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Global Health Pathway (GHP) 1 st year GHP Seminar Session #1

Global Health Pathway (GHP) 1 st year GHP Seminar Session #1. Global Health Pathway September 15, 2014 Michael Chin, MD Health Policy Associate, Office of Health Policy and Technology Co-director , International Medical Education Program University of Massachusetts Medical School

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Global Health Pathway (GHP) 1 st year GHP Seminar Session #1

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  1. Global Health Pathway (GHP)1st year GHP Seminar Session #1 Global Health PathwaySeptember 15, 2014Michael Chin, MDHealth Policy Associate, Office of Health Policy and Technology Co-director, International Medical Education ProgramUniversity of Massachusetts Medical School Ann Moormann, PhD, MPHCo-director, International Medical Education ProgramUniversity of Massachusetts Medical School Department of Pediatrics, Department of Quantitative Health Sciences

  2. Outline • Introductions • Overview of the GHP • Journal club • Global Health Case Presentation • Community Engagement Program (CEP) & Patient Advocacy Program (PAP) • Wrap-up (90 minutes total)

  3. Introduction • Medical school: UMMS Class of 2000 • 4th year medical school elective in Zimbabwe (infectious disease, internal medicine, ophthalmology)

  4. Introduction • After family medicine residency: 6 months teaching at a family medicine residency program in Uganda A typical district hospital in Uganda

  5. Footer Text Introduction • 4 months volunteer at a rural health clinic in Nepal A typical district hospital in Uganda

  6. Footer Text Introduction • Multiple short-term medical trips to Central America and DR

  7. Introduction • Today: • Co-director of the International Medical Education Program at UMMS • Health Policy Associate, Office of Health Policy and Technology • Clinical work: at a community health center in Boston • My goals for global health education at UMMS: • Train future leaders in global health • Promote a balance between learning and service

  8. Introduction • Ann Moormann, PhD, MPH • Introductions of the 1st year GHP students: • Name • Tentative plans for Global Health (GH) Summer Experience (which may turn into a capstone)

  9. Outline • Introductions • Overview of the GHP • Journal club • Global Health Case Presentation • Community Engagement Program (CEP) & Patient Advocacy Program (PAP) • Wrap-up (90 minutes total)

  10. History of the GHP: • History: • Began about 15 years ago • Previously, “Pathway on Serving Multicultural and Underserved Populations” • Last year (AY 2013-2014) launched the new Global Health Pathway: • A focus on “global health” (domestic & international) • A higher quality educational experience • The Challenge: achieving this in current realities (budget, security, time constraints, etc.)

  11. Goals of the GHP: • Prepare UMass Medical School (UMMS) students for clinical, research, public health, and cultural experiences with underserved populations both in the U.S. and around the globe. • Provide an opportunity in both global health learning and service • Train students to be mentors and teachers in issues regarding global health

  12. Expectations of 1st year GHP curriculum: • Global Health Seminars • Journal Club • Global Health Speaker Series • Community Engagement Program (CEP) &Patient Advocacy Program 5. Global Health Immersion Experience 6. Capstone Project 7. Global Health Service Project Each year, participation in the GHP will appear on your academic transcript at the end of the year

  13. Community Engagement Program (CEP) & Patient Advocacy Program (PAP): • WRAP (Worcester Refugee Assistance Program) • be a mentor a Burmese youth • ten 1st years; ten 2nd years • ACE (African Community Education) • be a Volunteer Health Educator, for Saturday program • three 1st years; three 2nd years • Health from an Immigrant Perspective (HIP) • paired with an immigrant family • Four 1st years • Other • Help establish a refugee health assessment program • Help establish visits to financial counselors at UMMHC, CHC, or HCFA • Profile & present Community-Based Organizations or Faith-Based Organizations addressing immigrant or refugee health in the US • Profile & present organizations addressing global health internationally • Student-identified CEP or PAP activity • Zero to five 1st years

  14. Overview of 1st year Seminar Series: Topics: • Millennium Development Goals • Refugee & immigrant health in the US • HIV • TB • Ethics in global health • Disaster relief & humanitarian crises Each seminar series will follow this format: • Self quiz • Journal club • GH Case Presentation • Capstone / Summer Experience / Travel prep • Other: e.g., GH Service Project Our goals: “The 3 E’s” • Educational • Engaging • Efficient

  15. Outline • Introductions • Overview of the GHP • Journal club • Global Health Case Presentation • Community Engagement Program (CEP) & Patient Advocacy Program (PAP) • Wrap-up (90 minutes total)

  16. Global health journal clubWorld Health Statistics 2013The World Health Organization, 2013 Global Health PathwayJanuary 26, 2014Michael Chin, MDHealth Policy Associate, Office of Health Policy and Technology Co-director, International Medical Education ProgramUniversity of Massachusetts Medical School

  17. Journal club: Millennium Development Goals Outline: • What are the MDGs? • Name the 8 different MDGs? (see handout) • “World Health Statistics 2013” report (WHO) • Read pages 13 – 18 • Discuss in groups of two • Discuss as a large group • Take home messages / quick “self-quiz”

  18. Millennium Development Goals: What are they? • 8 goals. Three of the 8 goals are related specifically to health. • 18 targets • 48 technical indicators (to measure progress towards the MDGs) • When: Adopted in September 2000 by the largest gathering of world leaders in history . (i.e., by all UN member states, and 23 international organization) • The purpose of the MDGs: to reduce extreme poverty by meeting these targets by 2015 • “The MDGs have been the most successful global anti-poverty push in history…. The MDGs have proven that focused global development objectives can make a profound difference” – UN Secretary-General Ban Ki-moon The 8 Goals: • Eradication of Poverty and Hunger • Achieve Universal Primary Education • Promote Gender Equality and Empower Women • Reduce Child Mortality • Improve Maternal Mortality • Combat HIV/AIDS, Malaria and other Diseases • Ensure Environmental Sustainability • Develop Global Partnership for Development

  19. Millennium Development Goals: What are they? Resources: • The goals, targets, indicators: http://www.unmillenniumproject.org/goals/gti.htm • The indicators: http://mdgs.un.org/unsd/mdg/default.aspx The 8 Goals: • Eradication of Poverty and Hunger • Achieve Universal Primary Education • Promote Gender Equality and Empower Women • Reduce Child Mortality • Improve Maternal Mortality • Combat HIV/AIDS, Malaria and other Diseases • Ensure Environmental Sustainability • Develop Global Partnership for Development

  20. Discussion questions for the group From reading pages 13 – 18: • What is something that you find very surprising, or very disturbing? • Did it make you personally want to do get more involved in one particular area of global health? (e.g., family planning & education, vaccinations, water & sanitation)

  21. 5. Quick self-quiz • Q: The Millennium Development Goals are a set of 8 goals that were adopted in what year? A: 2000 • Q: What is the goal of the MDGs? A: To reduce extreme poverty by meeting targets by 2015 • Q: Name any one of the 3 MDGs that are directly targeting health: A: #4. Reduce Child Mortality #5. Improve Maternal Mortality #6. Combat HIV/AIDS, Malaria, and other Diseases

  22. Outline • Introductions • Overview of the GHP • Journal club • Global Health Case Presentation • Community Engagement Program (CEP) &Patient Advocacy Program (PAP) • Wrap-up (90 minutes total)

  23. Introduction – Global health conditions • Goal: • Learn about diseases and conditions that may be seen outside the U.S., or in immigrant & refugee populations here in the U.S., which are rare in the general U.S. population • Gain experience in preparing and giving case presentations • Structure: • The presentation should mostly mirror the structure provided (in order to make it easy to prepare, and also to help learn these conditions) • The presentation should take: 15 minutes total • 12 minutes for a power point presentation(that follows the standardized format on the following 8 slides) • 3 minute for a quick self-quiz (It should take a student approximately 1 hour to prepare)

  24. Outline 8 slides: • Clinical case (presented as a question) • Answer to the clinical case Slides regarding the diagnosis / condition: • Definition • Symptoms • Diagnosis • Treatment • Outcomes, prognosis, prevention (optional) • Quick self-quiz (15 minutes total)

  25. Seminar Session #1Global Health CaseA case from an emergency room in Boston:headache, vomiting and mental status changes in a 33yo female from Guatemala Global Health PathwaySeptember 15, 2014Michael Chin, MDHealth Policy Associate, Office of Health Policy and Technology Co-director, International Medical Education ProgramUniversity of Massachusetts Medical School

  26. Clinical case • HPI: 33yo female is brought in by sister for headache, vomiting and confusion that started 6 hours ago. She is a Hispanic woman, who immigrated to Massachusetts 5 years ago from Guatemala. She has been seen at her primary care clinic and this ER three times over the past 6 months for complaints of vomiting and blurry vision and has been given diagnosis of gastritis and headache. • Physical exam: well-nourished female who appears somnolent, and only intermittently follows directions. Vital signs are within normal limits. Neurologic exam is significant for being oriented to person and place, but not time.  Stands up, but unable to keep upright without assistance.  PEERL, but gaze is disconjugate (see photo above). Rest of exam is unremarkable. • Labs: WBC 17.6 (normal is 4.6-10.2) with normal differential. The rest of the CBC, and basic metabolic panel were normal. • EKG: normal • CT scan showed: severe hydrocephalus with mass effect resulting in displacement of the brainstem

  27. Answer • The radiologist recommended an MRI scan which was done, and the result is above • Q: What is the diagnosis? A) neurocystercircosis B) bacterial meningitis C) cerebral malaria D) pseudotumorcerebri • Hint: it’s a parasite infection, that in the US is mainly a disease of immigrants, and the disease is prevalent in the states of California, Texas, and New Mexico. (i.e., it’s a major cause of morbidity among the Hispanic population.) • Answer: Neurocysticercosis. The MRI showed “cystic lesions within the confines of the 4th ventricle with eccentric enhancing nodule most compatible with focal cystic lesion of neurocysticercosis”

  28. 7. Taenia solium (pork tapeworm)

  29. 7. Taenia solium (pork tapeworm)

  30. 2. Definition (i.e., definition, cause & epidemiology) • Sources (for slides 4 – 8): • Emedicine on-line article on Cystercircosis: http://emedicine.medscape.com/article/215589-overview • Merck manual on-line article on Cystercircosis: http://www.merckmanuals.com/professional/infectious_diseases/cestodes_tapeworms/taeniasis_solium_and_cysticercosis.html • Definition: Cysticercosis is an infection that creates cysts in different areas in the body. The infection is caused by a parasite called Taenia solium (the pork tapeworm). • Cause: Cysticercosis is caused by: (1) swallowing eggs from T. solium, which are found in contaminated food, or (2) autoinfection through the fecal-oral route (i.e., when a person is already infected with adult T. solium, then swallows eggs following improper hand washing after a bowel movement). • Epidemiology (optional): • Neurocysticercosis is the most common parasitic infection of the central nervous system. • Approximately 2.5 million people worldwide carry the adult tapeworm. • Globally, neurocysticercosis is endemic in Central and South America, sub-Saharan Africa, and in some regions of the Far East, including the Indian subcontinent, Indonesia, and China, reaching an incidence of 3.6% in some regions. • In the United States, neurocysticercosis is mainly a disease of immigrants, and the disease is prevalent in CA, TX, NM (especially in Hispanic population.

  31. 3. Symptoms • Symptoms depend on where the infection is found. • Brain lesions can result in seizures or symptoms similar to a brain tumor. • Eye lesions can cause decreased vision or blindness. • Heart lesions can lead to abnormal rhythms or heart failure (rare). • Spine lesions can lead to changes in walking or weakness. • It is also common to be asymptomatic

  32. 4. Diagnosis (i.e., diagnosis, labs, tests) • Microscopic examination of stool (to find tapeworm eggs): • Taenia solium eggs are present in ≤ 50% of stool samples from patients with cysticercosis. • Imaging and serologic testing for patients with CNS symptoms • Diagnosis is usually made when CT or MRI is done to evaluate neurologic symptoms. • Scans may show solid nodules, cysts, calcified cysts, ring-enhancing lesions, or hydrocephalus.

  33. 5. Treatment • Antiparasiticmedication: albendazolepo bid x 8-30 days, or praziquantelpotid x 30 days (Source: Sanford guide, 2003)) • Steroids: used to reduce swelling in the brain. • If the cyst is in certain locations, such as the eye or the brain, steroids may be started a few days before the antibiotic to avoid problems caused by swelling during antiparasitic treatment. • Surgery: sometimes surgery may be needed to remove the infected area

  34. 6. Outcomes, prognosis & prevention (optional) • Outcomes, prognosis: • The prognosis is generally good, unless the lesion has caused blindness, heart failure, or brain damage. These are rare complications. • Prevention:   • Avoid unclean foods, avoid uncooked foods while traveling, and always wash fruits and vegetables well.

  35. 7. Quick self-quiz • Q: What is the pathogen that causes cystercircosisand neurocystercircosis? A: Taenia solium (the pork tapeworm) which can cause cysts in various parts of the body • Q: How do people get cystercircosis? A:By ingesting eggs from contaminated food or stool

  36. Global health cases: You will be asked to do at least one global health case during the next 4 years • Global health diseases: • ID: malaria, HIV, TB, leishmaniasis, dracunculiasis, measles, polio • Peds: trachoma, asthma, diarrheal diseases • OB/GYN: vaginal fistulas • Heme/Onc:Burkitt’slymphoma • Surgery: cleft palate, cataracts • Other: kwashiorkor

  37. Outline • Introductions • Overview of the GHP • Journal club • Global Health Case Presentation • Community Engagement Program (CEP) &Patient Advocacy Program (PAP) • Wrap-up (90 minutes total)

  38. Community Engagement Program (CEP) & Patient Advocacy Program (PAP): • WRAP (Worcester Refugee Assistance Program) • be a mentor a Burmese youth • ten 1st years; ten 2nd years • ACE (African Community Education) • be a Volunteer Health Educator, for Saturday program • three 1st years; three 2nd years • Health from an Immigrant Perspective (HIP) • paired with an immigrant family • Four 1st years • Other • Help establish a refugee health assessment program • Help establish visits to financial counselors at UMMHC, CHC, or HCFA • Profile & present Community-Based Organizations or Faith-Based Organizations addressing immigrant or refugee health in the US • Profile & present organizations addressing global health internationally • Student-identified CEP or PAP activity • Zero to five 1st years

  39. Outline • Introductions • Overview of the GHP • Journal club • Global Health Case Presentation • Community Engagement Program (CEP) &Patient Advocacy Program (PAP) • Wrap-up (90 minutes total)

  40. Next sessions: 1styear Global Health Pathway (GHP) Seminar Sessions: 1.  Monday Sept 15th:  2 - 3:30 pm.  Room S2-310 2.  Monday October 6:  2 - 3:30 pm.  Room S2-310 3.  Monday October 20th:  2 - 3:30 pm.  Room S2-310 4.  Monday November 24th:  2 - 3:30 pm.  Room S2-310 5.  Monday Dec 1st:  2 - 3:30 pm.  Room S2-402 6.  Monday Dec  8th:  2 - 3:30 pm.  Room S2-310  All session are 2 – 3:30pm

  41. Wrap-up • Sign up for a CAP / PAP • Sign up for a Global Health Case • Don’t forget to sign-in for attending today’s session

  42. Outline • Introductions • Overview of the GHP • Journal club • Global Health Case Presentation • Community Engagement Program (CEP) &Patient Advocacy Program (PAP) • Wrap-up (90 minutes total) Intro to the GH Summer Experience & Capstone

  43. Capstone projects – what to be aware of now that you are a Global Health Pathway student? • Capstone project should be part of your Global Health Pathway experience (logistics and interests align) – intent to build on experience during medical school. • Time set aside to work on Capstone • Monday afternoons • Summer between FOM1 and FOM2 • 1 week Flexible Clinical Experience (FCE) • Advanced studies elective • 1 month dedicated Capstone time • Advisor selection – there is no formal co-advisor role but this may make sense depending on your project (we can ask for permission, with rationale, from OUME if one mentor cannot be selected with other serving as assistant) – networking skills. • Your LC mentor not necessarily your Capstone Advisor. • Your LPP not necessarily your Capstone Advisor. • Check out list of Advisors on Capstone OUME website (we will be adding to this list for Global Health specialty advisor)

  44. Summer Experience (rising MS2) Funding for travel:Prior approval required by UMMS, estimate real travel costs (with a cap on amount of funding available per student). Goals:  may be prelude for your Capstoneproject. Where:  domestic (i.e. Massachusetts) or international Duration: 6 continuous weeks for overseas, can be 2 blocks for local UMMS Elective Advisor:may be different from your Capstone advisor, review faculty listed in your Learning Communities (we are adding more who specialize in Global Health, 2 per house). Deliverables:  Poster presentation in August 2014, evaluation forms similar to other non-pathway students. Brief write-up on how your summer experience may or may not lead into your Capstone Project. Timeline:  get started with the planning now, especially if there is no MOU or LOA that currently exists Process:  Updated process and forms will be posted online and also reviewed during our meetings (i.e., MOU, LOA, GHER, GHEN) Questions?

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