Case Studies in Program Design and Implementation

There is so much to learn from other’s experience in designing, administering, and improving global health programs. These 2-in-1 sessions provide an opportunity to learn about unique or foundational program models and time to discuss these models and their broader application.

Workshop Topics

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

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

Room location: Spring

2-in-1 Session

Challenges of Community Based Participatory Research with Syrian Refugees in an Underserved Neighborhood in Beirut

Lara Jirmanus, MD; and Jinan Usta, MD, MPH

The Tahaddi non-governmental organization (NGO) runs a health center in urban Beirut serving three social groups: the Lebanese, the Lebanese Dom (the Middle Eastern Roma), and Syrian refugees. With Syrian refugees comprising one-fourth of Lebanon’s population, the community struggles to meet the health needs of Lebanese and Syrian families. In the tradition of community-oriented primary care (COPC), we partner with patients and providers at Tahaddi to design a health program. Community-based participatory research (CBPR) proves complicated in the small geographic area where three different social groups compete for limited resources, and residents identify social determinants of health as the primary source of illness. However, neighborhood residents participate in and are motivated to find solutions to the local trash disposal problem. Our project demonstrates the important role that family physicians can play in partnering with communities in conflict settings to build a holistic vision for improved health.

Strengthening Family Medicine Global Health Training through a Refugee Screening Program

Douglas Collins, MD

In recent years, 70,000 refugees have been admitted annually into the U.S. With the crises in Syria and Iraq, that ceiling is projected to increase to 100,000. To provide care for this vulnerable population in need of health care and to strengthen our global health training, our family medicine residency integrated state-funded refugee health screening into our family medicine center in 2013. This session will provide an overview of the need for refugee health care, what refugee screening is, how we implemented the program, and the benefits and challenges we encountered. Survey feedback data on the impact of this program will be reviewed. In discussing the benefits, the session will also briefly review important clinical topics encountered in refugee screening, including tuberculosis, strongyloidiasis, schistosomiasis, malaria, and female genital mutilation.

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

Room location: Kennesaw

2-in-1 Session

Engendering Interprofessionalism in Global Health on an Academic Campus

Greg Carey, MD

During this session, three faculty members and high-level administrators from different professional schools at the University of Maryland, Baltimore will describe their successful efforts to create a robust interprofessional learning program on a graduate campus. The specific successes that will be described include creation of an interprofessional global health faculty and student council; an interprofessional global health certificate program; and an interprofessional experiential learning and grant program. This session will be conducted as a “how-to” session with a specific emphasis on concrete steps faculty and administrators can take to create interprofessional programming and overcoming barriers to interprofessional education.

Where Are We Now? An Update on an Interdisciplinary Global Health Track (Three Years Later...)

Tochi Iroku-Malize, MD, MPH, MBA, FAAFP; and Neubert Philippe, MD

Medical students and residents have requested global health education and exposure. As such, the family medicine faculty at the Hofstra-North Shore Long Island Jewish School of Medicine in 2011 decided to align the educational programs of our separate family medicine residency programs. In 2013, our goal to expand this program by partnering with the department of pediatrics to create a global health track became a reality. We created opportunities in other countries, as well as certain areas of the U.S. for a domestic educational experience. We continued to develop the didactics, research, mentoring, and attendance at global health conferences to share experiences and learn from other programs. In 2016, with a new name, Northwell Health, we look back at the lessons learned from our experience and how the program has evolved due to various internal and external factors.

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

Room location: Piedmont

Reimagining Global Health Engagement by the Department of Defense (DoD): Operationalizing the Bilateral Institutional Partnership Model

Jaime Wong-Lopez, MD; Andrew Baldwin, MD; and William Bynum, MD

Background: The bilateral institutional partnership between the National Capital Consortium Family Medicine Residency at Fort Belvoir Community Hospital (FBCH) in Virginia, and the Hospital Militar Central (HMC) in San Salvador, El Salvador, is a model longitudinal global health engagement—a mutually-beneficial, ethical global health initiative by the Department of Defense. Methods/Results: Trust has been built over three exchanges at HMC and one at FBCH, assessing mutual needs and sharing expertise in patient safety, non-punitive responses to error, and optimal learning environments. Adverse event tracking was developed, systematic analysis and process improvements were integrated into morbidity and mortality conferences, and resident and faculty development was introduced. Conclusions: The FBCH-HMC relationship is an operationalized paradigm shift from traditional, isolated provision of care activities to sustainable, partner nation-driven, bi-directional engagements, in which U.S. military family medicine physicians serve as trusted advisors over multiple trips, and develop competence in global health through immersive experience.

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

Room location: Techwood

Teaching Community Health Assessment During a Global Health Elective

Paul Dassow, MD; Robert Zylstra, LCSW, EdD; and James Haynes, MD

Introduction: From its inception, evaluation of community health has been an expected activity of the discipline of family medicine. Current learning objectives for residents in family medicine include the ability to perform a community health assessment. Content: The Department of Family Medicine at the University of Tennessee in Chattanooga used a global health elective to teach residents the fundamentals of community health assessment. This session will describe the experience of the design process and implementation of a health assessment created for use in a developing country. Discussion will include five specific lessons learned over multiple years. Acquired population data will be presented to support conclusions.

Thursday, September 8, 2016, 4–5 p.m.

Room location: Roswell

Bethel, Alaska: 20 Years Experience as an In-Country Global Health Training Site

Barbara Doty, MD, FAAFP

The Alaska Family Medicine (FM) Residency Program has used Bethel, Alaska, as a bush-Alaska rural immersion training site since 1997. Each second-year resident completes an individual six-week rotation in Bethel, a remote Alaskan village community unreachable by road and with stong Alaskan native cultural influence. The Alaska FM Residency strives to give residents the knowledge, skills, and attitudes required to not just survive but to thrive in the most challenging practice settings. These skills parallel the cultural, emotional, and situational demands of global medicine. Bethel is a resource-limited, geographically-isolated, culturally-unique, and environmentally-challenged community. Bethel's common medical conditions reflect similar situations found in global health practice. This workshop reviews 20 years of lessons learned in Alaska-based global health training, including curriculum, funding, subsequent trainee practice choice, and follow-up graduate satisfaction surveys.

Room location: Kennesaw

2-in-1 Session

Longitudinal Academic and Non-Government Organization (NGO) Partnerships, A Case Study: University of South Carolina Department of Family and Preventive Medicine and OneWorld Health

Mark Humphrey, MD, MPH; Jeffrey Hall, MD, FAAFP; and Mark Shaffer, MD

The University of South Carolina Department of Family and Preventive Medicine has partnered with the non-government organization (NGO) OneWorld Health since 2013. In each year of the partnership, learner activities have increased and mutual goals have expanded. Thus far, the partnership has seen 17 medical students, eight resident physicians, seven pharmacy students, and ten nursing students participate. This has resulted in over 3,000 patient encounters; a hypertension physician and nurse continuing education session; two separate community health needs assessments in areas where future permanent clinics were planned; development of a key international location for an academic global health fellow to rotate; and two academic physicians participating in the annual strategic planning session for OneWorld Health. Global health interest is increasing across learners in multiple medical disciplines. A good response is NGO-academic partnerships that work toward mutual goals.

Multi-organizational Partnerships in Global Health: Integrated Teams Providing Holistic Outreach

Sarah Jones, MD, FAAFP; Javier Sevilla-Mártir, MD; and Tessa Stecker, MD

At the 2015 AAFP Global Health Workshop, we described an emerging partnership between the nascent Kaiser Permanente Napa-Solano Family Medicine Residency Program and the well-established ENLACE Foundation, Taulabé, Honduras, founded in 2007. The authors' vision of holistic community outreach and health promotion is becoming reality, as the first multi-organizational group of professionals collaborated in a week of service to Taulabé and nearby villages in April 2016. Highlights included soccer clinics with local school children, breaking ground on a community garden, and installation of fuel-efficient stoves, in addition to direct patient care in rural outlying villages utilizing medical interpreters. We will discuss trip planning, coordination, and collaboration with local professionals and leaders, and elements germane to developing nurturing local-global partnerships. Of note, another integrated team is scheduled to continue the momentum in July 2016, and will inform the discussion at the upcoming AAFP Global Health Workshop.

Friday, September 9, 2016, 9–10 a.m.

Room location: Spring

Chronic Disease Management in Rural Guatemala: It Takes a Village and An EMR*

Jennifer Hoock, MD, MPH; Sherry Ann Santarina, RN, CCRN, BSN; Carolyn Bain, MPH; and John Jacob Wampach, MPH

Guatemala Village Health works to improve health in rural Guatemalan villages. Our ongoing screening program detected high prevalences of diabetes and hypertension, related to the introduction of "junk food" from local tiendas (shops). We developed a "Chronic Disease Management Program" that provides ongoing medication, health education, and chronic condition management through a tiered system of lay village health workers supervised by our professional nurse from Guatemala City who visits every six weeks to adjust medications in remote consultation with a physician. Care is based on Ministry of Health nursing protocols adapted to current diabetes standards and medication availability. Patients are tracked through our electronic medical record (EMR) system. We will present the evolution of our current program, including recent evaluations and revision of health education and health worker training; implementation of clinical monitoring using our EMR; and efforts to improve tracking of patient outcomes, to be followed by a discussion of adaptation for other settings.

Room location: Inman

Transforming Global Health Education with the Utilization of Simulations and Workshops to address Neglected Tropical Diseases

Michael Mankbadi; Bryan Thiel; Laura Goyack; Nicole Spitzer; John Stelzer; and Elizabeth Wellings, MS

While patients with neglected tropical diseases may present for care in the U.S., they are often encountered so infrequently that medical students may have little chance of being exposed to these illnesses during training. This presentation demonstrates use of a variety of simulations in a global health workshop as a means of teaching multifaceted issues of tropical diseases, including disease management, cultural competency, interdisciplinary collaboration, and sociocultural issues. Examples of simulations employed at the 2016 University of Central Florida College of Medicine Global Health Conference included the use of moulage kits to portray common dermatological presentations of tropical diseases; cardiopulmonary patient simulators to portray chronic Chagas disease; and a field hospital environment with simulated rounds. Feedback about the simulations was obtained and was exceptionally positive. These simulations can easily be adapted for use in conferences, health professional education, and patient advocacy making them relevant for training for a wide variety of settings.

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

Room location: Roswell

2-in-1 Session

A Sustainable Model for Short-Term Global Health Trips in Central and South America

Sommer Aldulaimi, MD; and Victoria McCurry, MD

For physicians interested in global health, it has long been recommended that they make long-term commitments, frequently investing years of work in developing countries. However, recently there is a trend towards short-term work in international sites–often involving “health care brigades” in which groups of clinicians work intensely in an area for short periods of time. Issues such as a spouse’s career, family concerns, or job requirements may be reasons for this. But ethical concerns have also been voiced about short-term assignments, even to the point of assigning negative labels such as “duffle-bag physicians” and “medical tourism.” So, we ask, is there a way for physicians to provide ethical, meaningful, and sustainable care to international communities using a short-term care model? Our presentation will describe a successful model that is community-based and involves working with local health care providers to enhance primary care for disadvantaged populations abroad through short-term medical trips.

Collaboration at a Systems Level for Safe Global Health Experiences

Maria Gabriela Castro, MD; Samuel Matheny, MD, MPH, FAAFP; Miko McFarland; and Niamh Minion

Family medicine is well positioned to share lessons learned from common challenges in global health education with other disciplines. Global health initiatives across the health professions are tasked with accomplishing simultaneously grand and profound goals in a short period of time with limited resources. One such institutional expectation includes preparing learners for international experiences with goals that assume a wide spectrum of topics from ethical engagement to travel safety and logistics. The expertise of global health faculty in operational aspects of international experiences is significantly varied. Many universities, on the other hand have centralized international education programs that address academic, travel, safety, and cultural implications for undergraduate and non-clinical travelers. Collaboration between medical educators and campus international educators strengthens the policies, procedures, and technology that support global health initiatives for all health professions. This session explores a unique preparatory model for clinical learners that demonstrates the benefits of this synergy.

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

Room Location: Techwood

The Utility of an Electronic Medical Record (EMR) in a Low Resource, International Environment

Paul Dassow, MD; Philip Sutherland, MD; and Michael Shepherd, MD, FAAFP

Applying the advantages of an electronic medical record (EMR) to rural international populations would seem an obvious matter, but is in reality fraught with difficulty. This session will walk attendees through the many difficulties a medical team experienced in implementing an EMR, including both hardware and software issues. Participants will have the opportunity to learn and demo the EMR as it was used in Haiti. A point/counterpoint presentation will follow delivered by team members delineating both the perceived pros and cons of attempting to implement an EMR in such low resource, international environments. The session will conclude with a discussion among attendees about the potential benefits and drawbacks with EMR implementation, idea sharing for improving EMR use in low-resource settings, and networking to aid other family medicine groups who are working internationally.

Friday, September 9, 2016, 2:30–3:15 p.m.

Room Location: Techwood

Implementing a Research Workshop to Expand Research Capacity in Family Medicine in Western Kenya

Katherine Jarrell, MD; Fadya El Rayess, MD, MPH; Patrick Chege, MD, MMEd; and Daria Szkwarko, DO

Research is an increasing priority among family medicine departments worldwide. In Kenya, family medicine residents are required to complete a Master’s thesis project for graduation and the requirements for study design, methodology, and analysis are becoming more rigorous each year. Through a large institutional consortium called the Academic Model Providing Access to Healthcare (AMPATH) and a Brown University departmental grant, we partnered with family medicine faculty at Moi University in western Kenya to host a two-day research workshop for family medicine residents and faculty. Topics covered included performing a literature review, study design, data collection, and reference management. This session will present the logistics for running a research workshop, lessons learned, and survey outcomes from our participants.

Room Location: Kennesaw

Global South to Global North: Innovative Cross-Cultural and Medical Education Collaboration Between Californian and Kenyan Family Medicine Programs

Neil Jayasekera, MD; Kevin Bergman, MD; Megan Mahoney, MD; Elisabeth Wilson, MD, MPH; Mena Ramos, MD; Naushad Amin, MD; and Jacob Shabani, MMEd

In 2009, the Aga Khan University (AKU) and the University of California, San Francisco (UCSF) committed to a long-term partnership to support medical education at both universities. Since 2012, 11 UCSF faculty and learners have visited the AKU department of family medicine in Nairobi, Kenya. In 2015, to enhance cross-cultural exchange and medical education between UCSF and AKU, family medicine residents from AKU were invited to visit the San Francisco bay area family medicine programs. Three AKU family medicine residents visited and participated in educational opportunities at Contra Costa Regional Medical Center, UCSF, and Stanford. Examples of educational opportunities for the AKU residents included shadowing residents and faculty in a variety of clinical settings; attending a one-day neonatal resuscitation course with NRP certification; attending a two-day Point of Care Ultrasound (POCUS) course with POCUS certification; participating in didactics focused on faculty development, motivational interviewing, and primary care transformation; and meeting with interested medical students and networking with residents and faculty.

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

Room Location: Roswell

More than a Passport: Global Health Pre-Departure Curriculum for Medical Students

Tessa Stecker, MD; and Sarah Jones, MD, FAAFP

Now more than ever, medical students seek opportunities to meaningfully engage in overseas medical experiences. To address the professional and ethical challenges of medical student participation in short-term global health trips, we created a curriculum for fourth-year medical students completing a global health sub-internship. Our curriculum focuses on the following five global health competencies: global burden of disease, capacity-strengthening, ethics, social and environmental determinants of health, and community collaboration. We offer self-study modules for medical students to complete prior to their one-month rotation. Evaluation strategies include pre- and post-surveys to assess their knowledge and attitudes. Our pilot learner demonstrated improved understanding in 15 preparatory components. Most notably of thes included, preparing for a short-term global health trip, anticipating ethical challenges, and understanding social determinants of health in both the local and overseas communities served. We will share components of curricular design, evaluation data, and next steps in implementing global health curricula for medical students.

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

Room Location: Inman

2-in-1 Session

Application of ALSO and BLSO in India: Prospective Observational Study of Emergency Services Utilization*

Ann Evensen, MD, FAAFP

Advanced Life Support in Obstetrics (ALSO) was introduced in India in 2011. An international pilot of Basic Life Support in Obstetrics (BLSO) was conducted in India in 2012, and has now been taught to over 20,000 emergency medical technicians. Emergency medical technician staff more than 5,000 ambulances which are commonly used for transport of patients with pregnancy-related concerns. This presentation will summarize the ALSO/BLSO partnership among institutions and individuals in the U.S. and India. We will also review the results of a prospective observational study led by partners at GVK Emergency Management and Research Institute in India and Stanford University that evaluated the demographics, management, and outcomes of 1,684 obstetric patients transported by emergency medical services. The study found that pregnant women from vulnerable Indian populations frequently use free-of-charge emergency transport for impending delivery and other obstetric complications.

The Role of Advanced Cardiac Life Support Training in Resource-Limited Settings: Inappropriate or Invaluable*

David Klee, MD, FAAFP; Jason Brotherton, MD; and Jim Ritchie, MD

Advanced cardiac life support (ACLS) is required training of U.S. family medicine residents. Does this training have a role for medical officer interns and family medicine residents practicing in resource-limited settings? We will review the current literature and discuss tailoring life support efforts to the capabilities of the hospital. We will present specifics about the modified ACLS course that we taught in March 2016 to medical officer interns at a district hospital in Chogoria, Kenya. We will discuss our course augmentations, ranging from discussions on cultural factors affecting resuscitation initiation and cessation to additional training in cardiac physiology, rhythm identification, and automated external defibrillator (AED) operation. We will present data showing knowledge retention and perceived learner competence at three months post teaching. Lastly, we will propose culturally consistent, local resuscitation protocols that are modified based on limitations in medications, airway support, and defibrillation abilities.

Saturday, September 10, 2016, 10:15–11:15 a.m.

Room Location: Inman

The Refugee Journey is Complicated Enough! Implementing a Transitional Family Medicine Refugee Clinic to Improve Care for Refugee Families in Worcester, Massachusetts

Olga Valdman, MD; and Daria Szkwarko, DO

With over 70,000 refugees being brought to the U.S. in 2016 it is important for the health care providers to understand unique needs and challenges of this population. Despite being greatly structured at the federal and state levels, refugee resettlement is a complex and fragmented process. Upon arrival, refugees are typically seen by different health care providers with often suboptimal integration into primary care. Communicable and non-communicable diseases, limited access to care prior to arrival and poor understanding of the U.S. health care system put these families at high risk. Family medicine is uniquely positioned to address the needs of this vulnerable population especially at Federally Qualified Health Centers. The Family Health Center of Worcester developed a transitional clinic that integrates refugee families into primary care upon their arrival with the support of multidisciplinary teams and in partnership with community organizations. This presentation will describe the model, discuss advantages to such integration, and review some of the challenges.

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

Room Location: Techwood

Going Beyond Training: Marrying Education and Policy in Family Medicine Development Efforts in Vietnam

Jeff Markuns, EdM, MD, FAAFP; Kristin Shaw, MPH; Nguyen Phuong Hoa, MD, PhD; Nguyen Minh Tam, MD, PhD; and Pham Le An, PhD

Vietnam has been working on the development of family medicine as a specialty for twenty years. While multiple training programs were developed and piloted over a decade and over 700 family physicians have now been trained, there became a realization that family medicine expansion could never be fully successful unless updated policies supporting primary care and family medicine were developed by the government. As part of this effort, we developed a program intended to explicitly link global health development efforts in training and education together with advocacy for policy supports. As a result, over the last five years, significant progress has been noted in primary care policy development. In this presentation, we will share our approach to providing support for family medicine development in Vietnam, and our efforts to support training and policy development in parallel. We will review methods used and policies developed along with successes and lessons learned.