Reflections in Global Health

Family Medicine is proliferating worldwide. These sessions profile the growth, development, and lessons learned in the expansion of family medicine and primary care globally.

Workshop Topics

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

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

Room Location: Roswell

Appropriate Technology For Global Health

Nicholas Comninellis, MD

Health care 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 are key. Appropriate uses of technology in low-resource health systems include rapid diagnostic tests, mobile health information systems, ultrasound imaging, and adherence to use of World Healt Organization and 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.

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

Room Location: Piedmont


Short-term International Medical Volunteering: The Good, the Bad, and the Ethical

Katherine Stolarz, DO

The ongoing debate regarding the ethics of providing medical care to international communities must be given careful consideration when deciding to volunteer. Before we can ensure that we are doing good, it is important that we become increasingly aware of our impact on the global community. We will delve into the ethics of short-term international medical volunteering as examined through the four principles of medical ethics: autonomy, beneficence, non-maleficence, and justice. Major points will include the dilemma of justice vs. non-maleficence. How does one reallocate much needed resources to an underserved international population in a short period of time while preventing potential iatrogenic harm in the long term? With a focus on the community in-need, and a conscious effort to be mindful of our effects on others, this care can be provided in a community-oriented, and ethical way.

Short-term Global Health Medical Trips: Making Them Ethical and Accountable

Victoria McCurry, MD; and Sommer Aldulaimi, MD

With an increasing focus on global health work among U.S. physicians and medical trainees, there has been growing interest in short-term medical trips. Accepted objectives for global medical work include promoting health care equality and resources; providing health education and emergency assistance; and developing collaborations. Short-term medical trips have appeal for clinicians unable to commit to extended time outside of their home country. However, ethical questions remain. Can short-term trips fulfill the aforementioned objectives, if the brief time commitment limits adequate understanding of the medical and cultural needs of the host country, and contributes little to lasting medical continuity? We suggest that with a more standardized approach, short-term medical trips can provide lasting benefit for global communities. Realistic steps include physician recognition of these identified ethical concerns; focused cultural education; and intentional collaboration with local medical infrastructures. With such guidelines for short-term medical trips, lasting host country benefits can be realized.

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

Room Location: Kennesaw

Ecuador Earthquake

Katherine Lynn Walker, MD

The country of Ecuador experienced a 7.8 magnitude earthquake on April 16, 2016. This earthquake was devastating to the people of the region where a medical mission trip had just concluded. After having treated over 700 patients in five days, our medical team had left the area 10 hours before the earthquake struck. In the aftermath of the earthquake, over 660 people died and over 35,000 Ecuadorians have been directly affected by having lost their homes and sources of income. This presentation and discussion will focus on three things. First, it will be a description of the evolution these sustainable medical mission trips. They are based on a partnership that has developed between the Universidad Catolica de Cuenca Medical School and the non-profit organizations, Adopt-a-Village and Project C.U.R.E. Secondly, it will be a detailed description of this particular brigade based in Junin, Ecuador. This will include a video of the medical team evacuation from a restaurant in Quito during the earthquake. Finally, there will be a discussion regarding the impact of the earthquake on this region and the implications for future medical missions to the area.

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

Room Location: Spring

The Aging Tsunami: A Global Phenomenon

Hasan Shihab, MD; and Katherine Stolarz, DO

Globally, the number of older persons (aged 60 years or older) is expected to more than double from 841 million people in 2013 to more than two billion people in 2050. Older persons are projected to exceed the number of children for the first time in 2047. Currently, about two-thirds of the world’s older persons live in developing countries. Aging adults are more likely to live with multiple chronic conditions and functional limitations. Furthermore, a reduction in cognitive ability among older adults compounds any existing comorbidities. The changing population demographics, changes in traditional values, and roles in these countries may lead to a decline of the availability of extended family members to provide care to the elderly. There is a need to recognize the changing age demographics globally and harness the appropriate resources to be able to take care of the elderly who usually require extended medical care.

Thursday, September 8, 2016, 4–5 p.m.

Room Location: Piedmont

Fighting Ebola, Between Warlords and USAID

Richard Randolph III, MD

Fighting Ebola, between warlords and the U.S. Agency for Interntional Development (USAID), this class will explore the social aspects of running an Ebola treatment unit as a family physician in a remote location in Tappita, Liberia, during the 2014 to 2015 Ebola epidemic. It will provide basic background information before proceeding to a detailed exploration of the relationships between Heart to Heart International with local populations, local medical providers, USAID, and with local warlords, as well as the relationships between the expatriate workers in the Ebola treatment unit. Examination of these relationships will form the framework for developing effective responses to these situations.

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

Room Location: Techwood

Coming Home: Challenges and Opportunities for the Returning Global Health Physician

Jerry Koleski, MD; Sarah Jones, MD, FAAFP; Javier Sevilla-Mártir, MD; and Esther Johnston, MD, MPH

Much attention is given to culture shock upon arrival in a low- and middle-Income country (LMIC). Often though, the returning practitioner is unprepared for “reverse culture shock.” It can be difficult mentally and emotionally for the practitioner to switch from treating diseases of poverty to treating those of over-abundance. Practicing abroad can have many positives, like broader differentials, cultural competency, and setting one’s self apart. However, returning to billing and coding, electronic medical records, and the litigiousness of practice in the U.S. can be overwhelming upon return from extended practice abroad. The families of practitioners can face issues as well, with adjusting to school, culture, and a new community. This panel will be composed of physicians who have worked overseas and will reflect on their global health experiences when returning home, and offer advise on how to better transition back to life in the U.S.

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

Room Location: Spring

Six Easy Steps to Become a Global Health Practitioner

Mori Morikawa, MD, MPH, FAAFP

The most frequently asked questions from residents and students about global health are the ‘how to’ ones: how to get involved, how to engage, and how to build a career. The purpose of my talk is to break down the process to become a global health practitioner into six steps and discuss each step to help designing careers in global health. There is no single path to become a global health practitioner, but family physicians have tremendous advantage to become one due to our comprehensive scope of our practice. A step-by-step approach in this presentation will guide the audience as what questions to ask and what advice to seek.

Room Location: Kennesaw

Utilizing a Global Health Exchange Program to Better Understand Divergent Health Care Systems and Strategies: A Resident’s Perspective

Marco Perez, MD; Neubert Philippe, MD; Tochi Iroku-Malize, MD, MPH, MBA, FAAFP; and Maureen Grissom, PhD

For several years, residents in our family medicine residency program have embarked on elective rotations overseas in places such as India, Sri Lanka, Colombia, and our most recent locations, Haiti and the Dominican Republic. Beginning last year, our residents also hosted family medicine residents from Italy, Spain, and Portugal. In addition to the obvious benefits in gaining experience diagnosing and treating patients in a different setting, as well as serving a distinct patient population, we have seen that these experiences have given residents insight into the workings of other divergent health care systems. With the rise of preventable worldwide epidemics, the global medical landscape is undoubtedly becoming increasingly interconnected and interdependent, and as such it is more important than ever for family physicians worldwide to understand each other’s experiences. There is no greater time than during residency training for such invaluable education to take place while ideas and opinions are being formed. With our Global Health 360 program as an exemplar, we will explore how the use of these exchange electives during residency can further enrich global understanding for residents and for the entire specialty of family medicine.

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

Room Location: Piedmont

Sensitization as Motivation: Empowering First Steps in Global Health

Varun Shetty, MD; and Ronald Magliola, MD

Sensitization is imperative to developing empathy and perspective. In an age of increasing global travel, migration, and attention to international health electives, there is an urgency for training health care providers that have a global health perspective. This has spawned a growing interest in the incorporation of global health experiences in medical training. We modify the Horatio-Alger exercise from a global health perspective to expose gross inequalities, laying bare the disparities in health care. Going through the exercise will enable educators to more effectively integrate sensitization education and cultural competency into their global health curriculum. This evocative experience, along with a guided vignette discussion will allow health educators to develop skills in exposing students and health care workers to the issues that affect international patients in home countries or in the U.S. Finally, participants shall identify one change they would make in their practice following this workshop.

Room Location: International Ballroom

Lessons Learned Providing Medical Care to Syrian Refugees in Greece*

Katherine Stolarz, DO; and William Dienst, MD, FAAFP

There are more than four million Syrian refugees registered with the United Nations High Commissioner for Refugees. Additionally, 155,399 refugees of multiple nationalities have arrived in Greece in 2016 alone. In April 2016, an average of 115 refugees arrived in Greece daily. The Greece government, itself in economic crisis, has been unable to coordinate care efforts for this many people, and has relied heavily on non-governmental organizations to provide much needed medical aid. Providing medical care in the Greece refugee camps requires a number of unique considerations, including adaptations for an unstable environment, special attention to the effects of the elements, balancing the benefit of the individual with the benefit of many, and creative coordination with other medical providers.

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

Room Location: Kennesaw

Ethics Considerations for Faith-based Initiatives in Global Health: Part 4

David McRay, MD, FAAFP; and Douglas Brown, PhD

Health care professionals participate in global health for multiple reasons. Many do so as an expression of deeply held religious faith. Yet, this motivation and the corresponding ethical issues have infrequently been discussed. In 2013 and 2014, we explored this topic, providing data about our motivations, helping to identify some of the ethical issues involved, looking at the ways participants have found to incorporate their faith in their work, and examining the objections others have to such motivations. In 2015, we moved further by examining the core considerations of medical ethics, common motivations for global health activities, and the idea of “trust” as a framing concept for an ethics-based approach to examining our activities and motivations. This year, we will look at four specific examples of global health activities and the types of ethical considerations which arise in each, sharing our experiences with published guidelines and exploring frameworks for developing additional ethics resources.

Room Location: Inman

Global Health and Natural Disaster: Lessons from a Local Health Care NGO at the Forefront of Nepal’s Earthquake Relief and Recovery Efforts

Robert McKersie, MD; and Christina Madden

On April 25, 2015, a magnitude 7.8 earthquake claimed over 9,000 lives in Nepal and destroyed roughly 770,000 homes, 50,000 classrooms, and 1,000 health posts. Himalayan HealthCare (HHC), a 501(c)3 nonprofit that has served Nepal’s northern Dhading District since 1992, is a key player in relief and recovery efforts. The villages it serves—some of which are a three-day walk from the nearest road—were close to the earthquake’s epicenter and were essentially leveled. HHC provided food, clean water, power, temporary shelter, medical care, and essential supplies in the immediate aftermath, and assisted with logistics for other relief agencies providing aid to Dhading. HHC is engaged in long-term recovery, helping to repair and rebuild health clinics and the Dhading District Hospital to world-class standards, as well as to reconstruct twenty schools. HHC’s experience can offer lessons on disaster preparedness and response for global health, particularly in rural settings.

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

Room Location: Piedmont

Interprofessional Collaboration Between Family Medicine and Pharmacy Residents in a Group Global Health Elective

Maurice Henein, MD, FAAFP; Ashton Beggs, PharmD, BCACP; Katee Kindler, PharmD; and Lauren Michelle Pence, PharmD, BCACP

Partnering with organizations in Hispaniola, the St. Vincent Indianapolis Hospital created and offered a family medicine residency global health elective. This elective was developed as an interprofessional learning experience and was available to post-graduate year 2 (PGY2) ambulatory care pharmacy residents. As part of the elective requirements, the pharmacy residents participated in pre-travel monthly meetings and a pre-travel didactic course. The pharmacy residents were responsible for providing pharmacy dispensing services during the international experience, as well as providing knowledge regarding medication or prescribing questions. The pharmacists’ expertise decreased the potential for medication prescribing and dispensing errors and provided valuable medication education to the family medicine residents in the field. The collaboration yielded positive long-term impacts in the careers of the pharmacy resident participants. The authors will discuss the integration of pharmacy residents and medical residents in a group elective and highlight the career paths of participating pharmacy residents following residency training.

Room Location: Spring

From Reflection to Action: Moving Voluntourism Toward the Ethical Ideal

Maria Gabriela Castro, MD; Hartley Feld, RN, MSN, PHCNS-BC; and Rebecca Yarrison, PhD

Short-term experiences in global health (STEGH) have been wrought with controversy due to the delicate balance of developing a program design that maximizes educational experiences and avoids the unethical realm of poverty tourism. Despite best intentions and guidance from published ethical frameworks, program growth and redesign can be limited by structural factors, including institutional agenda, organizational identity, and competing program priorities, such as funding and recruitment. As we celebrate the 14th anniversary of Shoulder to Shoulder Global, we challenge ourselves to critically examine our position on the spectrum, from ethical ideal to poverty tourism. Reflections on this shortfall between ideal and feasibility can promote transparency and support program transformation at an organizational level, as well as serve as a model for ethical action with learners.

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

Room Location: Techwood

Examining Global Maternal Health Through a Human Rights Prism

Katherine Stolarz, DO

The 1948 Universal Declaration of Human Rights indicates that every human has a right to medical care to obtain health and well-being, and that motherhood is a state that entails special assistance. Of all maternal deaths, 99 percent occur in developing countries, where a lack of resources and human rights violations are more prevalent. This presentation will examine the human rights violations that promote global maternal morbidity and mortality. We will foster group discussion around the specific violations that affect a woman’s right to safely become pregnant, her right to safe and adequate prenatal care, her right to a safe and effective labor and delivery, and her right to appropriate post-natal care. Our patients in the U.S. are compiled of women from across the globe. An improved understanding of the different environments and challenges that they may have previously faced can only improve our ability to provide comprehensive and compassionate care.

Room Location: Kennesaw


Narrative Medicine and Global Health: How the Stories we Tell Affect the Way We Engage Other Cultures

David McRay, MD, FAAFP; and Douglas Brown, PhD

We all tell stories about our work experience. For physicians, nurses, and other health care professionals, these stories often take identifiable forms and serve specific purposes. They also present rather significant ethical and professional challenges related to the way we tell the stories and the role the patient plays in the story. For those engaged in global health activities, the telling of stories involves additional levels of ethical and professional concern. We will identify and discuss several types of stories commonly told by health care professionals and explore the risks and benefits of sharing stories about our work experience in cross-cultural settings. We will create a space to share some of those stories and identify resources that might help us tell our stories with more care, caution, and respect.

Using Narratives as a Teaching Tool to Increase Skills and Competencies in Interprofessional Provider Learner Groups

Nidhi Lal, MD

Stories reflect experiences. As physicians we have stories that tell us about our patients and their lives and serve as examples and teaching tools. Our experiences teach us not to repeat mistakes. If captured and shared those mistakes can teach others not to make them. We have used narratives from our clinical practices to develop a teaching tool to increase competencies in various levels of interprofessional provider learner groups. This knowledge allows learners to understand, interpret, and empathize with human actions. Our initial “wave” of collecting narratives used a prompt, focused on “new immigrants.” We analyzed them with a medical anthropology lens to determine hidden biases, use of certain culturally appropriate words, and understanding of cultural practices. These results are insights into experiences and how this powerful approach can be translated to both improved patient satisfaction and care, and more informed, culturally sensitive, interprofessional providers.

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

Room Location: Spring

Team Building and Strategic Partnership: Multicultural, Interprofessional Medical Mission to Haiti

Carol Lang, RN; and Malinda Whitlow, DNP

An interprofessional team comprised of ten physicians, pharmacists, social worker, and nurse from Pusan National University Yangsan Hospital in South Korea, along with 12 nursing faculty, family nurse practitioner, and undergraduate nursing students from George Washington University in the U.S. partnered with a South Korean based international garment company (Sae-A Trading Co. Ltd). They provide primary health care for 3,000 people in Cap Haitian region of Haiti over a six-day period. This presentation will describe the overall goals of the medical mission, focusing specifically on health promotion and disease prevention objectives and expectations that each organizational entity had regarding the care of the Haitian community. It will also provide insights on building an international team when health care providers from different cultural backgrounds who speak different languages collaborate on one team. The presentation will use data from a focus group held during the trip and post trip surveys/interviews to inform its findings. Team-building techniques will be presented and evidence-based improvement methods regarding collaborating as one intercultural and interdisciplinary team to promote health and prevent disease to an underserved Haitian community will be posed. Data will be analyzed using content analysis on the themes that emerge about the interdisciplinary and intercultural understandings that occurred during the trip, as well as on the challenges and opportunities for future missions. In addition, lessons learned and benefits of partnering with a corporation that provided logistical support for a complex medical mission will be discussed.