GLOCAL: Local Global Health

Workshop Topics

Workshop sessions that focus on clinical issues are denoted with an asterisk (*).

Thursday, September 8, 2016, 9–10 a.m.

Room Location: Inman

Local Global Health Experiences and Integration of Interprofessional Education and Practice

Javier Sevilla-Mártir, MD

In an effort to provide the most needed health care services to the growing immigrant Hispanic/Latino community we have integrated interprofessional service learning opportunities for eight different health profession schools and the school of law. The partnership includes three local universities and offers services including medicine, dental, public health, nursing, social work, pharmacy, physical therapy, and occupational therapy, plus legal. The services are provided through the Student Outreach Clinic free of charge. One of the main emphasis and services provided is to connect patients to the system when possible and to manage their acute and chronic illnesses. Family medicine faculty and residents provide teaching and supervision. Outcomes demonstrate high quality of care and interprofessional service learning experience. This presentation will address the steps for implementation and management of the clinic, including funding, outcomes and interconnection to other programs designed to satisfied learners desire, and preparation for global health experiences.

Thursday, September 8, 2016, 10:15–11:15 a.m.

Room Location: Techwood

New Strategies for Primary Care of Refugees

Ana Maria Mendez, MD; Jenny Saint Aubyn, MD; and Tiffany Castellano, MD

Refugee patients present unique challenges to primary health care. They often require additional resources during office visits, have complex health needs, and have low U.S. health care literacy. These challenges lead to fewer medical concerns being addressed and increased provider stress. Refugees receive intense resources immediately upon immigration, which includes an initial health screening. After this initial screening, it is recommended that all refugees establish with a primary care provider. Refugees are typically accompanied to the initial screening, but then go to primary care visits alone. There are multiple guidelines and recommendations for the initial health screening visit, but there is a lack of information on how to integrate refugees into the health care system for ongoing care. Our clinic is establishing refugee-specific clinic sessions to provide structured programs on successfully transitioning into the U.S. medical system, to provide improved coordination of care, and to better meet provider needs.

Thursday, September 8, 2016, 11:20 a.m.–12 p.m.

Room Location: Inman

Pedagogical Challenges of Training Medical Students and Resident Physicians to Care for Refugee and Immigrant Populations in the United States

Jim Sanders, MD, MPH

Hundreds of thousands of immigrants in the U.S. are torture survivors and without access to competent medical care. This population suffers disproportionately from other immigrant groups with unique physical and mental health problems stemming from their trauma and torture. The U.S. government’s policy of not guaranteeing its own citizens health insurance means that it is ethically unjust to provide health insurance benefits to non-citizens. Torture survivors’ access to competent physicians is further undermined by trends in medical education that make learning about the clinical needs of torture survivors ethically challenging. This is especially true when seen through the ethical concepts that are often associated with clinical medicine: beneficence and truth telling. The Affordable Care Act offers new opportunities for educators to forge novel partnerships with community clinics where students might learn from and resident physicians might care for newly arrived immigrants and refugees.

Thursday, September 8, 2016, 2:15–3 p.m.

Room Location: Inman

Utilizing Simulation and Gaming to Teach Primary Care Providers to Prepare for a Global Health Isssue

Tochi Iroku-Malize, MD, MPH, MBA, FAAFP

Recently health care institutions have had to develop educational opportunities to update health care workers on the guidelines to follow when faced with a potential patient who may have been exposed to the Ebola virus and the Zika virus. Our department found a way to quickly educate clinicians within the health system, while ensuring front line staff (primary care providers) were aware of the basics for management. Combining elements of simulation, team based learning, procedure workshops, and interprofessional sessions became our method for creating an engaging session. Participants received an overview of the current global health issue, current data regarding its spread, and guidelines for managing the illness. They participated in a case-based scenario which played out across the continuum of care. The use of audience response, real time completion of medical records, utilizing appropriate equipment, role play, etc. helped to allow for better assimilation of information.

Thursday, September 8, 2016, 4–5 p.m.

Room Location: Techwood

Twenty Years of Caring for South Georgia Farmworkers

Susana Alfonso, MD, FAAFP; Maha Lund, DHSc, PA-C, DR AAPA; Emily Herndon MD, FAAFP; Jodie Guest, PhD, MPH; Erin Fitzpatrick-Lepp, PA, MMSc; and Alisha Smith-Thym, MA

For the past twenty years, the Emory University School of Medicine “South Georgia Farmworker Health Project” has provided compassionate, high-quality medical and dental primary care services to approximately 1,800 migrant and seasonal farmworkers and their families each year. Family medicine physicians, in partnership with physician assistant program faculty, have been the cornerstone of this interdisciplinary health outreach effort to create a unique teaching and supervisory model that offers an academic service-learning opportunity for over 200 learners, including medical and allied health students. The onsite teaching global health issues include developing cultural humility, learning the role of public health in rural communities, and how to identify and treat diseases that affect this population. Our highly-acclaimed project can serve as an exemplar of how to develop sustainable community-based partnerships that provide care to this vulnerable and underserved population, as well provide unique learning experiences.

Friday, September 9, 2016, 9–10 a.m.

Room Location: Piedmont

Enhancing the Value of Global Health Education Through Global-Local Curriculum

Olga Valdman, MD; and Daria Szkwrako, DO

Over the last decade the field of global health (GH) has grown tremendously with more than 30 percent of the U.S. medical students now participating in GH electives according to a 2010 Association of American Medical Colleges report. Similarly, GH learning and practice continue to grow within the specialty of family medicine (FM). The critics of FM-GH education argue that there are large numbers of underserved communities in the U.S. who are not being attended due to the popularity of the overseas-based global health experiences. However, research shows that FM residents who participate in GH education are more likely to work in undeserved communities in the U.S. The University of Massachusetts (UMass) developed a GH fellowship that incorporates local refugee health experiences with global clinical and educational opportunities at our partner sites in a structured and mentored curriculum. This presentation will describe the Umass model, discuss lessons learned, and review strategies for setting up local-global curricula elsewhere.

Friday, September 9, 2016, 10:15–11:15 a.m.

Room Location: Spring

Understanding and Teaching the Global-Local Connection

Jody Olsen

There has been a recent growth in the number of universities and non-government organizations (NGOs) specifically linking global health programs with campus community engagement and community public health efforts. These global/local or “glocal” programs acknowledge the value of bi-directional learning and focus on social justice and community-based strategies that are applicable both domestically and internationally. However, glocal education is undertheorized and universities struggle to make the glocal link without a conceptual framework to guide them in this pursuit. This session will report on a 2015 meeting during which global health academics from across the U.S. developed a definition of glocal and a proposed list of glocal program elements. The session will also describe three different global-local programs underway in the U.S. at a medical school, a dental school and at a health care system. This session will describe a relatively new pedagogical method and provide practical guidance via several successful models.

Friday, September 9, 2016, 11:20 a.m.–12 p.m.

Room Location: Piedmont

Development of an Interprofessional Home Visit Program for Homebound Refugees

Lesca Hadley, MD, FAAFP; and Mark Nelson, MD, MPH

In this presentation, we describe our experiences in developing an interprofessional home visit program for homebound refugees in an integrated county health system. Approximately 20 percent of current home visits are provided to refugee patients. Medical students, residents, and fellows accompany the medical provider. Medical translation is provided through a remote translation service which allows patients to see the translator through a web-based system. In this presentation, additional successes, challenges and common problems faced will be presented. Our interprofessional home visit team has successfully incorporated a home visit program for refugees into its services. Access to health care for this vulnerable population has improved. Refugee patients and their families appreciate the care provided in the home. Trainees benefit by being exposed to the immense challenges our refugee patients face. Our greatest challenges continue to involve coordinating care outside the home.


Friday, September 9, 2016, 4:15–5:15 p.m.

Room Location: Spring

Global Health at Home: An Interactive Curricula Experience (ICE) for Refugee and Immigrant Health

Ellen Plumb, MD; Marc Altshuler, MD; and Kevin Scott

As of 2009, there were 10.4 millions refugees worldwide, 80,000 of which were resettled in the US. Training family medicine physicians to care for immigrant and refugee populations, which now represent 12 percent of the U.S. population, presents unique challenges and opportunities for the integration of global health education and local clinical training. The purpose of this presentation is to describe the development of an innovative iPad-based interactive curricula experience (ICE) on refugee and immigrant health. It is aimed at providing essential training in clinical care, communication, cultural competency, systems-based practice, socio-cultural determinants of health, and health disparities.

Saturday, September 10, 2016, 9–10 a.m.

Room Location: Kennesaw

Dehydration, Exposure, Fractures, and Trauma: Issues Faced by Practitioners Caring for Border Crossers on the United States–Mexico Border*

Jerry Koleski, MD; Elizabeth Moran, MD; and Sommer Aldulaimi, MD

Global events are affecting emergency departments and hospitals near the U.S.–Mexico border. Based on global events, Mexicans, Central Americans, and even Syrians are crossing the U.S. border from Mexico. The highest death tolls for border crossers are as far apart as the Rio Grande Valley of Texas and the Sonora Desert of Arizona. Over 2,200 people have died trying to cross the border since 2000 in southern Arizona alone. Violence involving border crossers has occurred as far north as Colorado. Practitioners in southern Arizona, the southwestern U.S., and beyond will care for patients found with exposure, diabetes, and trauma complicated by dehydration, rhabdomyolysis, and being in custody of law enforcement. Physicians from the University of Arizona will present statistics and case studies showing that global health is local along the 1,989 mile southern U.S. border.

Saturday, September 10, 2016, 11:20 a.m.–12 p.m.

Room Location: Piedmont

Residency Training in Rural, Border-Health, Indian Health Service, and Underserved Settings as a Platform for Training Global Physicians

Shana Semmens, MD; and Sommer Aldulaimi, MD

At the University of Arizona College of Medicine at South Campus Family Medicine Residency Program, we have an unique opportunity for training our residents to be global physicians. Our residency program has required rotations for all residents in rural Arizona, Indian Health Service facilities, and underserved areas near the U.S.-Mexico border, all of which help residents develop the skills they will need to practice internationally. For example, during these rotations, residents learn how to practice in resource-limited areas, how to practice where the culture and language may be different, and how to approach medical care in systems other than those in with which they may be familiar. Resident evaluations have demonstrated that these rotations were the most helpful in preparing them for their international rotation, and that the experiences are similar. This presentation will review the various required rotations and demonstrate how they are similar to and prepare residents for global/international work.

Room Location: Inman

Collaboration to Improve Access to Care to Latina Immigrants in a Rural U.S. County: Impact on Office Costs, Birth Outcomes, Access to Care, Health Literacy, and Access to Care

Rebecca Lee, MD; and Cindy Barter, MD, MPH, IBCLC, CTTS, FAAFP

The farmlands of Hunterdon County, New Jersey draw many Latino day laborers and their families, many of whom are low income and undocumented. The lack of a local Federally Qualified Health Center has resulted in a delay in medical visits, including prenatal care. Hunterdon Family Medicine at Phillips Barber (HFMPB) and Hunterdon County Division of Health (HCHD) have acted upon this by creating truly collaborative programs for its pregnant population. HFMPB has implemented a bilingual centering pregnancy program which provides education and prenatal care. HCHD provides the transportation, since most patients would be unable to attend otherwise. HCHD implemented an improved pregnancy outcome program, where registered nurses and lactation consultants provide support, coordinate care, make post-partum home visits, and assist with access to care. This study reveals evaluations of these community interventions, including the number of Latina women receiving prenatal care, pre-term deliveries, health literacy, and cost-effectiveness, amongst other improved outcomes.