Thursday, October 5

Thursday, October 5

7:50–8:45 a.m.

Global Primary Care and Family Medicine

Masahiro Morikawa, MD, MPH, FAAFP


Primary care is the foundation of any healthcare system. The challenge is, however, where there is a greater need for primary care, there is an even greater shortage of providers. These providers are faced with a wide range of clinical problems in various age groups with limited resources. Unfortunately, there are a sparse number of educators to prepare them. This challenge is at the forefront of improving primary care in global health. This lecture will outline the primary care needs in different communities based on my experiences in program development. I will clarify the role of primary care providers in a global setting and address problems in training them. We will then examine assumptions that can hinder healthcare system building and discuss how we can implement and monitor sustainable interventions based on family medicine principles.

9:00–10:00 a.m.

2 in 1:

High-Risk Low-Resource Maternal Care

Nicholas Comninellis, MD, MPH, DIMPH


Surviving motherhood is a genuine concern. Maternal and newborn deaths make up the 6th and 7th leading causes of Disability Adjusted Life Years (DALYs) lost in the world’s poorest nations. Post-partum hemorrhage (PPH), eclampsia-preeclampsia, abortion complications and failure to progress are the leading maternal causes of death. Major modes of decreasing maternal morbidity and mortality
are to reduce family size and to provide quality obstetric care at time of delivery. Breastfeeding is the most natural, available contraceptive, with multiple additional benefits. Management of PPH requires immediate evaluation and intervention, particularly against atony. Basic newborn resuscitation should be universally available. Healthcare professionals must advocate for provision of these essential services to safeguard mothers and newborns.

Maternal Health in Zambia

Dan Jones, DO


Short Abstract: Africa is the most dangerous place in the world for a woman to give birth. The maternal mortality rate for Zambia is 17 times higher than America. The disparities between the health care for pregnant women in the U.S. and resource-limited countries like Zambia are highlighted. Factors for this inequitable distribution of maternal health services are identified. Serious maternal morbidities covered include obstetric fistula, ruptured uterus, and stillbirths as well as special obstetric conditions like twin pregnancy and breech presentation. Specific patient case scenarios have been collected from the maternity ward
at Zimba Mission Hospital over a ten year period. Cost-effective interventions with consideration of the appropriate setting can have an impact to significantly reduce morbidity and mortality for maternity patients in the developing world.

The ABCs of Female Genital Cutting/Mutilation: What Clinicians Need to Know

Ranit Mishori, MD


Female Genital Cutting/Mutilation (FGC/M) is a practice that involves partial or total removal of the external female genitalia or other injury to the female genital organs for non-therapeutic reasons. It is common in several regions worldwide and more than 100 million women and girls are estimated to have had FGC/M. The practice has serious, life-threatening health risks for children and women, manifesting acutely or chronically. Negative obstetric outcomes have also been reported. US-based physicians may encounter FGC/M in their immigrant and refugee populations and should have a basic understanding of the practice, its clinical management, cultural ramifications and communication strategies. In addition, practitioners should understand the legal and ethical implications surrounding deinfibulation and reinfibulation and their own beliefs regarding these practices. This presentation will draw on a variety of published sources and expert experience and opinion to present best practice in the management of girls and women with female genital cutting. The presentation will provide some case based examples to promote discussion and problem solving within the group.

From Global to Local: Development and Utilization of a Local Student-Run Free Clinic to Provide Interprofessional, Cultural, and Clinical Global Health Education for Medical Students

Arjun Patel, Sirikanya Sellers, Melanie Bui, Jenna Driscoll, Lauren Everett, Morgan Irwin-Weyant, Jacklyn Locklear, Paul Symansky, Judith Simms-Dendan, MD


Family medicine is inherently an interdisciplinary specialty that requires an enhanced variety of clinical and interprofessional experiences during education and training. In addition to preparing medical students for the rigors of clinical practice, comprehensive medical education must provide opportunities for students to gain experience that will develop their cultural competency, increase the variety of clinical exposure, and develop essential interprofessional skills. Here, we describe a local service-learning project based on global health principles, derived from our medical school’s annual international service trip, which not only provides medical students with the opportunity to develop specialty-independent skills necessary for medical practice, but skills that are essential for addressing global healthproblems in any capacity. Moreover, the local service-learning project allows for medical student experiences
in community-based health care practices focused on caring for the underserved which can enhance cultural competency, prepare students for medical practice, and provide an opportunity for socially-embedded learning.

Mental Health for Children in Conflict Zones

Leo Lopez, III MD


In 2016, the world witnessed the global refugee crisis unfold. Imagery of young Syrian children, suffering unfathomable despair, remain vivid. Nearly forty percent of refugees traveling to Europe via the Mediterranean sea are children. While 90 million children under the age of seven spend their entire lives in conflict zones, more than 230 million children around the world live in areas affected by armed conflict. Ongoing conflict retards individual, social and psychological development, which in turn destabilizes society. These conditions put children at increased risk for cardiac disease, diabetes, and drug abuse. While much focus addresses physical needs like hunger, somatic illness, and housing, less attention is paid to the psychological well being of these children. These vulnerabilities contribute to economic suppression, educational disparity, and opportunity for radicalization. I traveled to Israel and Palestine to examine how mental and behavioral health specialists manage psychological trauma for children in conflict.

Long Term Follow Up of Short Term Emergency Ultrasound Training in Tanzania

Mark Shaffer, MD; Prosper Bashaka, MD


Numerous studies have shown a positive immediate impact in short term bedside ultrasound trainings for providers in resource limited settings but long term impact of these trainings has not been well evaluated. In September, 2015 a team of ultrasound trained family and emergency medicine physicians from the USA and Tanzania performed a 5 day emergency ultrasound course for eight physicians in the remote area of Mbeya, Tanzania. In April 2017 the training team returned to the site for follow up evaluation including standardized exams, log book review and provider surveys. Positive findings included continued functionality and use of the bedside ultrasound machines by at least some trained providers. Impact on clinical decision making was documented. However, bedside ultrasound had not yet been incorporated into the standard evaluation of trauma patients as planned. A detailed analysis of site feedback, implementation challenges and recommendations for similar future trainings will be presented.

Growing Family Medicine Via Multiple International Partners: A Successful Model

Sunil Abraham, MBBS; Inis Jane Bardella, MD, FAAFP; Manorama Mocherla Khare, PhD


Christian Medical College of Vellore, India (CMC) has robust student and resident family medicine education programs lead by an academic Department of Family Medicine.
The specialty of family medicine in now recognized in India. Clinical family medicine care is recognized as high quality. Community-based research is beginning. This level of accomplishment results from 24 years of progressive work with partners from several countries and institutions. This workshop will discuss the benefits, challenges, contributions, failures and successes of engagement
with multiple international partners over more than two decades. Examination of this model will provide strategies and approaches that can be applied for progression and maturation of family medicine education and practice in countries and regions where it is not well established.

Parasitology I: Malaria

Mark Huntington, MD


Although global health involves more than exotic infections, infectious diseases remain common in much of the world. Malaria is arguably the most important infectious disease in the world today and throughout history. Pathophysiology, clinical presentations, diagnosis, transmission, treatment, and prevention—for both locals and expatriates—will be covered during our time together.

10:15–11:15 a.m.

2 in 1:

Easing the Transition to Citizenship: The I648

Paula Mahon, MD


Our refugee patients come to us with histories of trauma and deprivation. US immigration provides primary care physicians with a tool to assist our traumatized and cognitively impaired patients with access to citizenship, the I648 form. In addition to introducing attendees to this form and what US Immigration accepts as reasons for a waiver, I intend
to introduce various mental status tests (the MOCA, and the RUDAS) openly available to assist in the assessment of cognitive losses in refugee populations settling in the USA.

Forsyth County Refugee Health Collaborative: Building an Algorithm to Enhance Access

Shahla Namak, MD; Alexandra Kohl Brady, MD; Laura Cody, BS; Andrea Caldwell, RN; Julie M. Linton, MD


The Forsyth County Refugee Health Collaborative began as a resident advocacy project to enhance access and quality of care for refugee in our region and grew into the current, well established partnership. Our collaborative effort identified barriers and opportunities to connect refugees to medical homes and created an algorithm that improved communication and organized interventions between its partners, medical practices, and the Department of Social Services/Medicaid.

Designing a Point of Care Ultrasound Workshop Through a Multi-institutional and Organizational Collaboration for Family Medicine Physicians in Kenya

Daria Szkwarko, MD; Catherine Gathu, MBChB, M.Med; Sam Mucheru, MBChB, M.Med; Naushad Amin, MD; Mena Ramos, MD; Kevin Bergman, MD; Joseph Thigiti, MBChB, M.Med; James Amisi, MBChB, M.Med; Leanne Jones, MD; Elizabeth Berryman, MD; Jason Reinking, MD; Neil Jayasekera, MD


Point-of-care ultrasound (POCUS) has the potential to allow for affordable, reliable, and rapid diagnosis in low-middle income countries (LMICs) that otherwise lack the means for diagnostic imaging. In Kenya, family medicine physicians are well-positioned to utilize POCUS in ambulatory and emergency care settings but lack formal training in the use of this technology. To fill this need, the Kenya Association of Family Physicians partnered with University of Massachusetts Family Medicine, Contra Costa Family Medicine, and four Kenyan Family Medicine training programs to bring a 2-day POCUS training workshop to Nairobi, Kenya in May 2017. The workshop trained 44 family medicine postgraduate trainees and physicians representing most family medicine residencies all over the country and was the first of its kind in the Kenya. The goal of this presentation is to describe the logistics and implementation that were involved in organizing a multi-institutional/organizational POCUS workshop to family medicine trainees in Kenya.

Establishing, Building and Sustaining Global Health Projects

Javier Sevilla-Martir, MD


As new Global Health projects are established its important to consider the different options and take into account that these often take place in areas with no or limited access to health care which at times require building rather expensive infrastructure. It is essential to know local needs and plan accordingly for the success of the initiative and to ensure sustainability. We have established a series of academic programs and activities and collaborations with several organizations to carry out learning, service and research activities while serving the needs of the local underserved communities throughout Central America. Local and international partners have facilitated resources and made possible the construction of a clinical site that is now home for clinical services at main site. Experiences with different types of projects, building infrastructure and specific programs and successful ways for sustainability will be share through this presentation.

Round Table Discussion: Careful Caring for Our Global Patients

Victoria McCurry, MD; Sommer Aldulaimi, MD


Short-term medical trips (STMTs) are a popular form of medical volunteerism for both residents in training
and physicians in practice. STMTs afford structured opportunities to provide care for underserved populations while enabling travel to other countries. In the last few years, academic scrutiny of STMTs has highlighted the possible and often-unnoticed negative consequences of these trips. Several sources of adverse outcomes arise from a lack of continuity follow-up care, the damaging effect to local physicians’ practices, a pressure to perform interventions without appropriate training, the risks of ineffective care with limited resources, and an ignorance of culture and language leading to errors. Our interactive workshop will draw upon the global health expertise of the audience and presenters to explore solutions to these problems. Further, the workshop will seek to identify reasons family physicians engage in STMT work, collectively weigh risks and benefits, and explore other resulting ethical dilemmas encountered.

Maternity Care: A Balance Between Culture and Medicine

Beth Damitz, MD; Sandy Olsen, MS


Maternal morbidity and mortality is still a challenge globally. Efforts to reduce these rates have been addressed in various ways. The women of Somalia face similar and unique challenges. According to the World Health Organization, internal conflict and famine and a collapsed health sector left 80% of the population without access to basic health services. This prompted a Somali Reproductive Health National Strategy and Action Plan 2010-2015 to be established. Since our clinic cares for Somali patients, it was important to us to find ways to improve maternity care in this population. Because of the limited health resources in Somalia as well as their unique cultural and religious practices, their views on prenatal care and contraception were very different from our Western views. Our clinic has over the years, developed innovative ways to respectfully work with our patients with to improve our prenatal visits and contraception rates.

Clinical Update on Global Child Nutrition

Martha Carlough, MD


Malnutrition is a leading cause and cofactor in child morbidity and mortality globally and an often neglected area of clinical knowledge for health care practitioners and medical students. This workshop will review current demographics on the prevalence of undernutrition, micronutrient malnutrition and over-nutrition (obesity) and discuss appropriate methods of nutritional surveillance and evidence based management of acute malnutrition. Successful models for community based interventions will also be covered and consideration given to incorporating child nutrition work into global health programming. As nutrition and food security is complex, and intertwined with politics, agriculture, and culture, we will also discuss a potential role in nutrition advocacy for global health practitioners.

Do-It-Together Health Education: Community-Based Health Interventions for Mercado Global Artisans

Tricia Olaes, MD; Olga Morales; Masahiro Morikawa, MD, MPH; Aditya Bhatia, MD; Nkosi Mason, MD; Hikari Morikawa, MA, MSSA

For more than five years, our team of family physicians, social workers and local community workshop facilitators has worked intimately with the Guatemala-based non-governmental organization (NGO), Mercado Global (MG). Our objective has been to help the MG artisans self-identify areas of health needs, and then work with them to improve health literacy and health maintenance. Each expedition has been aimed at empowering MG facilitators and artisans to take active roles in maintaining their own health and that of their families and communities. This goal is accomplished through health education. During our most recent visit in February 2017, we developed and implemented two new educational modules. The topics were “Diabetes” and “First Aid” (elected by MG artisans). The information was disseminated using a “Do-It-Together Health Education” model that entailed: assessing the base knowledge of our audience, presenting simple but critical health facts on each subject in a fun and interactive way, and adjusting care plans to suit the cultural context, in an effort to facilitate adherence.

11:20 a.m.–12:00 p.m.

Cervical Cancer Screening and Treatment in a Rural Hospital in Malawi: A Four-year Comprehensive Review

Mai-Linh N. Tran, MD; Mary R. Goodrich, MD; Casey Graybill, MD; Marc Debay, MD, MPH, PhD; Karen Studer, MD, MPH

Eastern and Southern Africa, particularly Malawi, have
the world’s highest incidence rates for cervical cancer, a preventable and treatable condition if found and treated early. In September 2012, Malamulo Adventist Hospital (MAH),
a 212-bed rural hospital, initiated the only cervical cancer screening (CCS) program in Malawi based on cytology testing, colposcopy and loop electrosurgical excision procedure (LEEP). This study uses MAH’s clinical data to determine the number of women receiving these services over time; the proportion of women who had positive cytology tests, by age and by HIV status; and the proportion of women treated for pre-cancerous lesions or for cancer. The study also reviews the successes and challenges that MAH faces in maintaining and expanding its CCS program considering other approaches available in low-resources settings. Finally, this study discusses how Loma Linda University Family and Preventive Medicine residents contribute to this program through their curricular international rotation at MAH.

Practical Solutions for the Development of Long Term Global Health Partnerships


As resident interest in global health increases, more residencies are developing global health rotations. Ethical guidelines recommend the development of well-structured programs for trainees within long term partnerships between sending institutions and host organizations.. The Christ Hospital/University of Cincinnati Family Medicine Residency has over 20 years of experience training residents in global health. For many years, the program enjoyed a long-term partnership in Honduras through the non-governmental organization (NGO) Shoulder to Shoulder. However, since security issues limited the program’s ability to continue working in Honduras, the program has worked to establish a new partnership with Wuqu Kawoq, sending regular teams of residents and faculty to Guatemala. This presentation will offer practical solutions for programs on the development of partnerships with NGOs, balancing the dual mission
of offering quality educational and ethical global health rotations for residents and students, while also providing benefits to the community and organization on the ground.

Addressing Determinants of Health in Rural Honduras: One Residency's Approach

Ryan Cummings, MD; Stephen Schultz, MD


Over the past 14 years, the University of Rochester Family Medicine Residency Global Health Program has developed a sustainable and longitudinal relationship with the remote community of San Jose de Marcos de Sierra, Intibuca, Honduras. The program is unique in that the goal is primarily to address determinants of health as identified by the community. These projects include providing water filtration at a systems and household level, VIP latrines, improved cook stoves, school and community health education, scholarships, microfinance and improvements to local agriculture. We will provide an overview of how our program is structured and sustained, and highlight specific unique initiatives.

Partnership to Care for Yazidi IDPs in Kurdistan

Paul Fonken, MD; Charley Hardison, MD


Since early 2016, family medicine has played a key role in a unique partnership serving more than 40,000 internally displaced Yazidi people in a camp in the Kurdistan Region of Iraq. Partnerships between governmental and non-governmental organizations have contributed to the initial success of the project. The use of “Open EMR” for clinic records has been a unique feature. Planning for a gradual transition from relief to development is the current challenge for the two faith-based NGO’s involved in the project. This transition will be aided by the fact that one NGO is focused on relief and the other NGO is focused on long-term development. As the clinic matures, it will hopefully become a training site and serve as a model for a new approach for primary care in that region, not only for IDPs/refugees, but also for the general population.

Evaluation of the Implementation of Community Oriented Primary Care (COPC) Model through the Family Medicine Department at Christian Medical College, Vellore, India

Manorama Khare, PhD; Sunil George Abraham, MBBS; Inis Bardella, MD


The family medicine department at CMC has worked in collaboration with UICOMR’s department of family and community medicine to develop and operationalize a COPC model in five underserved communities served by CMC. At the time of submission, data has been entered into a database for 222 households with a total of 898 individual family members. Data collection is on-going. This workshop will discuss operationalization of the COPC model through an iterative process of developing a logic model, which includes goals, objectives, short-term and long-term outcomes, and measures of success. Our discussion will include 1) collection of socio-demographic and health risk data from all members in each household in each of these communities, 2) key findings from preliminary data analysis, 3) identification of the primary health needs in each community, 4) plans for use of the data to develop strategies and programs to address these health needs.

Regional Networks: An Approach to Enhance Global Exposure for Medical and Health Professional Students in Africa

Anna Iacone, MS; Faith Nawagi, MSPH; Eleanor Fitzpatrick, MA


Students from Africa have limited access to global health opportunities in developed countries due to cost and other challenges. With significant differences in health concerns and health care settings across regions of Africa, African students can gain a “global” experience on the continent. Regional networks offering exchange opportunities to students help to develop future African physicians and health care providers to serve the health care needs of their own patient populations while strengthening their communities and building the African healthcare workforce. GEMx serves as “facilitator” of African student exchanges through a Charter, technology and GEMx student grants GEMx partners with AFREhealth, COECSA, EAHPEA, and South-South exchange initiative. There are a total of 26 participating institutions in Africa offering elective exchanges in medicine, health professions and at the post-graduate level. The projected number of student exchanges is 98 by April 2018.

1:00–2:00 p.m.
Ideas Worth Sharing

Partnerships with High-income Country Academic Centers that Support Post Graduate Training  Programs in Family Medicine in Sub-Saharan Africa: Key Themes for Success

Katherine Billingsley, MD; Mathew Dacso; Phillip Keiser


Aim: To identify best practices for academic institutions that support developing capacity for family medicine (FM) training in Sub-Saharan Africa. Methods: A search of literature using key terms Africa, family medicine, family physicians, internship or residency, and graduate medical education resulted 56 articles. Of these, 13 were on development of post graduate training programs and were reviewed for key themes. Results: Literature on FM program development from 8 African countries were identified. Articles on multiple countries were also reviewed. Key themes identified were: 1) Need for a local FM champion, 2) Institutional Support, 3) Governmental support, 4) Local and international partnerships, 5) Funding, and 6) Faculty development and retention. Discussion: Academic institutions that engage in the development of FM training in Africa should start by identifying and supporting
a local champion. Successful partnerships are defined by sustained funding, institutional and host government buy-in, and host partner faculty development and retention.

The Correlation of Magical Thinking, Superstition, and Educational Level to Health Literacy and Risky Behavior in Honduras

Lena Kasaab; Susannah Rothstein


The aim of this study was to compare the prevalence
of health-related superstitions among Hondurans who reached high school, compared to Hondurans who did not. Secondary aims were to correlate risky behavior, trust in physicians, and religiosity, with “medical” superstitions. Investigators hypothesized no difference in the prevalence of medical superstitions in educated Hondurans compared to the less educated. Literature review revealed some anthropological exploration related to medical superstitions in Latin America and Afro-Caribbean cultures, but failed to provide substantial investigation into this topic in medical literature. The study’s results appeared to confirm the hypothesis, and showed no difference in superstitious beliefs based on education level, possibly indicating their pervasiveness even in the highly-educated. These results may prove significant for Western-trained physicians practicing in Honduras, to improve cultural sensitivity. This knowledge has the potential to help physicians partner with patients and improve approaches to health care in this patient population.

Development of a WhatsApp Ultrasound Consult Group to Improve Patient Care and Longitudinal Ultrasound Training in a Global Health Context

Erin Stratta, MD; Naushad Amin; Liz Berryman; Bradley Randles; Kevin Bergman, MD; Liz Berryman; Bradley Randles


Ultrasound is used in many health care settings, including extremely resource limited areas. However, the skill of ultrasound practitioners varies widely, often due to limitations in longitudinal training. For several years, the Contra Costa Regional Medical Center/UCSF Global Health Fellowship has supported ultrasound training in multiple countries. In 2017, they started a novel program using the instant messaging service WhatsApp to provide longitudinal support for ultrasound practitioners in various settings. By creating a WhatsApp consult group, members can post cases and receive real-time feedback and consults on their ultrasound findings. The consult group currently consists of practioners in Malawi, Kenya, and the U.S. There is specific focus on supporting two Malawian ultrasound techs working in separate and isolated rural health settings. The program connects hospital staff in resource limited areas with Family Medicine physicians experienced in ultrasound. The program improves diagnostic utility and patient care, while supporting local capacity building.

Ethical Considerations When Sending Traniees Abroad

Sommer Aldulaimi, MD; Victoria McCurry, MD


There has been increasing interest in global health by US medical trainees; more medical students and residents than ever are going abroad to learn and work. Although this is a very exciting time in global health, it raises several ethical concerns. How can educators send learners abroad in a more ethical manner - allowing them to gain knowledge and experience while also providing benefit for the host country? This presentation will discuss the common ethical pitfalls of sending learners abroad and propose practical solutions to these pitfalls based on current literature and experience. By acknowledging the potential hazards and implementing the proposed solutions, learners can be sent abroad in a more ethical manner, with value for both the learner and host country.

Inspiring the “Doctors of Tomorrow” in Detroit and Beyond through Medical Pipeline Programs

Kylie Steenbergh, BS; Evan Merryman; Carol Noronha; Gurjit Sandhu, PhD


Doctors of Tomorrow is a partnership between the University of Michigan Medical School and Cass Technical High School in Detroit, Michigan. This medical student-led pipeline program established in 2012 prepares high school students from racially and ethnically underrepresented communities to pursue careers in health professions. With the matriculation of 13 alumni at the University of Michigan we see evidence of the pipeline consummating. This longitudinal program of clinical immersion, academic preparation, leadership development, and mentorship from 9th grade through undergraduate studies has fostered strong local collaborations within Detroit and neighboring communities. For example, students engaged in capstone projects with community partners in Detroit to bring awareness to health disparities faced by inner-city populations. This program is designed to be easily replicated nationally. Family medicine physicians are uniquely positioned to implement and grow a pipeline program of this nature in ways that best fit the unique needs of their communities.

Supplemental Use of Visual Aids for Improved Communication with Rare Dialect Speaking Patients

Jennifer Rahn, MD; Shahla Namak, MD


As medical providers, we are often ineffective in communicating with patients who speak rare dialects. Few studies have assessed the efficacy of visual aid use to augment communication with rare dialect speaking patients in fast-paced medical environments. Therefore, this case presentation aims at reviewing the effects on patient outcomes and patient satisfaction that visual aids can have when administered during the time-sensitive labor and delivery process. We discuss the case of
a Mandarin-speaking patient and her husband who presented to an obstetrical unit where the only available option for English-to-Mandarin translation was via phone interpretation. Through the use of visual aids, we were able to improve patient understanding, increase patient focus, engage the patient and family, more quickly communicate time-critical information and instructions, and decrease distractions by eliminating the need for the phone interpreter and thus freeing the patient’s hands.

2:15–3:00 p.m.

Appropriate Technology For Global Health

Nicholas Comninellis, MD


Healthcare is chronically in crisis – especially in low-resource settings. Resolution demands skilled leadership, with attention to health systems. One ethical principle for developing successful health systems is effective use of limited resources. This includes appropriate application
of technology. What principles can be used to determine whether a technology is appropriate or not? Reliability, sustainability, and acceptability. Some often appropriate uses of technology in low-resource health systems include rapid diagnostic tests, mobile health information systems, ultrasound imaging, and adherence to use of WHO & National Essential Drugs. Partnership with local partners and hosts is also essential. Their guidance greatly increases the likelihood that technology will be used appropriately. This presentation includes interactive use of role-play to enhance the learning experience.

Promoting Patient Safety and Quality Improvement Through Collaborative Faculty Development: A Success Story From Nigeria

Greg Kirschner, MD; George Chima, MBBS


The Bingham University College of Medicine and Health Sciences and the Bingham University Teaching Hospital (formerly the ECWA Evangel Hospital) in Jos, Nigeria have become regional sponsors of Residency Program and Medical School faculty development, as well as providers of continuing education for practicing Family Physicians and other practitioners. The collaboration of this institution with the larger international medical community has continued to flourish beyond its roots as a small mission hospital. This session will share insights from an ongoing faculty development partnership with American-based relevant resources resulting in the promotion of the highly relevant topics of patient safety and quality improvement in the Nigerian context. The process of constructing appropriate cross-cultural faculty development workshops will be outlined, and workshop participant feedback shared. Successful learning activity features for the Nigerian context will be identified. A needs assessment revealing opportunities for further partnership will also be discussed.

Hypertension in a OneWorld Health Rural Nicaraguan Ambulatory Clinic: Prevalence and Management

Jennifer Lee, DO; Jeff Hall, MD; Mark Humphrey, MD; Myriam Torres, PhD


Given the rising threat of non-communicable diseases to population health globally, the Pan-American Health Organization (PAHO) has increased its effort toward improving the management of hypertension in Latin American and Caribbean regions1,2. A retrospective study was performed on a random sampling of 350 charts from a rural Nicaraguan ambulatory clinic to determine the prevalence of patients with hypertension in the town of El Viejo and surrounding area. Information collected and analyzed included age, date of visit, living zone of the patient, comorbidities, chief complaint, medications prescribed, adherence, and follow up. This study provides insight into acute and chronic disease states in rural Nicaragua and how they are being managed in the ambulatory setting. Such studies serve as the basis for future developments and interventions aimed at improving the management of non-communicable diseases in low-middle income countries. Research methodology and approach to epidemiologic survey in this settling will also be discussed.

Two Years in Tansen: Global Health Viewed Through the Lens of Life and Work in Nepal

Rebecca McAteer, MD


This seminar will review some of the opportunities, challenges and best practices surrounding the provision of medical care in a cross-cultural, developing-world context, as encountered during the presenter's time practicing full-spectrum family medicine at a rural Nepali hospital for two years (2013-15). Specifically, this talk will outline the current state of medical care in Nepal, attitudes and barriers to health infrastructure development, and common disease trends. Brief mention will be made of the Bhutanese-Nepali political situation that has led a number of Nepali-speaking refugees to emigrate to America, where they frequently seek attention for health concerns from community family physicians. The talk will address aspects of a skill set needed to engage successfully in global health, with time allotted at the end for participant questions and discussion.

Towards More Sustainable Programming for Global Health Missions

Laban Tsuma, MD


Medical outreach to disadvantaged or hard-to-reach areas is the focus for global health missions. How is population health momentum sustained after the missions? Where they exist, community health programs run by community health workers play are key role to fill the existing gap between the public health system and households. This helps to foster benefits after missions and prevents erosion of coping skills. What do we know about scaling up and sustainability of CHW programs? A CHW performance tool was applied in an established CHW program located at the site of ongoing health mission. Enablers and Barriers were identified and discussed. Tenwek Community Development uses the local church institution to mobilize community for health through volunteers called CRPs (community resource persons). Enablers and barriers exist and these keep on changing with time. Programs need to maintain a dashboard for sustainability that stakeholders can benchmark during the life of a program.

Global Neonatal Health Update: Status and Strategies

Martha Carlough, MD


While global child mortality has significantly decreased in the last two decades, neonatal mortality (death to infants in the first month of life) has lagged behind. This workshop/lecture will review the current demographics on neonatal health, evidence based interventions and training courses, and critical skills for primary care providers involved in care of the mother-baby dyad in low resource settings.

Zika Virus in the Neonate

Thara Foreste-Magloire, MD; Adaobi Nnaji, MD; Neubert Philippe, MD; Zafar Khan


Zika virus, is the new fear factor in pregnant women and their babies. Zika, has made its way all over the world and most recently in the USA. The Aedes mosquito is the proven vector involved in the transmission of Zika, Dengue and Chikungunya viruses. Co-infection with two or more of these viruses has been well documented. Refined diagnostic techniques such as RT-PCR and serology often yield false negatives. According to the CDC, RT-PCR has unknown reliability in detecting Zika across the different stages of pregnancy. The consequences of these challenges have been paramount. After the Zika epidemic that began in 2015, numerous births with documented microcephaly have occurred. It is therefore imperative to probe pregnant women who test positive for any of these three viruses- for the presence of Zika. In the event RT-PCR or serology yield negative results for Zika and positive results for
either Dengue or Chikungunya, alternative diagnostic tools such as fetal head ultrasound, newborn hearing and ophthalmology assessments, laboratory testing and routine follow up must be employed to rule out Zika in neonates.

3:15–4:15 p.m.

Global Health Conversations: The Aftermath of Surviving Ebola

Kent Brantly, MD interviewed on stage by David McRay, MD


On July 26, 2014, Kent Brantly called his friend and mentor, David McRay, to share heartbreaking news. Dr. Brantly was working at ELWA Hospital in Monrovia, Liberia, directing the Ebola treatment unit. He became infected with the virus. Within 24 hours, the news of Dr. Brantly’s illness had become an international story, and the course of this young family physician’s life – hanging in the balance for several days – would be profoundly changed. A group of family medicine educators gathered early one morning in September 2014, at the annual AAFP Global Health Workshop in San Diego, to talk about what had happened to Dr. Brantly, the tragedy that was continuing to engulf west Africa, and the ways we should now speak to our students and residents about the consequences of our global health activities. Since recovering from his near-fatal infection, Dr. Brantly has spoken hundreds of times – in the US, Africa, and Europe – about his experience and his perspective on compassionate service to humanity. He joins us at the workshop this year to share the story of his illness and to probe the multiple layers of its aftermath.

4:30–5:15 p.m.

Manual Laboratory Techniques for Resource-poor Settings

Marc Berger, MD


Many “Old-fashioned” laboratory methods are obsolete, no longer utilized; advanced, automated methodologies exist. These techniques may be manpower and time-intensive, but less expensive. In situations with limited resources, one may utilize “old-fashioned” technologies for clinical data not otherwise available. Because of regulatory issues (CLIA), many old techniques are not taught, creating a loss of expertise for simple, inexpensive laboratory methods; modern laboratory standards, and regulations prohibit these techniques FOR PROFIT, but they may be utilized by private, licensed physicians. Less-sophisticated laboratory results are better than nothing; providers can utilize simple techniques in situations with limited access to “high-tech” medicine. CBC requires a Coulter counter, while hematocrit, hemocytometer, and Wright smear will produce similar clinical information. This workshop will re-introduce low-tech clinical methods, do-able by providers, useful in situations lacking in technology, equipment, or funding. Methodologies include: unspun urinalysis, urine culture, plate cultures, stained bacterial smears, ESR, hematocrit, hemocytometer, and others.

Family Doctors are Our Rising Stars for the Future: A Discussion with Leaders of Family Medicine Expansion in Malawi, Guatemala and the US

Elizabeth Hutchinson, MD; Nitta Chinyama, MD; Jessie Mbamba, MD; Modai Mnenula, MD; Andrew Wei, MD; Nathaniel Guimont, MD; Akira Kobayashi; David Kennedy MD


Swedish Medical Center and Providence St. Joseph Health and Services will be launching their first Global Primary Care Leadership Forum this fall. These institutions are deeply engaged in supporting family medicine development in Malawi and Guatemala; both of which are at an early stage of their development. Through this forum, three Malawian and three Guatemalan doctors will participate in a seven week rotation where they will be students in a global health leadership course. They will acquire knowledge and skills unique to the US setting, build relationships with family medicine colleagues from other countries, teach about their experience with global family medicine development, and participate in this AAFP global health conference. This session will be a platform for discussions whereby Malawian, Guatemalan and US family physicians share their experience of working toward building the clinical and cultural infrastructure to grow family medicine in their context.

Creating the Human Trafficking Victim Medical Home in Resident Physician Education: A Synergistic Dynamic of Care

Ronald Chambers, MD


This presentation will provide an overview of human trafficking with physician guidance on identification of victims, protocols for intervention, and techniques for victim-centered, trauma-informed care. Best practices will be discussed from the development of a highly successful human trafficking medical home providing longitudinal care for victims within a residency clinic. Finally, a comprehensive yet succinct human trafficking curriculum for resident physician training will be shared along with preliminary relevancy data from a multi-hospital study indicating its’ utility and the importance of incorporating human trafficking training into residencies nationwide.

Global Health and the FM Milestones

Maureen Grissom, PhD; Tochi Iroku-Malize, MD; Neubert Philippe, MD; Rita Peila


Not only does the Global Health (GH) experience present an opportunity for resident development but including a component of written reflection can provide tangible evidence of development in areas that can be difficult to assess, specifically Accreditation Council for Graduate Medical Education (ACGME) milestones. We analyzed and integrated quantitative (frequency) data with qualitative content from the written reflections of 12 of our Family Medicine (FM) residents who participated in GH experiences. Written reflections touched on each of the 22 FM milestones. The most commonly identified milestones fell within the competency areas of Systems-Based Practice, Professionalism and Practice-Based Learning and Improvement. Our qualitative approach allowed us to gain an appreciation of the unique experiences that demonstrated growth across the various milestones. We conclude that any program that offers GH experiences should incorporate some form of written reflection to maximize resident growth and offer evaluative faculty a window into that development.

Multi-interventional Approaches to Child Malnutrition in Rural Guatemala: A Deeper Look at Cost Effective, Culturally Competent Care

Briana Williamson; Katherine Conway


Maternal undernutrition contributes to approximately 800,000 neonatal deaths each year due to small-for-gestational age births. Wasting, stunting, and micronutrient deficiencies cause an additional estimated 3.1 million child deaths annually [1]. Guatemala faces the highest rate of stunting in Latin America with 66% of indigenous children stunted [2,3]. The Organization for the Development of the Indigenous Maya has developed a four-pronged program to combat child malnutrition in indigenous villages. It focuses on culturally and linguistically appropriate pre- and postpartum medical care, maternal and child health nutrition education, micronutrient and targeted fortified food supplementation, and social support for mothers based on the Centering Pregnancy model. In this presentation, we evaluate the successes and challenges of this program, which was able to see a drastic reduction in acute
and chronic malnutrition. We also evaluate graduating participants’ perspectives on the program to gauge retention and the integral factors for programmatic success.

God Willing and the Creek Don’t Rise: Medical School Community Aides in Flood Relief Effort

Matthew Curry, MD; Charles Clements, MD; Alex Vance


On June 23rd, 2016 approximately 7.5 inches of rain fell on the town of Rainelle, WV within a 12 to 24-hour period causing one of the worst flooding events in state history. During the aftermath, Marshall Medical Outreach (MMO)- a student-led mobile clinical outreach associated with Joan C. Edwards School of Medicine- responded to a request for assistance in treating the town’s survivors. Medical and pharmacy students, physicians, and hospital administrators partnered with a local clinic to coordinate
a disaster relief effort. Within the span of 5 days, a mobile clinic was established to meet this need. Discussion will focus on disaster relief preparation, how involvement in MMO led to greater preparedness, lessons learned during the experience, and how family physicians are in a unique position to assist with disaster relief.

Ethics: Global or Local?

Catherine Scarbrough, MD; M. Shawn Morehead, MD; Gordon Zubrod, MD


Ethics is defined as the discipline dealing with what is good and bad and with moral duty and obligation. However, to what degree is medical ethics as a discipline universally accepted? Do different norms exist pending geography, culture, and/or degree of education? And how do views of physician authority and the therapeutic relationship influence such? Case presentations from Central Asia and the Middle East will be discussed.