Internal Medicine-Pediatrics Global Health
“Med-Peds and International Health Elective Experience
Patricia Chu, Zambia 2020
I spent one month at the University Teaching Hospital (UTH) in Lusaka, Zambia rotating on the adult infectious diseases consult service and the pediatric HIV clinic. On the adult ID consult service, I worked with house staff at UTH seeing patients with a multitude of pathologies such as HIV-related opportunistic infections, multi-drug resistant tuberculosis, and parasitic infections. In the HIV clinic, I learned about management of children and young adults with HIV, as well as the challenges they face transitioning to adult clinics. During my rotation, it was particularly meaningful to be able to take care of patients with HIV across all ages and get a glimpse into a different medical training and healthcare system. I developed a deep appreciation for how my Zambian colleagues diagnosed and managed complex patients despite having limited resources at their disposal. I feel very lucky to have had the opportunity to work and learn alongside residents and faculty at UTH and hope to be able return in the near future!
Tara Lane, Zambia
We hope to provide you with some history about why our program feels international health education is important. We also want to show you some photos and stories of experiences our residents and faculty have had in other countries. We also hope to provide you with some initial contact information if you are seeking to set up an international experience for yourself as a student, resident or faculty member.
Recent Statistics on Global Health Needs
In the past decade there has been a dramatic surge in the global awareness of and response to the overwhelming health needs among the poorest of the poor. The adoption of the Millennium Development Goals by the United Nations (a link to the UN site: http://www.un.org/millenniumgoals/) was a remarkable display of multinational solidarity in recognizing the most critical factors contributing to global poverty and disease. In 2003, the United States took a lead in the global fight against HIV/AIDS when the president signed the President's Emergency Plan for AIDS Relief (PEPFAR) (a link to PEPFAR: http://www.pepfar.gov/), thus pledging $15 billion dollars towards treating, preventing, and caring for people with HIV/AIDS in the 15 most severely afflicted nations of the world. The Bill and Melinda Gates Foundation alone contributes approximately $800 million dollars a year towards global health concerns. Yet the world's poorest people continue to sink deeper into poverty (1 billion people currently live on less than $1 a day). Though great strides have been made in some areas of global health, 2.8 billion people have no access to basic sanitation, mortality rates are increasing in many of the world's poorest areas, and approximately 40 million people are currently living with HIV/AIDS.
While there will always remain a very real need for long term financial commitments in the addressing issues of global health, in the past few years there has been increasing realization that the most pressing problems revolve around a severe human resources crisis. An Institue of Medicine (IOM) report in 2005 (link to the IOM report: http://www.iom.edu/CMS/3783/22871/26494.aspx ) stated that "the dearth of qualified health care professionals in most low-income countries is the single most important constraint faced in responding to health care needs" (IOM 2005: Healers Abroad). Low wages, stressful working conditions, lives lost due to HIV/AIDS, and "brain drain" have all decreased the ranks of health workers in many countries, particularly in sub-saharan Africa.
Vanderbilt Internal Med-Peds recognizes the great importance of being involved in global health from both a service and service learning standpoint. We also recognize that there is currently more interest on the part of medical students and residents in global health than ever before. We are committed to supporting our residents our students, and offering contact information for residents and students elsewhere, who desire to be involved with international medicine and public health during their training.
Here are some photos and stories from our residents who have traveled abroad.
During my third year of residency, I traveled to Lusaka, Zambia to complete a rotation at the University Teaching Hospital (UTH). For the first part of the rotation, I worked on the infectious disease (ID) consult service, and it is amazing how much I learned in a short amount of time. One of my objectives for rotating at an international site was to learn about diseases that are not common in the U.S., with the hope to return home and both teach my colleagues and be more prepared to recognize and manage these diseases should I see them in recent immigrants, refugees, or travelers. During this rotation I saw patients with multiple iterations of tuberculosis (pulmonary TB, TB meningitis, TB arthritis, possible TB pericarditis), which is something I often screen for in the U.S. but rarely diagnose. I also saw a much higher prevalence of HIV than I do in the U.S., especially in admitted patients. I had the opportunity to work in the HIV clinic, where I learned more about the disease but also about its social impact and how programs such as PEPFAR have influenced HIV treatment in Zambia.
During the second part of my rotation I worked in the pediatric malnutrition unit. This is a dedicated unit for children with severe acute malnutrition. I have seen malnutrition in the U.S., usually in the context of another disease such as cancer, inflammatory bowel disease, anorexia nervosa, etc. This was the first time that I saw malnutrition on a more severe and systemic level. The most striking part about caring for these children was that malnutrition is an avoidable problem. The reason for malnutrition is multifactorial, but underlying systemic issues (at least from what I could tell from my short time there) such as poverty, difficult access to nutritious foods, lack of access to clean water leading to diarrheal disease, and prevalence of comorbid conditions (such as HIV, TB, and malaria that decreases a child’s reserve) are contributing factors.
Beyond gaining medical knowledge, another (and more important) goal I had for this rotation was to learn about healthcare delivery in resource-limited settings and improve my ability to care for individuals in such settings. Working in an environment and country that is different than my own provided insight that would not be possible if I never traveled outside of the U.S. I am grateful to the attendings, residents, and nursing staff whom I worked with. They took extra time to teach me, incorporate me into the team, and discuss the differences and similarities between our home countries’ healthcare systems. My career goal is to work in med-peds primary care, and I hope to provide quality care to diverse patient populations, regardless of their income or social barriers. This rotation emphasized the importance of healthcare access and resources for all people. I am grateful to both VUMC and UTH for their support during this integral part of my residency training.
Ben Martel, M.D.
Experiences in Tanzania April 2007
During my third year of residency I spent two months in a teaching hospital in Tanzania with Dr. Rob Peck, a former Vanderbilt medical student now working as a full-time faculty member as part of a twinning collaboration between Weill Cornell Medical College and Bugando Medical Centre in Mwanza, Tanzania. It was a difficult and revealing time during which I saw first-hand the difficulties that many developing nations face in confronting a growing burden of sick patients in the context of insufficient numbers of health workers. It was rewarding to have a skill set to offer not only in clinical rounds but also in helping to give lectures to medical students. I found the patients, students, nurses, physicians, and health workers I came to know to be an incredible source of encouragement to me and the experience helped me to remember again why I chose to medicine in the first place.- Ben Martel, M.D. Med-Peds resident 2005-09.
Contact information for Ben's trip:
Dr. Rob Peck:firstname.lastname@example.org
Ashley Karpinos, M.D.
Nalerigu, Northern Ghana
I spent 3 weeks working at the Baptist Medical Center in Nalerigu, Ghana. Everyday, we made rounds on the pediatrics ward in the hospital and then saw both kids and adults at the walk-in clinic. The waiting room was packed full everday, and a majority of those seeking care had malaria. - Ashley Karpinos, M.D., Med-Peds Resident 2007-2011
Contact Information for Dr. Karpinos' Trip:
Dr. Earl Hewitt
Health Ministry Team
E-mail contact: email@example.com
Michael Bowen, M.D.
Diospi Suyana Hospital
Drs. Michael Bowen (senior resident 2008-09) and Alex Brunner (med-peds graduate 2005- now faculty in Peru) at the Hospital Diospi Suyana getting ready for a day of work together.
Mike and Lizza Bowen spending some time off hiking the Inca trail to Machu Pichu.Mike and Lizza's Blog site for their recent trip: http://www.dosgringoslocos.blogspot.com/
Drs. Alex and Laura Brunner with their daughters at their home in Peru.
Their youngest daughter, Sofia,
was born while the Bowens were with them!
Contact for Drs. Brunner (Alex in med-peds and Laura in pediatrics) in Peru: