Diane Appelbaum
• Natural and Traditional Medicine in Cuba: Lessons for global medical education •
The Institute of Medicine, Academy of Science in the United States has recommended that US medical schools incorporate information on Complementary and Alternative Medicine (CAM) into the required medical school curriculum. The purpose is to train physicians to competently advise their patients in the use of CAM. The report states a need to study existing systems that integrate CAM and allopathic medicine into one system. Cuba’s medical education and health care system is one such best practice model. CAM, called Natural and Traditional Medicine (NTM) in Cuba, is integrated into all levels of medical education and clinical care. This presentation will outline the Cuban medical education model in which students, residents and practicing physicians are trained in both CAM and allopathic medicine. In Cuba, only health professionals are permitted to practice NTM; therefore Cuba’s medical education not only teaches about NTM, it also teaches basic NTM clinical skills throughout Cuba’s six-year medical school curriculum. Similarities and differences between the U.S. and Cuban approaches to CAM will be presented, including issues of access, cost and levels of NTM acceptance. CONCLUSION: Given the exceptional health statistics of Cuba, i.e., the first country to eliminate polio and measles, the lowest AIDS rate in the Americas and an infant mortality rate less than the US, there is much to learn that can be applied globally from the Cuban integrative medical education and health care delivery model. Diane Appelbaum, Faculty, Medical Education in Cooperation with Cuba, Inc., Decatur, Georgia; CoAuthors: Benjamin Kligler, (Faculty); Moshe Frankel,( Faculty); Mary Guerrera (Faculty); *Kofi Kondwani (Faculty); Bennet Lee ( Faculty); Ellen Tattelman (Faculty); Leoncio Padron Caceres (Faculty); Martha Perez Vinas (Faculty)
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Mariko Koya
• Global Health in Our Own Backyard: Complementary and alternative therapies among Bronx, NY-children •
BACKGROUND: Culturally based complementary and alternative therapies (CAT) are prevalent among immigrants who seek traditional care in the US. According to the 2000 US Census, 30% of residents in the Bronx, New York are foreign born; 50.1% of children are living below the national poverty level, the highest in the nation. Hence, patients in communities such as the Bronx are representative of their underserved global counterparts. OBJECTIVE: To explore and categorize various forms of CAT used by a diverse group of parents for their children in the Bronx. METHOD: Thirty-two semi-structured interviews of parents of children admitted to Bronx-Lebanon Hospital (n=20) and Children’s Hospital at Montefiore (n=12) were audio-taped and transcribed verbatim. Qualitative analysis of the coded transcripts produced descriptions of CAT that parents report using for their children. PARTICIPANTS: 32 parents participated in the study, representing 7 non-US countries. Foreign born participants account for 53% (n=17) of the study group. US born participants were categorized as Hispanic (n=9), Black (n=4), and White (n=2). RESULTS: 97 instances of CAT were enumerated, and organized into six categories: oral remedies and preparations (n=27), teas (n=20), topical application (n=15), preventative measures (n=14), spiritual practices and prayers (n=12), and practices and procedures (n=9). CONCLUSIONS: The diversity of CAT in our study reflects the need for doctors in underserved, culturally diverse areas to be knowledgeable about health practices used globally. Doctors interested in international health can often look into their “medical backyards” for opportunities to learn about global health practices. * Elaine Hsieh, MS2 & *Mariko Koya, MS2, Albert Einstein College of Medicine; CoAuthors: Mimi McEvoy; MA, CPNP (Faculty); Maria Marzan; MPH; (Faculty); T.J. Jirasevijinda; MD (Faculty)
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Shahla M. Jilani
• Perspectives on the Use of Complementary Medicine: A qualitative examination of patients, physicians and healers in San Jose, Costa Rica •
Costa Rica represents a unique intersection of both westernized medical practices and traditional folk medicine. OBJECTIVE: We aimed to examine the attitudes and perspectives of Costa Rican patients, physicians and healers toward the use of complementary medicine. METHOD: Subjects from distinct socio-economic and medical backgrounds were recruited for focused interviews centered on 1) their motivations for practicing complementary medicine, and 2) the effects of such practices on health and wellness. Qualitative analysis following an inductive format revealed a number of recurring and convergent themes. RESULTS AND CONCLUSIONS: In contrast to the U.S. where most users of complementary medicine are higher-educated and affluent females, a more socio-economically diverse cross-section of Costa Ricans practiced this form of medical therapy. Such practices ranged from sobador healing to homeopathic and herbal therapeutics. Costa Ricans interviewed preferentially incorporated the use of complementary medicine into their daily health practices. Likewise, the efficacy of long-term complementary medical therapy was a widely held perspective. The majority of subjects interviewed limited the use of conventional westernized medicine to only those situations when emergency medical attention was necessary, reverting to complementary medicine for both long-term and preventative health care. *Shahla M. Jilani, MS2, Univ.of Rochester School of Medicine & Dentistry; CoAuthors: Nancy Chin (Faculty)
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Sarah Barnhard
• Infant and Child Feeding in HIV+ Mothers in Port-au-Prince, Haiti: An assessment of food insecurity and introduction of liquids for children ages 0-6 months •
Because Haiti is the country with the highest rates of infant, under-five, and maternal mortality in the Western Hemisphere, attributable to diarrhea and HIV/AIDS related infections, the GHESKIO clinic compared and contrasted the WHO pediatric nutritional recommendations with the feeding practices of a patient sample in August, 2006 to evaluate the barriers to reaching the recommendations. The sample included 12 pediatric patients ages 0-6 months, all with HIV+ mothers from the clinic site in Port-au-Prince, Haiti. The questionnaire used was modified from a compilation of the IFPRI-Cornell-World Vision 2005 Impact Survey and the WHO KPC Modules for nutritional assessment in developing countries. It addressed three variables: food insecurity, the age of introduction of liquids, and maternal beliefs regarding HIV status and child nutritional needs. To assess food insecurity, mothers were questioned about their choice of formula or breastfeeding, whether they had difficulty obtaining formula, and the substitutions used when formula was unavailable. In order to assess the age of introduction of liquids, mothers were questioned about their child’s age when he or she first received water, sugar water, breast milk, formula, tea, and complimentary foods, along with what was the first liquid the child received after birth. Finally, in order to assess maternal beliefs regarding HIV status and pediatric nutritional needs, the mothers were asked at the end of the questionnaire to describe the feeding patterns they would utilize for an HIV+ vs. and HIV- child. The information collected through this nutritional assessment has given GHESKIO a better understanding of the primary barriers faced by the Port-au-Prince patient population to reaching WHO recommended pediatric nutrition guidelines. *Sarah Barnhard, MS2, GHESKIO Clinic/Weill Cornell Medical College; CoAuthors: Rebecca Heidkamp, PG2; Daniel Fitzgerald, MD; Charles Macarthur, MD, PhD; Pape, JW, MD
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Cabe Clark
• Etiology of Childhood Respiratory Disease in Kumasi, Ghana •
Laboratory diagnosis of respiratory disease has been limited at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana where malaria is the most frequent and serious disease of young children. During the summer of 2006, University of Utah medical students and faculty worked with KATH laboratory personnel in setting up procedures to identify causes of respiratory illness. A direct fluorescent antibody (DFA) test was used to search for respiratory syncytial virus, influenza, parainfluenza and adenovirus with a rapid ELISA test for group A streptococcus and a urinary antigen test for pneumococcus. Children, average age 16 months, male/female/not recorded 60%/37%/3%, with symptoms of cough (94%), nasal congestion (67%), respiratory rate >30 (89%), pulse >100 (95%) were studied. Of the 116 children tested by DFA and ELISA, there were 9 RSV (7.7%) and 14 (12%) Group A streptococcus with no positives for influenza, parainfluenza or adenovirus. Of the 42 children tested for pneumococcal antigen, 14 (33%) were positive. Of the 116 children, 37 (32%) were identified with a potential respiratory pathogen. Of the 116 children, ten were tested for malaria, two had positive smears for malaria and 42 (36%) were treated for malaria. This study has helped broaden the knowledge base, laboratory diagnosis and treatment of children presenting with fever and respiratory disease in Kumasi, Ghana. * Cabe Clark MS2, University of Utah Medical School; CoAuthors: Neil Argyle, MS2; Pamela Royer, MS2; Alex Owusu-Ofori M.D., Steve Alder PhD, Devon Hale M.D.
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Robert W. Comer
• Introduction of a Modified Neonatal Resuscitation Course to Lay Midwives in the Dominican Republic •
 for their knowledge base prior to, and after, the course. Twenty-six and 29 of the original participants were retested at 3 and 9 month intervals, respectively. The overall course was then evaluated by 24 participants in focus groups at 12 months. RESULTS: There was a highly significant change in posttest knowledge immediately after (p < 0.01), at 3 month (p < 0.01) and 9 month (p < 0.01) intervals and participants were more confident in performing resuscitation at 12 months. CONCLUSION: Implementation of a neonatal resuscitation course is effective in training lay midwives and has a lasting effect on their knowledge base and ability to perform resuscitation. Outcome studies are needed to determine if neonatal resuscitation is feasible in resource poor settings. * Robert W. Comer, PG4; Baystate Medical Center, Western University of Tufts University; CoAuthors: Barbara Graves (Faculty); Jane Cross (Faculty)
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Milani Patel, Tara Paulose
• The Orphan Crisis in Sub-Saharan Africa: An example of excellence in orphan care in Ethiopia • BACKGROUND: HIV/AIDS has affected 38.6 million people worldwide and left the traditional family model in crisis. The largest social impact has been in Sub-Saharan Africa where an estimated 12 million of the 15.2 million children orphaned by HIV/AIDS worldwide live. The loss of caregivers often thrusts these children into the extended family safety net, which, due to poverty, saturation, and mortality, is rapidly unraveling. OBJECTIVE: Over a 5 week period, two students lived and participated in all activities at an orphanage run by AGOHELD (Abebech Gobena Yehtsnant Kebekabena Limatt Dirijit), an indigenous NGO in Addis Ababa. This opportunity allowed them to assess the impact of institutional care on the development of orphaned children. METHODS: The students interacted daily with 49 girls, from ages 4 months to 16 years. They developed an understanding of the organization by working at the on-site health clinic, implementing educational and social activities for the children, taking on parental duties for the youngest children, and consulting with the governing body, the AGOHELD General Assembly, to evaluate their programs and mission. CONCLUSIONS: The nurturing environment at AGOHELD is both a viable and preferable alternative to the fraying extended family safety net and should be considered a model for institutional care. AGOHELD addresses all aspects of a child's psychosocial development through its surrogate family structure, reunification program, school system, vocational skills training, HIV/AIDS awareness initiatives, and support of recreational activities that allow orphans to preserve their childhood. *Milani Patel, MS2 and *Tara Paulose, MS2; Albert Einstein School; CoAuthors: Carol Harris, MD, MSc (Faculty); Agonafer Tekalegne, MD, MPH
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Donna DeGracia
• Global Health: A three-pronged approach to education •
Augsburg College is located in the heart of the Twin Cities of Minneapolis and St. Paul, Minnesota. The Twin Cities are home to large numbers of immigrant and refugee populations including the largest Somali population outside of Somalia, the second largest Hmong population and one of the largest Tibetan populations in the United States. Urban and rural Minnesota also have large Native American and growing Hispanic populations. Providers practicing in Minnesota should be aware of global health-related issues even if they never leave their home state. The Physician Assistant Program at Augsburg College has developed a structured 3-pronged approach in addressing global health issues. All first-year students participate in a clinical medicine unit devoted to health care disparity, both within the US and globally. This unit highlights the interconnectedness of global migration and refugee issues and local health care. Masters degree research options include international travel and exposure to global health care settings. The number of students choosing this option has been growing. The past summer over half of all academic phase students chose courses in Nicaragua or Namibia. Clinical phase students can continue their global health education with an elective international rotation. To date students have elected rotations in India, Guatemala, and Nicaragua. Other students choose local rotations in underserved areas. Although statistical analysis of outcome is not available, student feedback has been positive. Phase two has only a 3-year history, but is already producing increased interest in phase three. * Donna DeGracia MPAS, PA-C; Augsburg College Physician Assistant Program
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Nicole E. Dumas, Faye W. Chan
• Alcohol Use, Sexual Behavior, and HIV/AIDS in Internally Displaced Persons Camps of Eastern Uganda •
Since the early 1980s, the northern and eastern regions of Uganda have suffered from the instability created by the rebel group known as the Lord’s Resistance Army (LRA). LRA attacks, include child abductions and killing of innocent civilians, and led to the displacement of about 2 million people from to Internally Displaced Persons (IDP) camps. Although the public health initiative to eradicate HIV/AIDS in Uganda is regarded as one of the few “success” stories in sub-Saharan Africa, significant numbers of HIV/AIDS affected individuals living in IDP camps have been largely ignored. By interviewing 202 men and women from the ages of 18 to 89 living in the Soroti district in Eastern Uganda, researchers investigated alcohol related behavior, sexual practices, and HIV/AIDS knowledge. As people have begun resettling in nearby villages within the last year, the survey population was divided into current IDPs living in the camps (n=104) and recently resettled individuals (n=98) to allow for comparison. Although 100% of respondents indicated that they were aware of sexually transmitted diseases (STDs) and 88% discussed HIV/AIDS with their family, 79% of respondents never used condoms. The vast majority of respondents considered alcohol use to be a problem in their community, with many indicating its contribution to sexual violence and promiscuity. Compounded by congested camp conditions and severe psychosocial trauma, HIV/AIDS remains a significant problem, with women and children disproportionately affected. *Nicole E. Dumas, MS2 and *Faye W. Chan, MS2; Boston University School of Medicine; CoAuthors: Suzanne C. Sarfaty (Faculty)
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Kristina A. Lishawa
• “Doctor, you want to kill me.”: Hospital avoidance by the Krikati of Maranhão, Brazil •
BACKGROUND: The 600 members of the Krikati tribe in Maranhão, Brazil, have retained their indigenous language and traditions despite the pressures of surrounding western influence. The Brazilian government provides free medical care, yet the Krikati often shun the hospital and choose costly treatment by local spirit healers, even when critically ill. OBJECTIVE: The study objective was to understand the cultural logic behind choices to avoid the hospital despite the population’s high rates of morbidity and early mortality. METHODS: The author spent eight weeks living in a missionary household in the village. Interviews were conducted with thirty-four informants, included the village chief, a community health worker, a spirit healer, and two Brazilian physicians. All were consented, and conversations were recorded and transcribed with translation of Portuguese and Krikati by Brazilian missionaries. FINDINGS: Four inter-related themes were identified as contributing to avoidance of the hospital: 1) terror of doctors, including belief that physicians intentionally kill indigenous people, 2) reports of maltreatment and displeasure at the hospital environment, 3) fear of abandonment, and 4) animistic beliefs that disease has a spiritual origin. CONCLUSION: Hospital avoidance among the Krikati people is rooted not only in conflicting cultural explanations of illness and healing, but also in historically unequal relationships in which the Krikati feel disrespected and existentially threatened. Without compassionate attention in a clean hospital, the Krikati are unlikely to accept care, even if free. Physicians need to partner with local spirit healers to address illness in a holistic, culturally relevant manner. * Kristina A. Lishawa, MD, University of Rochester Medical Center
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May Liu, Jeff Mora, Joel Ornelas
• Economic Recession and the Chemistry of Despair: Coca paste comes to Argentina •
HYPOTHESIS AND BACKGROUND:Cocaine paste is an intermediary product in the chemical extraction of cocaine hydrochloride from coca leaves. Over the past 10 years, abuse of this drug has reached epidemic proportions in many Andean countries. Recently, this phenomenon has reached Argentina and the public health sector is now concerned with the health and social dangers associated with its use. Due to the dearth of research completed on this subject, exploratory study identifying pertinent areas of research was conducted for future investigations. The study looks at the basis of cocaine paste's spread to Buenos Aires, Argentina, the identity of population groups who use this drug, and the users' understanding of what coca paste really is. METHODS: Through interviews with cocaine paste users, physicians, and social workers, we conducted a qualitative study of the use of cocaine paste in Buenos Aires. RESULTS: Further studies are needed among health facilities and law enforcement personnel to quantify the risk. It is evident that the increased use of cocaine paste in Buenos Aires coincides with the crash of Argentina's economy in 2001; consequently, cocaine paste has become a popular drug because it is cheap to purchase. There was no consensus among the users and health workers interviewed on exactly who uses coca paste but most subjects had heard of its use in their own work or home environment. *May Liu, MS2; *Jeff Mora, MS2; *Joel Ornelas, MS2; University of Southern California, Keck School of Medicine
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L. Nneka Mobisson
• Knowledge, Attitudes and Practices of Healthcare Providers towards Prenatal HIV Screening and Prevention of Mother-To-Child Transmission in Nigeria •
OBJECTIVE: The purpose of this study was to assess the knowledge, attitudes and practices of healthcare providers regarding prenatal HIV screening and the use of antiretroviral drugs in the prevention of mother-to-child transmission of HIV in Nigeria. METHODS: A cross-sectional survey using self-administered questionnaires among 150 healthcare providers was conducted at four healthcare facilities in Nigeria from June to August 2000. Two of these healthcare facilities are the designated pilot centers for the national prevention of mother-to-child-transmission (PMTCT) program. Differences in responses between physicians and nurses were compared for each category and at each hospital. RESULTS: Of 150 fielded self-administered questionnaires, 86 healthcare providers responded, representing 57% of physicians and nurses. Less than two-thirds of respondents had correct knowledge regarding the use of antiretroviral drugs in mother-to-child transmission with physicians being more knowledgeable than nurses. Despite the differences in knowledge levels, more nurses than physicians agreed on the importance of screening pregnant women for HIV (93% vs. 70.91%; P=0.04). In addition, a significantly larger proportion of nurses routinely inquire about the HIV status of pregnant women (60% vs. 38%). CONCLUSION: Healthcare providers have limited knowledge levels regarding the use of antiretroviral drugs in the prevention of mother-to-child transmission. A significant proportion of healthcare providers do not have attitudes or practices conducive to the prevention of perinatal transmission. This may negatively impact the success of the PMTCT programs in Nigeria. This study highlights the need for comprehensive training of healthcare providers at healthcare facilities to ensure the success of the PMTCT programs. *L. Nneka Mobisson, MD, MPH, MBA, PGY3; Donna Neale, MD (Faculty); The Children's Hospital of Philadelphia, Philadelphia, PA
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Monique Tanna
• Effects of Hurricane Katrina and Subsequent Displacement on Health, Access to Medical Care, and Social Stability of Children and Families •
BACKGROUND: In 2005, Hurricane Katrina devastated the Gulf Coast region, affecting thousands of people. The aftermath of this disaster is still present today, over a year later. OBJECTIVE: We surveyed the health status and social service needs of households displaced by Hurricane Katrina in Mississippi. These findings should better enable policymakers, advocates, and providers to address the needs of the affected population. METHOD: A 30-minute questionnaire was administered to a random sample of households in both individual trailers and FEMA-subsidized congregate trailer sites. Research domains included health status, medical and social service needs, access to care, economic and social resources, and personal preparedness for future disasters. RESULTS: Households reported moving three times on average since the hurricane, with some as many as fifteen times. 25% of children who had a personal doctor who knew their medical history before the hurricane did not have a medical provider almost a year later. Of those that did still have a provider, 14% had a new provider. 46% of children returning to school planned to attend school in a new community. CONCLUSIONS: Displacement and migration has had a large impact on the health and resources of this population. Poor access to care and loss of stability in terms of medical care, education, and community, along with further data analyses which may demonstrate increased medical needs and loss of income and security, point to the overwhelming and ongoing crises facing these displaced families. These issues must be addressed to prevent multiple long term consequences. * Monique Tanna, MS2, Albert Einstein College of Medicine; CoAuthors: David Abramson (Faculty); Richard Garfield (Faculty)
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Benjamin N. Angarita
• Why are there so few female surgeons in Japan? •
Medical Students assisting surgeons in the pediatric cardiothoracic department at Tokyo Women’s Medical University, will not meet one female surgeon. This leads one to explore the question, “why are there so few female surgeons in Japan?” In order to research this topic, the experimenter conducted ethnographic interviews with female physicians, nurses, and laypeople. During these interviews, professional women told the experimenter “women are just not strong enough to be surgeons” and that “women just do not become cardiothoracic surgeons in Japan.” After these discussions, the experimenter concluded that one of the principal reasons why there are so few women surgeons in Japan is because Japanese society has constructed misconceptions about surgery and surgeons in order to mislead women into believing that they cannot perform surgery.*Benjamin N. Angarita, MS2 , Weill Medical College of Cornell University
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Robert Starke
• A Cultural Understanding of Chagas’ Disease in Arequipa, Peru •
BACKGROUND: Chagas’ disease is a major public health concern throughout Central and South America affecting 16-18 million people. Objective: To evaluate the knowledge, attitudes, and practices (KAP) related to Chagas’ disease in an endemic region, Arequipa, Peru. METHODS: Using a questionnaire, the KAP of the residents of the Hunter district, a district of the city where there had been Chagas’ Control Program (CCP) for the last year, was compared to the KAP of the residents of the city not living in that district. Results: Data analysis revealed that residents believe that Chagas’ disease is a significant health concern. Residents of the city of Arequipa have a high level of knowledge and awareness of Chagas’ disease and its vector. Knowledge of symptoms and treatment was limited, but was higher in the Hunter district. 68% of the Hunter district respondents received education about the disease versus 31% in the surrounding city. CONCLUSIONS: The CCP is a potentially effective means of educating the public and should be considered in other districts. Future programs should place more emphasis on symptoms and treatment for Chagas’ disease. Findings suggest that effective plans should involve continually monitoring the level of infected household infestations in all areas of the city and eliminating the misconception that the disease is associated with low socioeconomic status. Future work should include communicating how important Chagas’ disease is to the health of each individual and to the health of the community. *Robert Starke, MS4, Albert Einstein College of Medicine; CoAuthors: John Amatea; Maureen McEvoy; Dr. William Burton.
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Malinda Fitzgerald
• Minority Health International Research Training Grants •
This NIH/Fogarty International Center grant offers research training opportunities to qualified eligible students and faculty to participate in all expenses paid, summer-long international biomedical and behavioral research programs abroad. Projects address problems inherent to health care in minority and rural populations in developing countries. Faculty can do research with students at a site of choice, or make it possible for students to participate in ongoing health-related research. Students with resident status from any university can apply to any MHIRT program in the United States, so there are a variety of options. Students can be from any field of study as they receive research and language training before they leave. The program is expected to increase awareness of international research issues and opportunities, acquaint students with a range of career opportunities in biomedical and behavioral research, encourage participants to pursue post-baccalaureate degrees and careers in biomedical and behavioral research especially related to minority health problems, and enhance international collaborative research activities. A point of interest for those attending from small institutions is that our program is unusual for this grant, as we are a small private university competing for funding with large research institutions elsewhere in the U.S. Our recent projects include a wildlife preservation and health care exchange program and research in diseases of the eye in Brazil, and malaria prevention and "lost generation" children in IDP camps in Uganda. We would also like to gain input from others in related programs. *Malinda Fitzgerald (Faculty) and Teri Mason (Faculty) and Mohamed Kanu (Faculty); Christian Brothers University
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Eva Holsinger
• Ahead of the Curve: Twenty years of global health training in pediatrics •
BACKGROUND: The Rainbow Center for Global Child Health of Rainbow Babies and Children’s Hospital in Cleveland established a special track for pediatric and medicine-Pediatric residents in 1987 with the first three participants entering the program in 1988. The track was based on global demographics. 90 percent of children were born into the developing world in 1987 and this figure has not changed. OBJECTIVE: The pediatrician of the 21st century must have knowledge and skills related to all the world’s children. Regardless of whether he/she travels to a resource poor area, children from these areas continually enter more developed areas. They bring along infectious diseases such as tuberculosis and some have long term psychological scars from experiences in man made or natural disasters. METHOD: The curriculum for the international child health track consists of didactic lectures, journal clubs, and optional overseas rotation and/or management of disasters course. In addition, many residents complete a research project related to their international experience. RESULTS: The number of residents opting for this track has steadily increased to the present year when there are currently 58 residents enrolled. A total of 96 have completed the program since its inception. Alumni have gone on to work with international NGOs, medical missions, the CDC, academic international research, and UN agencies. CONCLUSIONS: A detailed survey has been distributed to all graduates of the International Health Track evaluating their training experience and its impact on their professional career with results to be presented at the time of the conference. * Eva Holsinger, MD (faculty), Case Medical School; CoAuthors: Arlene Dent, MD, MPH ( Faculty); Barbara Baetz-Greenwalt, MD, MBA (Faculty); Marisa Herran, MD, (Faculty); Anna Mandalakas, MD, MA (Faculty); Karen Olness, MD (Faculty)
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Amy Yager, Teresa Lynch
• Pilot Program Using Spanish Teaching Sheets in a Developing Country •
BACKGROUND: For more than 30 years, the Institute for Latin American Concern (ILAC), has been conducting “make-shift” multidisciplinary clinics in the rural areas of the Dominican Republic (DR). ILAC serves over 200 communities in the rural underserved. Students participating are in their senior year of clinical study. Seven of the most common diagnoses seen in the past programs were chosen to develop the teaching sheets in Spanish and English. Available teaching sheets included: 1) back pain, 2) headaches, 3) heart burn, 4) dental care, 5) parasites, 6) head lice and scabies and, 7) yeast infections. No formalized method of teaching was used in these clinics, in the past. OBJECTIVE : The main objective was education and disease prevention. This pilot program was implemented to improve the method of patient teaching done in the clinic setting. METHOD: In June of 2006, twelve nursing providers went to six different villages or “campos”. The role of the nurse was to record the demographic data of each patient, take vital signs, perform limited treatments, and teaching. Teaching stations provided a place to review the appropriate teaching sheet with each patient. RESULTS: There were 3,471 patients seen in six clinics throughout the summer. Teaching sheets were utilized in all six campos. Teaching sheets were given to the patients after they were reviewed and reinforced by a health care provider. CONCLUSIONS: This pilot program was well received by the interdisciplinary team members, as well as the patients served in these communities. * Amy Yager, MSN, APRN, FNP-C and *Teresa Lynch, BSN, MA, C.; Creighton University, Institute for Latin American Concern (ILAC) Mission, Santiago, DR 
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Adam Aliusio
• Demographic Profile and Health Maintenance Behaviors of Peruvian Female Sex Workers •
BACKGROUND: Female sex workers (FSWs) represent a high risk population for STDs. In Peru commercial sex is common with 34-56% of men reporting purchasing sex. FSWs are targeted by health services in Peru; however, even with the trades’ importance there is no large-scale descriptive analysis. OBJECTIVE : To provide a cross-sectional description of Peruvian FSWs and analyze the role of socioeconomics in condom use and health seeking behaviors. METHODS : During 2001 FSWs from 28 cities were surveyed for socioeconomics status, STD knowledge, sexual commerce, condom use and health seeking behaviors. RESULTS: Information from 6154 FSWs was statistically described and analyzed. Condom use was reduced in FSWs from the highlands (AOR, 0.40 95%CI, 0.31-0.52) and jungle (AOR, 0.57 95%CI, 0.38-0.86) regions and for non-brothel workers (AOR, 0.22 95%CI, 0.15-0.31). STD treatment via federal facilities was increased in older FSWs (AOR, 1.03 95%CI, 1.01-1.05) from the jungle (AOR, 6.19 95%CI, 1.52-25.14). STD treatment through pharmacies was diminished for more educated FSWs (AOR, 0.66 95%CI, 0.51-0.86), while increased in the highlands (AOR, 2.81 95%CI, 2.13-3.71) and for those working outside of brothels (AOR, 1.94 95%CI, 1.35-2.78). CONCLUSIONS: Peruvian FSWs in brothels report greater health maintenance behaviors in condom use and STD treatment. Diversification of outreach programs promoting condoms and healthcare services targeting FSWs outside of brothels is needed. Refocusing the pharmacist STD treatment program for non-brothel FSWs in the highlands could enhance efficacy. Conclusions necessitate follow up with implementation but provide a possibility of improving Peruvian public health initiatives. *Adam Aluisio, MS2, Stony Brook University Medical Center; CoAuthors: Patricia Garcia, MD, MPH (Faculty)
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Forough S. Ghavami Shirehjini
• Assessment of the Rural Mexican Population's Awareness of Hypertension, with Possible Preventive Measures •
BACKGROUND: Many health care issues throughout the world arise from the lack of awareness and educational resources. These issues can be addressed once the problems are identified through an evaluation process. OBJECTIVE: To assess the health educational needs of rural populations in Mexico while providing educational tools and resources to increase the population's knowledge of hypertension, with hopes of preventive efforts being made to maintain the health of the population. METHOD: A study of men and women aged 15-88 (mean age 43) living in rural populations of San Blas and Tecate, MX. Participants were interviewed via a questionnaire about the consequences, causes and prevention of hypertension. A short one page flyer with illustrations was given to participants as an educational tool. RESULTS: Of the 68 participants interviewed, all are aware of the consequences of hypertension, 14.5% are not aware of the causes of hypertension, and 38.2% are not aware of preventive measures to be taken for hypertension. The subjects have a mean systolic blood pressure of 112.57 mmHg. CONCLUSIONS: There is no significant difference in the level of awareness between the two populations of San Blas and Tecate, and the majority is not at risk for hypertension (mean systolic < 120 mmHg). The participants have a better understanding of the consequences of hypertension compared to their understanding of hypertension causes prevention. Therefore, focusing education efforts on causes and prevention of hypertension would have the biggest impact on both the San Blas and Tecate communities. *Forough S. Ghavami Shirehjini, MS2, Western University of Health Sciences, College of Osteopathic Medicine; CoAuthors: Rafi Younoszai (Faculty)
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Sade Kosoko-Lasaki, Teresa Lynch
• Glaucoma Screening in Santiago, Dominican Republic •
INTRODUCTION: The epidemiology of open angle glaucoma suggests considerable variability in risk, based upon ethnicity. Studies have shown that the prevalence of primary open angle glaucoma (POAG) is higher in Blacks and Hispanics compared to their white counter parts. Patients with glaucoma are diagnosed usually when they become symptomatic, at which point they have already lost 30% of their optic nerve. Thus, the prevention of glaucoma blindness from identification to diagnosis and control remains a challenge to blindness prevention programs. METHOD: In March 2006, Creighton University’s Office of Health Sciences’ Multicultural and Community Affairs (HS-MACA), in collaboration with its Institute for Latin American Concern (ILAC) and a Dominican ophthalmologist screened adults ages 30+ years for POAG. The primary health care workers (Cooperadores) received a half-day review and training session on the clinical signs and symptoms of POAG. RESULT: A total of 178 adults received visual acuity evaluation, visual field (using the FDT Visual Field Analyzer), slit lamp, tonometry and fundus exams. Thirty new cases had glaucoma while 44 existing cases of glaucoma were diagnosed, and six individuals underwent glaucoma surgery (trabeculectomy and the insertion of The Glaucoma Ahmed Valves.) Referrals were seen by Dr. Sebastian Guzman and the ILAC clinic in Santiago. CONCLUSION: The glaucoma screening efforts of the team yielded positive findings which translate to a reduction in blindness. *Sade Kosoko-Lasaki, MD, MHPS, MBA, HS-MACA and *Teresa Lynch, Creighton University; CoAuthors: Sebastian Guzmon, MD; Radalme Pena, ED; Leopoldo Carretero, MD; Gisselle Medina, DDS; Margaret Black, COT, HS-MACA
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Cheruba Prabakar
• Somatization: Contributing factors among young, unmarried Tamil women in Mumbia, India •
Somatization is a process in which psychological states are manifested via physical symptoms such as headaches and chest pain. This poster explores the relationship between sources of tension and somatization among young unmarried ethnic Tamil women in a Mumbai slum community. The data presented was collected from an urban poor community consisting primarily of migrants from various parts of India. Since the investigator is Tamil and speaks the language, the focus was on young Tamil women. Information about the women’s lives was collected through in-depth interviews (25) and a survey instrument that was administered to 70 women between the ages of 16-24 through face-to-face interviews. The research sought to explore three domains: the presence of tension; the stressors in women’s life situations that included family dynamics, romance, and gossip; and somatic symptoms. Data was analyzed using SPSS. Preliminary results show that the top two stressors in these women’s lives were family dynamics (62%) and involvement in romantic relationships (15%). There was a strong correlation between women who experienced high levels of tension, and those who experienced a greater number of somatic symptoms (chi: 12.9 p=0.002) Those who lacked the freedom to work exhibited higher levels of tension (chi: 6.7, p=0.03). There was a greater desire to leave home vs. stay in women who experienced higher levels of tension (57% vs. 24%) (chi: 5.4 and p=0.03) and a greater number of somatic symptoms (chi=5.2 and p=0.03). Those exhibiting greater than 3 somatic symptoms were also involved in a romantic relationship (chi: 5.4 p=0.02). * Cheruba Prabakar, MS2, University of Connecticut School of Medicine; CoAuthors: Stephen Schensul (Faculty)
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Lois Ritter
• Urbanization and Health: current concerns and possible solutions •
The demographics of urban settings are continuing to change, and so are the health concerns for those living in these urban environments. Environmental issues, such as air and water pollution, continue to expand as well as issues related to contagious diseases, such as tuberculosis, and noncontiguous health problems, such as obesity and lack of physical activity. Social problems, such as violence and prejudice, are also increasing. In order to address these issues, professionals need to have an understanding of the current trends on an international level and ideas on strategies for resolution. After conducting an extensive review of the literature for a global health project, the author has a comprehensive understanding of the problem and strategies that have been used to address them. This bird-eye view, which has been established by reviewing research in a variety of fields, will provide the attendees with a broad perspective of health problems in urban settings and approaches to resolving them, which will enable the audience to bring these ideas into their own communities. * Lois Ritter, Ed.D, MS, California State University East Bay
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Enid Santana-Ortiz
• Immigrants to Puerto Rico: A demographic and health portrait •
The second half of the 20 th century has showed a tendency of considerable magnitude of incomers to Puerto Rico. The island has played a relevant role as both, origin and host country. Migrants account for 10 percent of the total population and have played an important role not only from a demographic point of view, but also from a health perspective. Dominicans, Cubans and Americans are the main ethnic groups living in P.R. During the last two decades a considerable amount of people from the Dominican Republic has moved to the island. The main objective of the present study was to examine the maternal and child health of migrants in Puerto Rico . This was a descriptive study. A secondary data (Births File) analysis was performed. Findings indicate that groups under analysis differ considerably in their socio-demographic and health characteristics. Puertorricans and Americans had the greatest percentage of low weight at birth and share the lowest apgar score value. Dominicans showed the greatest risks. They also look for prenatal care later than other ethnic groups and had a considerable number of pre-term babies. Cubans showed the largest proportion of mothers having some kind of health conditions. Complications at birth and anomalies were more likely to occur among puertorricans and Americans. Dominicans are in a socioeconomic disadvantage position. They are followed closely by the native population. Since migration flows tend to be a continuing process these groups' socioeconomic and health characteristics need to be addressed by ethnic groups. *Enid Santana-Ortiz, MSc, University of Puerto Rico Medical Science Campus School of Public Health; CoAuthors: Luz Leon-Lopez, PhD
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Yulia Semeniuk
• WHO Internship Summer 2006: Demographic data on youth ages 10-24 in Kiev, Ukraine •
Background: Ukraine is experiencing one of the fastest growing HIV/AIDS epidemics in Europe. In Ukraine the epidemic is driven by injecting drug use and to a lesser extent by sexual transmission. About 80% of people living with HIV/AIDS are under age 30, however there is limited standardized or disaggregated data on adolescents aged 10-19, young people 15 – 24 and particularly those most at risk. Objective: This WHO study collected information related to the demographics, health status, risk behaviours and HIV/AIDS status of adolescents and young people (10-24) in Kiev, Ukraine, in preparation for more extensive research. Method: A list of international, governmental and non-governmental organizations that currently collect information on, or interact with young people was created. A total of 16 out of 29 identified agencies were contacted. Staff in each of these were interviewed about what and how they collected, disaggregated, analyzed, and applied data relevant to adolescents, young people and HIV/AIDS as well as what specific health data they were collecting. Results: Currently, epidemiological, behavioural, and social data are collected using interviews, record reviews, questionnaires, and focus groups. Inconsistencies across agencies were identified in data collection methods and definitions of many terms. While data was uniformly disaggregated by gender, it was not disaggregated by age and social status. Conclusions: Designing preventive services and targeting most at risk groups will only be possible with more standardized measurements of indicators. Also needed is a database of relevant research, which requires improved quality of data collection. *Yulia Semeniuk, PhD, Nursing Student, University of Wisconsin, Madison; CoAuthors: David Rivett
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Andrew Suchocki
• The Minimum Data Set: Creation of a uniform field analytic tool •
Shoulder to Shoulder (STS) has been active in the Santa Lucia region of Honduras since 1990. The organization allows for intensive field experiences for all participants, including physicians, dentists, nurses, nearly every type of pre-professional student, and other professionals. STS, based at the University of Cincinnati, has collaborated with other institutions including the Universities of Rochester, Baylor, and Pittsburgh. In addition to establishing a comprehensive clinic, STS has been actively involved in field activities since its inception. These activities have a wide scope of intent, dealing with a variety of public health concerns. In order to facilitate educational encounters in the field and assess aspects of community health, a broad-based assessment tool was created to measure multiple social determinants of health (SDH). The instrument, called the Minimum Data Set (MDS), has been combined with the Rapid Catch Survey as a quantitative and qualitative assessment survey. It is a two-tiered assessment document that combines both observation and interviewing with an adult member of a household. It assists the volunteer to consider all factors that affect health, regardless of the project aim. Additionally, the tool allows for a variety of longitudinal research opportunities, such as assigning a risk score to households and communities. *Andrew Suchocki, MD, University of Cincinnati/Christ Hospital Family Medicine Program; Coauthors: Phillip Diller, M.D., PhD (Faculty); Douglas Smucker, M.D., MPH (Faculty)
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Peter Boehringer
• The Prevalence and Resident Knowledge of Metabolic Syndrome in Santa Cruz, Bolivia-Hospital Universitario Municipal San Juan de Dios •
PURPOSE: Bolivia, like many other developing countries, is facing the challenge of providing basic preventive health services while at the same time the population is shifting toward more complex and chronic medical conditions. The purpose of this study was to measure the prevalence of metabolic syndrome in hospitalized patients in Santa Cruz, Bolivia and to survey the Bolivian internal medicine residents on their knowledge about this syndrome. METHODS: During a 4-week period in January and February of 2005, all hospitalized medicine patients at the Hospital San Juan de Dios were assessed for the presence of metabolic syndrome. In addition the Bolivian medicine residents received several lectures on metabolic syndrome and their knowledge about metabolic syndrome was post-tested through a written 17-question exam. RESULTS: 58.3% of the female hospitalized patients were overweight with a body mass index (BMI) > 25. This compared with only 26.5% of the male hospitalized patients. 16.6% of the female patients and 6.1% of the male patients were obese (BMI > 30). Overall, the metabolic syndrome was found in 50% of females and 12.2% of males (p<0.0001). The mean score on the resident exam of medical knowledge of metabolic syndrome was 43% correct responses. CONCLUSIONS: Overweight and obesity is much more common in the female than male hospitalized patient population in Santa Cruz, Bolivia. The metabolic syndrome disproportionately affects females more so than males. Despite the high prevalence of female obesity and metabolic syndrome the Bolivian medicine residents had low levels of knowledge about this syndrome. *Peter Boehringer, PG3, University of California at San Francisco, Medical Education Program, Fresno; CoAuthors: Steven Stoltz (Faculty)
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Arthur Fournier, Marie Chery
• Improved Health Parameters in Rural Haiti Associated with a Community Health Worker Program •
INTRODUCTION: How can U.S-based medical schools provide continuing health services in host countries? The University of Miami – Miller School of Medicine (UMMSM) has addressed this issue through an innovative community health program. PROGRAM DESCRIPTION: The University of Miami - Miller School of Medicine in partnership with two non-governmental organizations, Zanmi La Sante and Project Medishare, has been working with the three impoverished, rural communities in Haiti’s Central Plateau (estimated population, 72,000) to improve their health. With funding from the Green Family Foundation, three years ago, we commenced a program to provide continuing preventive and primary care services, utilizing a cadre of community health workers as peer educators and providers. Sixty (60) health workers conducted a health assessment of every household and provide home visits, weekly mobile clinics, screening for malnutrition, pre-natal care and direct observed therapy for patients with TB and HIV and refer the severely ill for consultation. RESULTS: In three years, the health workers conducted 28,168 home visits, 1959 rally posts and 118 mobile clinics. Immunization rates have increased from less than 10% to 86% and pre-natal care for has increased from no pre-natal visits to an average of 3 visits for each pregnancy. A total of 766 patients successfully completed direct observed therapy for Tuberculosis. The cost of the program is $588,506.00 per year, less than $10 per person per year. CONCLUSIONS: Community health workers are a cost-effective way to deliver continuing primary care and preventive services in resource-poor settings. * Arthur Fournier, MD (Faculty) and *Marie Chery, MSN (Faculty), University of Miami Miller School of Medicine; CoAuthors: Asma Aftab, MPH; Ellen Powers, MPH
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Selom Gasinu
• Ghana's National Health Insurance Scheme and Treatment of Proximal Femur Fractures •
Background: In Ghana most patients use a “cash and carry” system that requires payment up front for healthcare. This system poses a significant barrier to timely treatment that is exacerbated for orthopedic surgeries requiring implants. Proximal femur fractures have been presented at Korle Bu Teaching Hospital, at higher rates in recent years due to increased diagnosis and referral to tertiary care centers such as Korle Bu. The standard of treatment for these fractures involves the use of Dynamic Hip Screw for extracapsular fractures and Austin Moore Prosthesis for intracapsular fractures. Objective: Ghana has begun implementing a National Health Insurance Scheme (NHIS) which will provide enrolled patients assistance in payment for medical care including the implants involved in proximal femur fracture repair. This study aimed to look at the load of proximal femur fractures in the orthopedics and trauma unit at Korle Bu and the effect that the cash and carry system has on the presurgical wait time. Method: Charts were reviewed for patients in the orthopedic wards over the course of one month. The fracture site, injury date, admission date, operation date, and implant used were colleted and patients were interviewed. Results: There were 20 patients awaiting surgery for proximal femur fractures and the average presurgical wait time for these patients was 28.5 days. Conclusion: Patient difficulty in gathering funds for orthopedic implants greatly delays surgery. The assistance offered by NHIS would cover the cost of the implants and thus decrease the presurgical wait time and hospital stay for patients. *Selom Gasinu, MS2, Weill Cornell Medical College; CoAuthors: Madelon FInkel Ph.D (Faculty)
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Edgar Mora
• Stemming the Rise of Type 2 Diabetes in Rural Amazon •
In order to address the rise in Type 2 Diabetes Mellitus in the rural Amazon, Dr. Edgar Mora has developed an interactive and practical strategy for patients to manage the disease, in order to avoid the onset of complications such as diabetic retinopathy and neuropathy. The tool has been implemented for 130 patients in the rural Ecuadorian Amazon region of Pastaza province. 57% of patients are male, and 43% female, and most are over the age of 60 years. 95% of the patients participating in the study are low-income individuals. The tracking tool will enable low-income and illiterate patients to interpret biochemical criteria in a color-coded card system, so that current lab data can be associated with a color that indicates the patient%92s level of risk for developing certain complications. This periodic tracking system will educate patients and encourage them to become more active in their metabolic control through diet, exercise and preventative care. Dr. Mora will also offer insight on how to manage other health issues with similar tools for largely rural and uneducated populations. *Edgar Mora, MD, El Centro Integral de Medicine Interna y Diabetes (CIMED); CoAuthors: Wilfrido Torres, MD, MPH
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Maria Victoria Peralta
• Physicians' Understanding of Diagnosing and Treating Diabetes in Bluefields, Nicaragua •
BACKGROUND: Diabetes currently affects 200 million people around the world. This life threatening condition especially affects underserved regions, where proper medical care and supplies are limited. Diagnosis and management is complex because it requires long-term treatment and strict patient adherence to prevent complications. OBJECTIVE: This descriptive study examines the knowledge and experience physicians have when diagnosing, treating, and managing care for diabetic patients in Bluefields, Nicaragua. METHODS: By using the "Standards of Medical Care in Diabetes" as outlined by the American Diabetes Association as a guideline, a 47 item written survey questioned physicians in Bluefields (n=14). RESULTS: The knowledge of each physician varied greatly. The most knowledgeable physicians correctly stated that diabetes can be diagnosed by 1) symptoms of diabetes with plasma glucose 200mg/dl, 2) fasting plasma glucose 126 mg/dl, or 3) two hour postprandial glucose 200mg/dl. The other physicians did not follow any particular guideline when diagnosing diabetes. In terms of treatment and maintenance of care, most physicians agreed that daily glucose testing was essential for control of diabetes, but inadequate funds prevent most of the patient population from proper care. Most physicians were also able to explain the importance of diet and exercise but did not know what hemoglobin A1c tested. CONCLUSIONS: This survey indicates a lack of knowledge of the diagnosis, treatment, and management of care in diabetic patients among physicians in Bluefields, Nicaragua. Given the increasing incidence of diabetes, programs for continued medical education would deepen physicians' understanding about this chronic disease for improved patient care. *Maria Victoria Peralta, MS2, Keck School of Medicine at the University of Southern California
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Nicole Prudent, Rob Chamberlin
• Structural Barriers to Healthcare Access for Haitians in the US and Haiti •
While Haitians suffer from many structural barriers to accessing healthcare in Haiti, new Haitian immigrants to the United States are also confronted with challenges in accessing healthcare options in Massachusetts, a state with the highest physician to patient ratio in the country. A recent study conducted by a Boston University medical student documented the healthcare differences in beliefs and practices between Haitians living close to, and those living far from an affordable and user-friendly hospital in Haiti. Findings from this study will be compared to the experience of the Boston Haitian community presented by a Haitian-American pediatrician who has served this community for over 20 years, developing programs to decrease the struggles that Haitians face in trying to access culturally competent health care. CONCLUSIONS: Haitians in both Boston and Haiti have great trust in physicians and desire access to the healthcare system. However, on top of the economic barriers to access to care, Haitians in Boston suffer most often from legal and cultural barriers, while Haitians living in Haiti suffer most often from physical infrastructural barriers such as a lack of roads and hospitals. Awareness campaigns, reducing economic barriers, and increased community participation, improve healthcare for Haitians in both settings. * Nicole Prudent, MD; and *Rob Chamberlin, Medical Student; Boston University School of Medicine
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Patricia Susemihl, Patrick Mason
• Needs Assessment Survey for Rural Villages of Honduras •
BACKGROUND: To alleviate some of the inadequacies of care in Honduras, we developed a medical mission as part of a Global Health education program between medical students at Virginia Commonwealth University and Inova Fairfax Hospital for Children. These trips generally relied on individual short "Brigada's" that provide short medical interventions but no sustainable partnership with the local communities. For a more sustainable relationship, we sought to better understand the medical needs of several of the communities in which we were traveling. OBJECTIVE: Assessment of the communities’ health care needs, and the living conditions that affect their healthcare. METHODS: 365 random patients (adults) at the clinic were surveyed. RESULTS: Women accounted for 67% of those surveyed. The mean age of the women and men were 31.8 and 43.7 years respectively. The women had an average of 4.2 children. 75% lived in a mud house and most (90%) cooked in doors with wood as the major fuel source (93%). 81% burned their trash in their yards and 21% drank water from a well or the river, with questionable water treatment. 70% said access to healthcare was their biggest health concern. Almost half had never been seen for their illness prior to our clinic due to costs, access, or lack of time. Of those that reported being seen, only 21% were actually seen by a physician. CONCLUSION: Access to health care appeared to be the major issue. Other contributors to poor health include access to clean water and waste disposal away from living areas. This information will aid us in future discussions with local health care officials and community leaders as well as guiding development of future teams. * Meena Srivastava, PGY3, *Patricia Susemihl (Faculty), *Patrick Mason (Faculty), Inova Fairfax Hospital for Children
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Michelle K. Trivedi
• Knowledge about Chagas Disease within the Blood Banks of Mexico City •
BACKGROUND: Chagas Disease is the leading cause of cardiac failure in Mexico. The causal parasite, Trypanosoma cruzi , is commonly transmitted via blood transfusions. It is not standard practice to screen for this parasite in all Mexican blood banks. In areas where blood is not screened for T. cruzi, blood bank officials rely on patient interviews to assess whether the patient is at high risk of being infected with Chagas. Therefore, it is important that blood bank officials are knowledgeable about Chagas disease.OBJECTIVE: To assess blood bank officials’ knowledge of Chagas disease within Mexico City. METHODS: Surveys designed to assess knowledge about Chagas disease were distributed to blood bank directors, nurses, doctors, and laboratory technicians throughout a random sampling of blood banks in Mexico City. Results: The majority of directors, doctors, and lab technicians were aware of the prevalence, background, etiology and characteristics of Chagas disease. Yet, 80% of nurses were not knowledgable about Chagas disease facts, with a 95% Confidence Interval for this population proportion of 68%- 92%. CONCLUSIONS: Since nurses help evaluate potential donors in order to discern whether may have been exposed to Chagas disease, the nurses’ lack of knowledge is significant and concerning. This data suggests that until T. cruzi blood screening is mandatory in all areas of Mexico, nurses should be educated about Chagas disease so they can effectively screen out potentially infected donors. *Michelle K. Trivedi, MS2, University of Massachusetts Medical School
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Ana Carolina Victoria
• Chennai, India - A model of a community cataract and refractive error screening program •
A successful community-based screening program for cataracts and refractive error will be described. This program is highly successful thanks to the cooperation of non-governmental organizations, volunteers, local associations, and local ophthalmologists and optometrists. Screening a high volume of patients is done in rural camps and schools, where the presence of refractive error and cataracts is assessed. Corrective lenses are given and patients that qualify for cataract surgery are offered cataract surgery at no expense. This program is self-sustaining thanks to generous international donations, the availability of inexpensive surgical supplies and involved members of the local medical community. * Ana Carolina Victoria, MS4, Albert Einstein College of Medicine; CoAuthors: Rudrani Banik M.D. (Faculty)
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DeAnna Friedman
• Relationship Between HIV-1 Subtype, Antiretroviral Response and Resistance in a Ugandan Pediatrics Clinic •
Is the current model of treatment for HIV in Africa sufficient? While the efficacy of HAART and various treatment combinations has been extensively studied in the United States and Western Europe, few studies have been done that have proven the same efficacy in developing countries. In Western countries, the predominant subtype of HIV is B, but subtype B makes up a minority of cases worldwide. In Uganda, the predominant subtypes are A and D. Some studies have concluded that subtype D might have a faster and more severe progression than subtype A. Similarly, the subtype could affect response to treatment. In order to prepare for a prospective cohort study, data and blood samples from a retrospective cohort of 48 patients were collected from a pediatric clinic in Kampala, Uganda. Multiple clinical parameters were collected in order to compare length of infection, length of HAART, virologic and immunologic failure, and adherence rates with subtype of infection. Blood was collected and shipped back to the University of Wisconsin-Madison for subtyping, resistance testing, viral load measurement, and CD4 count. The data collected through this study and the subsequent prospective study could provide important information in the management and treatment of patients infected with non-B HIV.  *DeAnna Friedman, M2, University of Wisconsin at Madison; Frank Graziano, MD, PhD (Faculty)
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Rachna Bali
• Evaluation of Malaria Control Measures, and Efficacy of its Treatment in Pediatric Patients at Shirati KMT Hospital, Tanzania •
WHO estimates that one Tanzanian child dies of malaria every five minutes. In this study, 170 pediatrics malaria medical records were reviewed, bed net survey of 25 families was conducted, and the pediatrics department chair at Shirati KMT hospital was interviewed. Goals of this study were to evaluate malaria control measures, assess the efficacy of malaria treatment by determining what percentage of patients—under the age of five—developed anemia secondary to malaria, and make recommendations to reduce pediatric malaria cases. We hypothesized that lack of education within the community, poor socioeconomic status, and scarce medical resources have led to the endemic. The hospital was found to not have malaria prevention programs. Exhaustion of funds forced termination of free distribution of insecticide-treated bed nets. Our analysis showed that 59% of pediatric malaria patients developed anemia secondary to malaria with a recurrence rate of 7%, and 20% of these patients died. The bed net survey showed that 72% of the families did not have a bed net due to lack of education and poverty. To alleviate malaria in Shirati and the surrounding villages, we recommend creating malaria prevention posters, subsidizing bed-nets distribution program, and appointing health educators to teach malaria prevention. It is imperative to educate families about completing the drug regimen and discourage herbal treatments. This study gives the hospital a direction on how to combat malaria. It also reinforces steps that must be taken by regional hospitals in rural Africa and the developed nations to mitigate malaria. *Rachna Bali, MS2, Touro University, College of Osteopathic Medicine; CoAuthors: Rachna Patel, MS2; Bwire Chirangi, MD; *Eiman Mahmoud, MD, MPH
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Helena J. Chapman
•Impact of Dengue Fever on Behavior in the Dominican Republic •
BACKGROUND: Dengue is an acute vector-borne disease of Family Flaviviridae, common to tropical and subtropical geographic regions. Increasing trends of co-circulating viral strains and Aedes aegypti mosquito distributions affect health with risk of transmission to over 2.5 billion individuals. Increased international travel and immigration may provide further threat to disease transmission as well as higher rates of morbidity and mortality within the community. OBJECTIVE: To examine protective behaviors against mosquito infections utilized by citizens toward reduced risk of Dengue infection in the Dominican Republic. METHODS: Cross-sectional study (2005). Surveys and semi-structured interviews examined daily practices for protection against mosquito infections. Collected data identified demographics, daily personal protective routines and interactions with health professionals. RESULTS: Preliminary statistical findings suggested variations in socioeconomic status, age, prior Dengue exposure status and number of social networks. Personal protection strategies were generally utilized (clothing, repellent, nets, candles), but screens were not implemented. Government fumigation was rarely seen unless purchased by the individual. CONCLUSIONS: Preliminary findings suggested that personal utilization of protective behaviors may reduce risk of infection. Other strategies performed within the house and patio, such as eliminating standing bodies of water around patio or covering water tanks, may be evidence of effective dissemination of health information. Strong public health programs may be essential to increasing community awareness of the potential transmission and severity of this infectious disease. *Helena J. Chapman, MS2, Iberoamerican University, Dominican Republic; CoAuthors: *Bienvenido A. Veras, MD, MPH; *Nabih R. Asal (Faculty)
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Helena J. Chapman
• Knowledge and Attitudes of Citizens on Tuberculosis Disease Transmission in Five International Sites •
BACKGROUND: Tuberculosis (TB) is an airborne, bacterial infection common to Latin America and the Caribbean. Low literacy levels and poor educational systems may result in a lack of effective health promotion and disease prevention to communities at risk of infection. With poor access to health care, many citizens may be exposed to TB and not receive proper medical treatment. International travel and immigration provide further opportunity for disease transmission with increased rates of morbidity and mortality within the community. OBJECTIVE: To describe knowledge of TB symptomology, disease spread and process of five rural international communities. METHODS: Cross-sectional study (2005). Convenience samples of citizens were selected across five sites in the Dominican Republic, Ecuador, Haiti and Mexico. A structured, closed-ended 17-item survey was developed and translated to accommodate local language to examine knowledge and perceptions of these citizens. Semi-structured interviews were completed with key informants to learn about community TB health programs. RESULTS: Descriptive statistics characterized variations in subjects per age, gender and education. Student impressions described clinic setting and targeted population. Demographic characteristics reflected differences in knowledge and attitudes about TB. Preliminary content analysis suggested need for sustained health education programs, improved understanding of TB disease and motivation for healthy living. CONCLUSIONS: Findings from this baseline assessment will assist in future University of Florida global health outreach trips to develop targeted and tailored health and health behavioral programs and interventions that strive to reduce incidence and negative impact of TB. *Helena J. Chapman, MS2, Iberoamerican University, Dominican Republic; CoAuthors: Nabih R. Asal (Faculty)
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Andres E. Cruz-Inigo
• Plain film imaging: an invaluable modality in the diagnosis, staging and management of diseases in a setting of limited diagnostic resources at a hospital in sub-Saharan East Africa •
With few resources at hand, many physicians practicing within a developing country’s health care system continuously assess the most effective allocation of available resources towards modalities that may be of diagnostic value and improve the outcomes of their patients. While the field of diagnostic radiology in many countries is steadily moving away from plain film imaging towards more costly and technologically advanced modalities, X-ray imaging equipment remains an essential diagnostic tool in the care of patients at Tanzania’s Kilimanjaro Christian Medical Center. Without underestimating the value and benefits of modern imaging modalities, here we illustrate that plain film imaging plays an invaluable role in the diagnosis, staging, and management of diseases—such as AIDS and its associated opportunistic infections and Kaposi sarcoma—in sub-Saharan East Africa. These observations emphasize that in the absence of reliable histologic, hematologic and/or cytologic diagnostic resources, allocation of resources towards diagnostic imaging modalities, such as X-ray equipment, throughout clinics in developing countries would provide physicians practicing in a setting of tropical medicine and limited diagnostic resources with an efficient, and, in certain instances, a lifesaving diagnostic tool. *Andres E. Cruz-Inigo, MS2, Weill Medical College of Cornell University, CoAuthors: Estomih Mtui, MD (Faculty)
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Margo Harrison, William O'Brien
• Measuring the Effect of HAART in a Pediatric HIV/AIDS Population: The Guatemalan experience funding provided in part by the David E. Rogers Fellowship, NYMC •
INTRODUCTION: The purpose of this paper was to describe patients’ experiences at one of Guatemala's two major Pediatric HIV/AIDS clinics. Guatemala struggles with managing the burdens imposed by HIV/AIDS without having adequate resources. METHODS: Analysis of a structured database maintained by the Clinica Familiar Luis Angel Garcia pediatric HIV/AIDS clinic located within the Hospital General San Juan de Dios in Guatemala City, Guatemala. RESULTS: From 1997 through summer of 2006, 536 new children were seen in the clinic; 241 were known to be positive at the initial visit, 293 were exposed, and 2 were classified as unknown. Among the exposed children, serostatus was determined for 173; 57 were positive. Of all new patients for which sex was known, 51.4% were female; in exposed children, 52.4% were male. New patients came from all 24 departments of Guatemala, and 63.6% were from Guatemala City. Three patients were infected sexually (all male), 433 perinatally, and 6 by other methods of transmission. In the exposed group, prenatal ARV treatment and delivery by Cesarean section were both associated with a reduced risk of infant infection. 167 children received HAART. On therapy, CD4 counts increased by 267.55 cells/&#61549;L, CD% by 8.6%, and viral loads decreased by 324,559.6 copies/mL. Based on entry serostatus, there were 15 deaths among 293 of the exposed patients, and 29 deaths of the 240 positive patients; no patients of unknown entry serostatus passed away. CONCLUSIONS: Pediatric HIV/AIDS is an important and pressing problem in Guatemala and programs to prevent maternal to child transmission, or to provide appropriate treatment for children living with HIV/AIDS, are a public health priority. *Margo Harrison, MS2 and *William O’Brien, MS4, Albert Einstein College of Medicine; CoAuthors: Matt Anderson, MD
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Kurtland Ma
• The Use of Traditional Chinese Medicine and its Possible Relationship with Adherence to Highly-Active Anti-Retroviral Therapy in Patients with HIV/AIDS in Hong Kong •
OBJECTIVE: To examine the usage of traditional Chinese medicine (TCM) and its possible relation to adherence to HAART by HIV-infected Chinese patients in Hong Kong. QUESTIONS: 1. How prevalent is TCM use among HIV-infected Chinese patients? 2. What types of TCM are used by this population? 3. What are the goals/reasons for TCM use? 4. Is there a relationship between TCM use and adherence to HAART? METHODS: 81 self-administered questionnaires were completed by ethnic Chinese patients who were on HAART for at least one year at Integrated Treatment Centre, a public HIV clinic run by the Hong Kong Department of Health. RESULTS: 62% (n=50) reported having taken any form of TCM at least once. 30 forms of TCM were used by the 50 TCM-using patients, of which, 26% (n=13) were Infrequent Users while 72% (n=36) were Regular Users. The most frequent forms were: prescriptions provided by TCM practitioners (56%, n=28), over-the-counter TCM preparations (52%, n=26), and used herbal teas (28%, n=14). During the month preceding the study, 67% of participants (n=54) had full HAART adherence and 33% patients (n=27) reported having missed one dose or more. DISCUSSION: Results did not suggest any definite relationship between TCM use and HAART adherence. However, a wide range of forms of TCM is used by this patient population. Our findings suggest that TCM-use among participants was not used to treat HIV/AIDS or related complications. Further study is needed to understand the biological activity of these TCM remedies and any possible interactions with HAART. *Kurtland Ma, MS3, Yale School of Medicine; CoAuthors: Elsie Chu, RN; K.H. Wong, MD; V.S. Wong RN; C.F. Ho, RN, Michele Barry, MD, S.S. Lee, MD
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Sara Mayer, Kea Parker
• Sexual Behavior of National and International Travelers to a Peruvian Amazon City •
BACKGROUND: Iquitos, Peru is located in the Amazon region of Peru and Brazil and is only accessible by boat or plane. Despite its geographic isolation, 150,000 travelers visit Iquitos each year. Possibly catering to these populations, Iquitos has an active formal and informal market for commercial sex workers and a more liberal attitude towards casual sex than seen in other parts of Peru. A high proportion of Iquitan sex workers have tested positive for an STD. One potential route for STD transmission is via travelers. OBJECTIVES: To evaluate sexual behavior of Peruvian and non-Peruvian travelers to Iquitos, Peru. METHODS: Anonymous written questionnaires were administered to all departing passengers in the in the CF Sacada airport in Iquitos, Peru. RESULTS: 909 of the 1008 (90.2%) completed questionnaires contained useful data, of these 123 (12.9%) reported a new sex partner during their stay in Iquitos. Seventeen percent of Peruvian travelers (PT) to Iquitos had a new sex partner during their stay. Of non Peruvian travelers (NPT), 6.5% reported a new sexual partner during their stay in Iquitos. CONCLUSIONS: It is essential to address migrating populations, tourists as well as business travelers, and their effect of disease spread and introduction. Our project demonstrates the powerful influence both national and international traveling populations can have on STD transmission in an otherwise relatively isolated community and stress the need for STD interventions that target travelers. *Sara Mayer, MPH, Scientific Applications International Corp., *Kea Parker, MS3, CoAuthors: Robert H Gilman MD (Faculty); Cesar Carcamo MD (Faculty); Ruiz Escalante, RN
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Rakhi Sinha
• Evaluation of Antiretroviral Adherence in HIV-infected Patients in a South African Township Clinic and Identification of Tools of Adherence •
BACKGROUND: The Langa Clinic in Langa, South Africa, is a government supported antiretroviral (ARV) distribution site and polyclinic. Adherence studies are beginning to emerge from this area, but it has not been determined if self-reports (SR) or pill counts (PC) are a better measure of adherence. The primary objectives of this study were:
1) assess adherence to ARVs in the clinic; 2) compare SR adherence to PC adherence; 3) identify SR tools of adherence; 4) identify factors that are correlated with better adherence. METHODS: During June 2005, all HIV+ patients on treatment at least 3 months and willing to participate were included. Adherence to ARVs was determined by SR and PC. Demographics and SR tools of adherence were recorded and identified using surveys. Data analysis was performed using Microsoft Excel and SPSS. RESULTS: 107 of the clinics 469 patients (average age = 34±8.6yrs, 70% female) were seen. 93% of subjects reported adherence was easy or very-easy. Although 31% reported missing at least one dose within the prior month, 98.6% of all doses were taken. The SR adherence was well correlated with the PC adherence (r=0.690, p<0.001). Approximately 1/3 of patients utilized cell phone alarms as a tool for adherence. CONCLUSIONS: This study found ARV adherence rates were comparable to those seen in developed countries and SR or PC were acceptable measures. This study will be useful when designing adherence programs in this resource-limited region. *Rakhi Sinha, MS3, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific; CoAuthors: James D. Scott, Pharm.D; Beth Harley MBChB, Ryan Quist, Ph.D
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Anna Karina Celaya, Alejandro Sanchez
• Diagnosis and Management of CNS Syphilis in HIV-Positive Patients •
OBJECTIVES: Participants will learn: how to use a quantitative immunological measure, Treponema pallidum particle agglutination (TP-PA) index, to assess the presence of central nervous system syphilis (neurosyphilis) among HIV positive patients who have serologic evidence of prior Treponema pallidum (syphilis) infection. With a more cost-effective, specific, and sensitive approach to diagnosis, appropriate treatment can be delivered to patients in resource-limited clinical settings. BACKGROUND: Syphilis is a curable disease that causes significant morbidity and mortality worldwide, especially among persons infected with HIV. An estimated 30-70% of HIV persons are co-infected with syphilis and approximately 20% of those untreated develop neurosyphilis. The current method of diagnosis (CSF VDRL) has low sensitivity, missing 50-70% of those with neurosyphilis. The TP-PA index is hypothesized to be a more effective method for the detection of neurosyphilis and for the subsequent evaluation of treatment. METHODS: The TP-PA index was performed on 215 HIV positive, CSF VDRL negative patients as part of the on-going research program associated with the California NeuroAIDS Tissue Network. None of the patients had active syphilis or previous neurosyphilis at the time of CSF sampling. 59 (27%) of the 215 had positive serum RPR results. Of these, 41 (70%) had an abnormal CSF. 4 of the 59 (7%) had a positive TP-PA result. CONCLUSION: Current recommendations in syphilis screening missed 7% of neurosyphilis in this study. A targeted screening approach would potentially yield a higher percentage of missed neurosyphilis cases and further validate the need of a more effective diagnostic test. * Anna Karina Celaya, MS2, Keck School of Medicine, USC, *Alejandro Sanchez, Fellow; CoAuthors: Madeline Bauer (Faculty); David Holtom; Robert A. Larsen (Faculty)
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Jennifer L. Dearborn
• HIV Knowledge and Perception of Risk Among Pregnant Women in Guayaquil, Ecuador •
OBJECTIVE: To examine the relationship between HIV knowledge, perception of risk and test acceptance in pregnant women in Guayaquil, Ecuador. BACKGROUND: Due to the rising number of pediatric HIV cases in Guayaquil, a protocol for prevention of mother-to-child transmission (PMTCT) was implemented in 2004. An important step in PMTCT is HIV testing of pregnant women. Factors affecting test acceptance may include perception of risk and HIV knowledge. METHODS: Women seeking prenatal care (N=485) were approached in the waiting area of 4 maternity hospitals. Questions asked included information about: demographics, prenatal care, HIV knowledge (scale α = 0.707), risk perception and willingness to be tested. RESULTS: Sample mean values include: age(25.7 years), formal education(9.4years) and household income($125/month). Knowledge was lacking in prevention, for example 58.8% considered mosquitoes to be a vector for transmission. Knowledge was not related to perception of risk. Most women perceived themselves to be at low risk for infection. Women who wanted to take an HIV test perceived more personal risk(F=5.698,p=0.004) and had more knowledge(F=7.143,p=0.009). Women who had taken the HIV test before had more knowledge than those that had not (F=16.952,p<0.001). CONCLUSIONS: The most important factor in HIV test acceptance was a physician’s recommendation, thus emphasizing the importance of the physician’s role in test allocation and counseling. Increased knowledge of disease prevention and transmission may positively alter health-seeking behaviors to further PMTCT efforts. Creative strategies should be implemented to address inaccurate knowledge and perception of risk among pregnant women. *Jennifer L. Dearborn, MS2, University of Connecticut School of Medicine ; CoAuthors: Judy Lewis (Faculty), Great Miño
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Rashmi Kudesia
• Coping Mechanisms among Obstetric Fistula Patients in Niamey, Niger •
BACKGROUND: Obstetric fistula is a preventable childbirth injury still prevalent throughout much of the developing world. Though surgical repair often succeeds, the women still face obstacles in reintegrating into society, notably a lack of spousal and peer support. To address the psychosocial aspects of fistula, it is imperative to analyze the typical coping methods utilized. OBJECTIVE: To investigate coping mechanisms employed by obstetric fistula patients at the National Hospital in Niamey, Niger. METHOD: Semi-structured interview of women presenting for evaluation of fistula. Women were interviewed with a standard set of questions regarding circumstances of marriage, relationship with their husbands, post-operative plans and sources of emotional and financial support. RESULTS: Of 30 women interviewed, the average age of marriage was 15.15±2.39 years, likely an overestimate due to underreporting of underage (<15) marriages. At interview, 20 women remained married, though sometimes tenuously, and all but two aimed to return to their husbands post-discharge, often after recuperation at their parents' household. These cases illustrated three predominant options for these women – to return to a supportive husband, an unsupportive partner, or the parental household. In coping with their situations, many patients responded with faith-based beliefs, optimism, and wit. CONCLUSIONS: More so than interpersonal support networks, readily available in the USA, faith and humor are the dominant coping mechanisms for fistula patients. Given the extraordinarily disruptive nature of their condition, these women betray little to no psychological distress, and it would appear that they have found powerful and culturally appropriate coping mechanisms. * Rashmi Kudesia, Sc.B. MS3, Duke University, CoAuthors: Supriya Rao, B.S., MS3; Jeffrey P. Wilkinson, MD (Faculty)
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Lauren M. Ullman
• An Assessment of the Need for and Plausibility of Administration of Prenatal Care
in Rima Village, Qinghai Province, China •
BACKGROUND: Infant mortality is a significant problem in the rural areas of China. One of the factors that may contribute to the problem is the lack of prenatal care administered in these areas. OBJECTIVE: A team of investigators from the University of Rochester in Rochester, New York, visited Rima Village, Qinghai Province, China, for three weeks to assess the villagers' knkowledge of prenatal care. METHODS: An IRB-approved study was administered to five women in the village addressing socioeconomic status, nutrition, prenatal care received, environmental exposures, chronic and acute diseases contracted before pregnancy, and a family history of premature birth. RESULTS/CONCLUSION: The limited results provide an interesting glimpse to the multifaceted issues that can impact the outcome of pregnancy. However, in order to further the study, a number of logistic, cultural, political and economic problems will need to be addressed. Some of these challenges, as well as proposed solutions, will be discussed. *Lauren M. Ullman, MS2, University of Rochester School of Medicine and Dentistry; CoAuthors: Alexis A. Weymann, MS2; Ravi DeSilva, MS3; Nancy P. Chin (Faculty), Chin-To Fong (Faculty)
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Jennifer C. Lee
• Untangling perfectionism and sensory phenomena from Obsessive Compulsive Disorder, a Brazilian study •
BACKGROUND: Perfectionism has a long historical association with Obsessive Compulsive Disorder (OCD), particularly in cognitive models of OCD. Yet, only a few empirical studies have looked at the association between perfectionism and OC symptoms in clinical patients using validated measures of perfectionism. OBJECTIVE: The first objective was to investigate the role of perfectionism and sensory phenomena (SP) in OCD diagnosis and symptom severity. The second aim was to examine the correlation between perfectionism and SP severity in OCD treatment response. METHOD: The study utilized 44 subjects recruited for a larger OCD clinical trial. The control group of 37 subjects was recruited from the community. OCD was diagnosed using the SCID-IV. Instruments used were Frost MPS for perfectionism, DY-BOCS to measure OC symptom severity, and USP-SPS to measure SP. RESULTS: The Frost subscales of concern over mistakes (CM), doubts about action (DA) and parental criticism (PC) are most closely associated with the OC dimensions of symmetry and aggression (r=0.36-0.60,p <0.01). SP occurs about twice as often in OCD than non-clinical subjects. In addition, SP severity is associated with OCD symmetry severity (r=0.49,p<0.01). Treatment response results suggest that higher Frost PE score resulted in worse treatment response (p<0.01) while higher Frost PC score seemed to predict better treatment response (p<.001). CONCLUSION: The Frost scale is related to certain OCD dimensions and certain dimensions maybe useful in predicting OCD treatment response. SP severity is a continuum and that after a certain threshold value becomes more associated with OCD. *Jennifer C. Lee, MS2, Yale University School of Medicine; CoAuthors: Helena S. Prado, PG2; Maria C. Rosario-Campos (Faculty); Euripedes C. Miguel (Faculty); James F. Leckman (Faculty)
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Julia R. Hanebrink
• Implementing Malaria Prevention through Education in Uganda •
In an area where malaria is a major threat to life as well as general health, an efficient way to combat this infectious disease is through the dissemination of knowledge about preventative behaviors. Based on previous malaria research conducted in Bushenyi District of Uganda and in accordance with the specifications of communities interviewed in 2003, a preventative educational tool was constructed and access to continuous resources was established. During the summer of 2006, researchers educated communities in Bushenyi district using the malaria guide. To solidify community participation and sustainability of the program, local leaders who participate in a health plan scheme were trained on sensitizing using the intervention as well as the general questions respondents asked the researchers. This pilot project attempts to demonstrate community ownership and simple access to resources, i.e. affordable mosquito nets, in relation to health outcomes and preventative behaviors. *Julia R. Hanebrink, MA, Christian Brothers University; CoAuthors: Crystal Ton, MA2
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Gary D. Michels
• Introduction of Personal Water Filters into Rural Dominican Communities •
BACKGROUND: Because water quality plays a central role in public health, the ILAC (Institute for Latin American Concern) / CESI (Centro de Educacion para la Salud Integral) mission distributes personal water filtration systems to families in rural areas in the Dominican Republic. These affordable, simple, family-based, gravity purification systems are constructed from two 5-gallon buckets, a ceramic filter element, and a spigot. OBJECTIVE: Approximately one year after introduction into four rural communities, the personal filters were checked for functionality. Results from water tests and correct procedures for using and maintaining the filters were reviewed with each family. METHODS: Personal filters were visually inspected for physical problems (leaks, broken spigots, and plugged filter elements). Drinking water quality was determined by testing water samples for contamination by fecal bacteria. The membrane filtration method was used. RESULTS: Of the 42 filters tested, 36% had physical problems that prevented them from working. Of the working filters, 90% produced either no risk or low risk quality of drinking water according to World Health Organization standards. CONCLUSIONS: Personal filters are an effective way to improve the quality of drinking water in rural Dominican communities. Upon receiving filters, families must be given instruction on how to use them correctly and on how to care for and maintain them. Within 3 months of introduction, follow-up testing should be done on the personal filters. Correct procedures for filter usage and the results from water quality tests should be reviewed with each family. * Gary D. Michels (Faculty), Creighton University; CoAuthors: Amber Oberle, Undergraduate Student
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Catherine Berger Pass, Marnita Coenraad, Josh Steere
• Science and Service Learning in the Dominican Republic •
BACKGROUND: The Institute for Latin American Concern (ILAC)/Centro de Educacion para la Salud Integral (CESI) and Creighton University’s Chemistry Department sponsor a unique international program that combines scientific research, cultural appreciation, and service learning. OBJECTIVE: The three pillars of this project provide undergraduate students with a well-rounded approach to scientific research related to health care that is centered on social justice and human dignity. METHODS: ILAC/CESI directs a public health program that distributes personal water filtration systems to families in rural communities. Students work with this program to test the ongoing effectiveness of these filtration systems and to test the purity of local water sources in rural communities. While performing this research, students also visit and learn about the unique aspects of each community, stay several nights with a host family, and participate in local service projects. RESULTS: The scientific data obtained by the students is used to improve education programs regarding proper use and maintenance of personal filters, and it reveals contamination levels of local water sources, indicating whether additional communities need personal filters. Students develop personal friendships with the Dominicans throughout the project and witness first-hand the benefits that scientific