honduras and after several attempts we have advanced
to a more concrete position to share current status and discuss the future. Family Medicine has been implemented in most Central American countries but Honduras. With support from the Pan American Health Organization and the Honduran academia through the Universidad Nacional Autónoma de Honduras (UNAH), an integrated commission visited Indiana University and had a working visit to learn about family medicine first hand and determine the steps to follow for the development of the first program in Honduras. Through this presentation we will describe the current and previous consultation processes and share recommended structure for consultations reports as well as open discussion for sharing participant’s own expertise and advise for the future of the project.

2 in 1:

First, Do No Harm: Principles for Effective Global Health Volunteering and Education

Yasir Abunamous, MD; Sweety Jain, MD


In residency programs around the US, increased emphasis is placed on the family physician’s role as a global citizen and culturally-competent healer. Numerous programs develop international electives organized as mission trips, offering free medical care to underserved populations in nations abroad. Despite the noble intentions and arguably positive impacts involved in such efforts, there can be significant unintentional harm inflicted on both participants and “beneficiaries.” Thus, it becomes imperative for Family Medicine physicians and residents to commit to service that is anchored in a strengths-based, stakeholder-driven, multidisciplinary approach that maximizes benefit for volunteers and their host communities. These concepts can be elucidated by examining a case study of the partnership between LVHN’s Family Medicine Residency and the NGO “Institute for Indian Mother & Child.” A literacy and proficiency in this realm of global health can better promote the objectives of developing leadership, service, and astute understanding of complex health systems.

Teaching Global Health in Medication Education: Focus on Health Care Disparities

Ben Fredrick, MD


Over the past ten years global health competencies have been developed to clarify key areas of learning for health professionals. Competencies run the gamut from ‘basic’
to ‘advanced’, from broadly applicable to all students to only for those who intend a future career in global health. With so many options, how are global health educators
to choose? This presentation proposes that global health medical education should prioritize training on health care disparities, a subset of health disparities. Unlike the broader category of health disparities which can appear daunting, health care disparities are within the purview and sphere of influence of all family physicians to address. Valuable opportunities exist in global health to reinforce the twin solutions of addressing health care disparities through person-centered and equitable health care, whether those disparities are identified here or abroad.

A Question of Faith: Do Faith-Based Organizations Empower or Impose?

Sheila Perkins, B.S.


This breakout session hopes create a space for
respectful discussion surrounding the role of Faith Based Organizations (FBOs) in global health. We prompt the question: How can faith be incorporated into global health appropriately? Faith Based Organizations have brought about a lot of positive social change such as founding schools, hospitals, and organizations to serve the most vulnerable. However, there are often concerns that religious ideology may hinder the delivery of some healthcare services and as result may play a divisive role. In today’s cultural climate it is often taboo to talk about religion, but because Faith Based Organizations are influential players in global health initiatives the conversation should not be overlooked. This breakout session, which will use participants’ experiences with faith and global health, aims to facilitate dialogue about the role of faith in the field of global health.

Seven Years Teaching Family Medicine in Africa (And Why I Want You To Help Me Build a Medical School In Western Ethiopia)

Barry Bacon, MD


The process of teaching family medicine in Africa is transformative in a number of ways. It opens our eyes to our role in the world and what we are capable of accomplishing. It illuminates the need for greater understanding of the specific challenges to teaching medicine and transforming healthcare leaders in Africa. It clarifies healthcare disparities in our own communities at home that we were previously blind to. Finally, teaching family medicine in Africa makes it clear that education is one of the most important and significant gifts that we as American Family Doctors can give to the world, and by building a medical school in western Ethiopia in a refugee dense population, we can provide hope, security, education, healthcare transformation, and promote peace in a conflict area of the world.

Initiation of Graduate Medical Education in Family Medicine in the Islamic Republic of Iran

Mark Huntington, MD; Stephen Schultz, MD


In 2016, formal graduate medical education (GME) in Family Medicine was implemented in the Islamic Republic of Iran. A total of eight residencies have been established, involving a total of 60 individual residents. While the ultimate plan is for a 3-year duration of residency for recent medical school graduates, the initial class matriculated into a 2-year program. These initial participants met rigorous admission criteria, including substantial experience in community clinical practice, a written examination, observed structured clinical evaluation, and completion with distinction of a Master in Public Health (MPH) program in Family Medicine. That spring, a small team of foreign consultants was invited to conduct a one-day workshop on Family Medicine GME as part of the annual National Medical Education Congress. They also visited three of the new residency sites, visited with leadership and representative faculty members of all eight residency programs, and met with key decision makers at both the University and Ministry of Health and Medical Education levels. In addition to these academic encounters, experiences with Iranian culture and history were provided to enable the consultants to gain a rudimentary understanding of the context into which the discipline of Family Medicine is being introduced. It is the purpose of this presentation is to share an encouraging report on the development of Family Medicine as a specialty in the I.R. Iran with other Family Medicine educators with an interest in the global expansion of the specialty.

A Search for Global Health Training During and After Family Medicine Residency: A Resident’s Perspective

Muhammad Shoaib Khan, MD; Raye Reeder; Viviane ESS Sachs, MD


The age of globalization, a growing worldwide immigrant and refugee population, infections that cannot be contained within borders and numerous other reasons have led to an increased interest in global health. As a family medicine resident interested in a career in global health, learning about the diverse aspects and the existing training opportunities in global medicine can present
a challenge. An elective rotation during residency can assist in improving insight into the various aspects and the possibilities for post-residency training opportunities in global health. The objective of this project is to elaborate on the development of a new elective global health rotation and the associated curriculum for residents. Also included are reflections from a two-week observer-based rotation at various global health programs and a comprehensive list of global health conferences and workshops for residents in the United States.

11:20 a.m. – 12:00 p.m.

Sustainable Neonatal Resuscitation Programs Amongst Medical and Nursing Students in Dar es Salaam, Tanzania

Elise Duggan, MD; Esther Johnston, MD; Florence Salvatory, MD; Jason Kroening-Roche, MD; Olivia Kroening-Roche, CNM; Kristen Cahill, APRN


Each year in Tanzania approximately 39,000 newborns die their first birthday, with 30% due to complications such as birth asphyxia. The need for neonatal resuscitation is most urgent in low-resource settings where the burden is greatest and the capacity to provide adequate neonatal resuscitation is lacking. To address this critical gap, medical and nursing students at Hubert Kairuki Memorial University created a student-led organization to teach Helping Babies Breathe
(HBB). HBB is a hands-on training program designed to prevent neonatal mortality from birth asphyxia in low-income countries. This student-led organization, building on the training they received in 2015, achieves sustainability by maintaining a pipeline of student master trainers across university cohorts. To date the group has trained more than 800 students and health care workers, and helped develop a similar student-led group at CUHAS University in Tanzania.

The Contra Costa/UCSF Global Health Fellowship and Malawi College of Medicine Collaboration to Strengthen the Family Medicine Rotation of Fourth Year Medical Students

Naushad Amin, MD; Elizabeth Berryman, MD; Erin Stratta, MD; Bradley Randles, MD; Neil Jayasekera, MD; Kevin Bergman, MD


Malawi has one of the lowest Gross Domestic Products per capita in the world. Due to this widespread poverty and limited educational resources, Malawi’s health care system is fragile. Although family medicine is a relatively new specialty in Malawi, the Ministry of Health has placed a high priority on primary care and family medicine. To improve primary care services, a formal family medicine rotation was introduced as part of the College of Medicine (COM) curriculum in 2009. Since 2014, the Contra Costa/UCSF Global health fellowship has supported the COM family medicine rotation through ongoing student precepting both at the bedside and in the classroom. The role of direct mentorship, role-modeling, community engagement, and precepting in the development of family medicine in Malawi will be discussed. The session will address informal ultrasound training for medical students and local staff, journal club for faculty education, and other innovative collaboration with COM stakeholders.

Critical Questions for Learners Going Abroad

Brandis Belt, MD


The goal of this talk is to help medical students and residents prepare for international and/or global experiences. Key themes will be explored through images and structured discussion. Importantly, the themes are broad-based and intensely relevant. 1. Image: Nursing home with a rickety stairway leading in to it How can learners best conceptualize their work in context? We will discuss the difference between “medicine” and “public health” in broad terms and start to differentiate between types of interventions. 2. Image: Wedding with audience members watching through cell phones How can one limit being a “cultural voyeur”? We will go over tips to fully experience experiential learning. 3. Image: "Child" feeding their elderly parent What is the optimal relationship with the host country and established workers/colleagues? We will explore the complex role and nuances of being a medical learner abroad.

Human Rights – Why it is a Doctor’s Business

Ranit Mishori, MD


Why should doctors care about human rights? What are major human rights crises in the world today and how can doctors get involved? Whether they work abroad or in the US, students, residents and doctors will encounter individuals whose health and well-being are deeply affected by human rights violations, such as torture, female genital mutilation, violence, human trafficking, sub-standard prison conditions, child labor or illegal working conditions. Health professionals have a unique role to play not only in caring for these individuals, but in responding to human rights violations, and in mobilizing others to try to stop these violations. Doctors have a special responsibility to speak out based on their ethics and broader advocacy for their patients and in support of global health issues.

Emergency Obstetric Skill Retention Pilot: Ethiopian Midwives 18 Months Post Advanced Life Support in Obstetrics® Course

Ann Evensen, MD; Allie Kinsloe Dittmar


Advanced Life Support in Obstetrics (ALSO®) is a short, hands-on course to improve management of obstetric emergencies such as postpartum hemorrhage. Although ALSO training has been shown to improve self-confidence and management of postpartum hemorrhage, no assessment of skills retention over time has been done. Studies of other emergency training courses show diminishment of skills over time, suggesting the need for repeated training or drills (ref). Our study was a pilot to evaluate retention of ALSO skills in Ethiopian midwives 18 months after initial training. We will present information about the initial training, design and execution of our study, results of the skills assessments, qualitative feedback from participants, and recommended preparations prior to a larger study.

Separating Fact from Fiction: 14 Years Experience of a Residency Global Health Book Club

Stephen Schultz, MD; Ryan Cummings, MD


There are a myriad of different issues to explore when teaching global health in a family medicine residency—history, cross-cultural awareness, social conflict, economics, prejudice, and social action, to name only a few. Reading books together can be a much more effective approach to sharing and discussing these issues than attempts to lecture on the same topics. We will give an overview of how our book club is organized, and will include a list of books, separated by fact and fiction, we have read over the last 14 years, highlighting some particular books we think are especially high yield.

12:00–12:30 p.m.

Global Family Medicine: Let’s Do It!

Jeffrey Markuns, MD; Cal Wilson, MD


The most significant concepts brought out in this conference will be highlighted in this session. While the basic principles of family medicine practice are universal, the application of those principles must be tailored to specific conditions and needs of the local setting. We will summarize ideas that generated significant comment and interest among the participants, and suggest the importance of carrying on this interest into individual and corporate global action. An emphasis will be placed on the sharing of our resources of people, education, products, and money, but it must be done in a spirit of true humility and not with arrogance or paternalism. All participants will be encouraged to make a contribution toward the good of the marginalized in other cultures, and to go beyond themselves, their settings, and their personal comfort zone to make this happen.