The UQ-OCS Global Health MIS Curriculum

The rotation is intended to provide medical students the opportunity to understand and experience the benefits and challenges of clinical practice amongst population groups and/or in communities that face access and equity challenges associated with health service delivery. It will provide students with a global view of clinical medicine which will contextualize how factors such as poverty, geographic isolation, socio-economic status, religion, culture, ethnicity, as well as political matters can adversely affect the health of individuals and populations. The course will emphasize the potential benefits, risks and concerns associated with international healthcare work as well as the regulatory requirements necessary to safely execute such work. The medical students who participate in this rotation will develop a keen understanding of the link between poverty, disease and education.

Specifically, placement in Haiti will give students one perspective of the benefits, responsibilities and the sociopolitical dilemma of providing global aid. Despite Haiti’s proximity to the more prosperous U.S., the nation has suffered from sequential natural disasters that resulted in years of instability. It is widely known that large international aid organizations that came to help Haitian communities in the wake of the 2010 earthquake have failed in their mission by causing long-term damage to the region. Medical students will learn about the Haitian Revolution, Haitian medical beliefs, Haitian culture, and current political events. This knowledge will be relevant in learning the process of medical mission planning and caring for patients in Haiti. The Haiti rotation provides valuable experience and opportunity for medical students to learn to provide meaningful humanitarian aid work while limiting harm done while in country and after the medical team has returned home.

The rotation this year will be held in the southern part of Haiti, which as you know was devastated by Hurricane Mathew in October 2016. Prior to the Hurricane it was one of the most plush and beautiful areas of the country with a totally different landscape and topography when compared to the North. If you can imagine, this area is even more remote then Mayaya and even more difficult to get to. FONDYLSAHH has been providing humanitarian, medical and financial support since then. We have established a relationship with Centre De Sante De Moron in the commune de Jeremie, Department De La Grand’ Anse. The community of Moron was impacted by the storm and the clinic, which is under the auspices of the Haitian Ministry of Health, has partnered with FONDYLSAHH for support and to rebuild the area. This experience will be fundamentally different from the experience Centre De Sante De Mayaya. We will be attempting to again support the local community by attempting to purchase all medications, supplies and goods locally to help the local community. We have provided employment and support services through FONDYLSAHH to the community and again emphasize the importance of involving the local communities with whom we partner.

The importance of partnering with local authorities for guidance to ensure that our activities are consistent with the goals and objectives of the Ministry of Health of Haiti i.e. Ministere De La Sante Publique Et De La Population, the Hononarable Dr. Florence D. Guillaume. The educational objectives of the Medicine In Society Rotation are in complete alignment with the Minister’s comprehensive Plan Directeur De Sante 2012-2022 published in October 2013.

Students are responsible for preparing a peer-reviewed journal article which discuss one of the following topics and presenting at a weekly Journal Club lead by Dr. Nnedu.

1. Ethical Issues
   1. Ethical dilemmas in delivery of clinical care in resource poor settings
   2. Understanding cultural barriers to adherence
   3. Global Health Disparities/Human Rights
   4. The Role of International Organizations in Global Health/Disasters/Advocacy
   5. Incorporating Global Health into a Career as a Physician
   6. Care of Domestic Vulnerable Populations: Community Health & Mental Health Centers
   7. Domestic Aid: Public Assistance, Public Housing, Food Stamps, Medicaid, Health
   8. Care for the Homeless and Free Clinics
   9. Spirituality, Alternative/Traditional Medicine
   10. Death & Dying, Medical futility
2. Maternal Child Health
   1. Maternal Mortality
   2. Infant Mortality
   3. Malnutrition Acute/Chronic
   4. Vitamin Deficiencies
   5. Child/Adolescent Development
3. Infectious Disease
   1. Helminth Infections
   2. Malaria
   3. Febrile Illnesses (Emerging Infectious Diseases)
   4. HIV/AIDS
   5. Diarrheal Disease
   6. Acute Respiratory Infections
   7. TB
   8. Travel Medicine
4. Special Populations
   1. Refugees and Internally Displaced Persons
   2. International Adoption
   3. Vulnerable Populations (trafficking, child soldiers, child labor)
   4. Disabled Persons
   5. Global Mental Health
5. Public Health
   1. Major Causes of Mortality Internationally
   2. Preventive Medicine
   3. Injury Prevention
   4. Environmental impact on communities, effect of racial segregation, location of toxic/hazardous waste sites domestically and globally
6. Region Specific Health Issues
   1. Haiti/Caribbean
   2. Latin America: Central, South America
   3. Africa: Northern, Eastern, Western, Central and Sub-Sahara
   4. Asia: South Asia, South East Asia, Middle East & the ‘Stans’

Case Based Learning

Students will be provided cases with only basic patient information and chief complaint (in Creole). Students will take into account research reviewed throughout the course and work together to construct a likely:

• Past medical history
• Past surgical history
• Social history
• Physical exam findings
• Labs ordered and why

While also taking into account the limitation of resources in Haiti in comparison to typical practice in New Orleans. Students will be expected to develop at least three differential diagnoses with rationale and ranked based on likelihood.

• Haiti students will be given access to Creole online learning materials and attend a daily session studying the language via WebEx with Professor Marky Jean-Pierre (Tulane) and Dr. Laurephile Desrosiers prior to being in country.
• Required readings
  • Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World (Random House Reader's Circle) – Deckle Edge, August 25, 2009
  • A Creole Phrase Book
  • Andreoli and Carpenter’s Cecil Essentials of Medicine (Cecil Medicine) by Thomas Andreoli MD MACP FRCP (Edin), Ivor Benjamin MC FACC FAHA, Robert Griggs MD FACP FAAN and Edward Wing MD (Apr 6, 2010)
  • AIDS and Accusations: Haiti and the Geography of Blame by Paul Farmer (May 3, 2006)
  • Neuberger A Et al. Infectious Diseases Seen in a Primary Care Clinic in Leogane, Haiti. Am. J. Trop. Med. Hyg., 86(1), 2012, pp. 11–15
• Recommended readings
  • The Black Jacobins: Toussaint L'Ouverture and the San Domingo Revolution by C.L.R. James (Oct 23, 1989)
  • Lonely Planet Dominican Republic & Haiti (Country Travel Guide) by Paul Clammer (Author) , Michael Grosberg (Author) , Kevin Raub (Author)
  • The Big Truck That Went By: How the World Came to Save Haiti and Left Behind a Disaster by Jonathan Katz (January 8, 2013)

Students are responsible for composing a review article of a common cause of mortality in their country of interest as described by the CDC. This article should identify the disease, causes of the disease, reasons why this country is of increased risk, and review potential interventions to address this burden of disease in this country. Students should review public health research, interventions and problems making headlines in print and television media and develop a proposal. Discussion of how the problem is presented and evaluated will take place and students will discuss alternate approaches. Parallels should be drawn between patient populations, disease burden and barriers to health care in Haiti and locally in New Orleans. Commonalities in challenges of global and local health should be discussed.

Course activities: brief presentations, short written assignments, class participation.

Ex: Haiti

1. lschemic heart disease
2. Stroke
3. Lower respiratory infections
4. Neonatal disorders
5. Road injuries
6. Diabetes
7. HIV/AIDS
8. Diarrheal diseases
9. Congenital defects
10. Interpersonal violence

Student proposals will have the potential for implementation on their trip or future trips.

At the end of each trip, students should collectively work together to write a paper reporting on their experiences in country. Topics should include location, patient populations, frequent treatments/procedures, a comparison to previous trips as well as details on any special intervention implemented the year of their travel.

Haiti:
Students are required to complete scheduled sessions in OBGYN clinic, Excelth Clinic, ED, infectious disease clinic, primary care, palliative care, MedVantage, and Urgent Care. You will also complete venipuncture training, iStat training, and a laboratory tutorial.

Clinical Duties: You will share clinical duties with your fellow classmates and rotate between stations in pharmacy, laboratory, clinic, and triage. It will be your group’s role to divide the responsibilities amongst yourselves.

Other: You will be responsible for managing and updating the EMR and debriefing with your fellow classmates after each clinic day.

The learning objectives facilitated through Global Health student experiences are:

1. Recognize and appreciate cost-effective approaches to medical care in a resource constrained setting. Students will have the opportunity to practice medicine relying heavily on the history and physical examination with limited access to diagnostics, choice of medicines and hospital facilities.
2. Demonstrate effective team-building skills with colleagues from multiple medical disciplines and with local health care providers.
3. Recognize and treat illnesses common to those seen in the developing country.
4. Recognize the delivery of health in a multi-culture region of the world while gaining an understanding of the country's political, cultural and historical context and their impact on health and health care delivery.
5. Recognize prevalent cross-cultural and underserved issues in primary care, and gain an understanding of how this knowledge can be applied to a practice in the participants’ home country.
6. Understand the benefits and challenges of working with communities and recognize strategies to overcome the challenges.
7. Develop the skills, knowledge, and attitudes necessary to effectively work with communities to identify and appropriately access community-based resources.
8. Understand and appreciate how psychological, economic, spiritual, social and biological factors interrelate to affect patient health.