Global Health Pathway (GHP)
1st 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
Ann Moormann, PhD, MPH
Co-director, International Medical Education Program
University of Massachusetts Medical School
Department of Pediatrics,
Department of Quantitative Health Sciences
1
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)
2
Introduction
•
•
Medical school: UMMS Class of 2000
4th year medical school elective in Zimbabwe (infectious disease,
internal medicine, ophthalmology)
3
Introduction
•
After family medicine residency: 6 months teaching at a family
medicine residency program in Uganda
A typical district hospital in Uganda
4
Introduction
•
4 months volunteer at a rural health clinic in Nepal
A typical district hospital in Uganda
Footer Text
7/24/2016
5
Introduction
•
Multiple short-term medical trips to Central America and DR
Footer Text
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Introduction
•
Today:
o Co-director of the International Medical Education Program at UMMS
o Health Policy Associate, Office of Health Policy and Technology
o Clinical work: at a community health center in Boston
•
My goals for global health education at UMMS:
o Train future leaders in global health
o Promote a balance between learning and service
7
Introduction
•
Ann Moormann, PhD, MPH
•
Introductions of the 1st year GHP students:
o Name
o Tentative plans for Global Health (GH) Summer Experience (which may
turn into a capstone)
8
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)
9
History of the GHP:
• History:
o Began about 15 years ago
o Previously, “Pathway on Serving Multicultural and Underserved Populations”
o Last year (AY 2013-2014) launched the new Global Health Pathway:
• A focus on “global health” (domestic & international)
• A higher quality educational experience
o The Challenge: achieving this in current realities (budget, security,
time constraints, etc.)
10
Goals of the GHP:
1. 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.
2. Provide an opportunity in both global health learning and
service
3. Train students to be mentors and teachers in issues regarding
global health
11
Expectations of 1st year GHP curriculum:
1. Global Health Seminars
2. Journal Club
3. Global Health Speaker Series
4. 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
12
Community Engagement Program (CEP) &
Patient Advocacy Program (PAP):
1.
WRAP (Worcester Refugee Assistance Program)
o be a mentor a Burmese youth
o ten 1st years; ten 2nd years
2.
ACE (African Community Education)
o be a Volunteer Health Educator, for Saturday program
o three 1st years; three 2nd years
3.
Health from an Immigrant Perspective (HIP)
o paired with an immigrant family
o Four 1st years
4.
Other
o Help establish a refugee health assessment program
o Help establish visits to financial counselors at UMMHC, CHC, or HCFA
o Profile & present Community-Based Organizations or Faith-Based Organizations
addressing immigrant or refugee health in the US
o Profile & present organizations addressing global health internationally
o Student-identified CEP or PAP activity
o Zero to five 1st years
13
Overview of 1st year Seminar Series:
Topics:
1. Millennium Development Goals
2. Refugee & immigrant health in the US
3. HIV
4. TB
5. Ethics in global health
6. Disaster relief & humanitarian crises
Each seminar series will follow this format:
o Self quiz
o Journal club
o GH Case Presentation
o Capstone / Summer Experience / Travel prep
o Other: e.g., GH Service Project
Our goals: “The 3 E’s”
o Educational
o Engaging
o Efficient
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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)
15
Global health journal club
World Health Statistics 2013
The World Health Organization, 2013
Global Health Pathway
January 26, 2014
Michael Chin, MD
Health Policy Associate, Office of Health Policy and Technology
Co-director, International Medical Education Program
University of Massachusetts Medical School
16
Journal club:
Millennium Development Goals
Outline:
• What are the MDGs?
• Name the 8 different MDGs? (see handout)
• “World Health Statistics 2013” report (WHO)
o Read pages 13 – 18
o Discuss in groups of two
o Discuss as a large group
• Take home messages / quick “self-quiz”
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Millennium Development Goals: What are they?

8 goals. Three of the 8 goals are related specifically to health.
o
o
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:
1.
Eradication of Poverty and Hunger
2.
Achieve Universal Primary Education
3.
Promote Gender Equality and Empower Women
4.
Reduce Child Mortality
5.
Improve Maternal Mortality
6.
Combat HIV/AIDS, Malaria and other Diseases
7.
Ensure Environmental Sustainability
8.
Develop Global Partnership for Development
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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:
1.
2.
3.
4.
5.
6.
7.
8.
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
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Discussion questions for the group
From reading pages 13 – 18:
1. What is something that you find very surprising, or
very disturbing?
2. 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)
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5. Quick self-quiz
1.
Q: The Millennium Development Goals are a set of 8 goals that
were adopted in what year?
A: 2000
2.
Q: What is the goal of the MDGs?
A: To reduce extreme poverty by meeting targets by 2015
2. 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
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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)
22
Introduction – Global health conditions
• Goal:
o 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
o Gain experience in preparing and giving case presentations
• Structure:
o
The presentation should mostly mirror the structure provided (in order to make it easy
to prepare, and also to help learn these conditions)
o
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)
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Outline
8 slides:
1. Clinical case (presented as a question)
2. Answer to the clinical case
Slides regarding the diagnosis / condition:
3.
4.
5.
6.
7.
8.
Definition
Symptoms
Diagnosis
Treatment
Outcomes, prognosis, prevention (optional)
Quick self-quiz
(15 minutes total)
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Seminar Session #1
Global Health Case
A case from an emergency room in Boston:
headache, vomiting and mental status changes in a 33yo female from Guatemala
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
25
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
•
•
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Answer
•
•
The radiologist recommended an MRI scan which was done, and the result is above
Q: What is the diagnosis?
•
Hint: it’s a parasite infection, that in the US is mainly a disease of immigrants,
•
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”
A)
B)
C)
D)
neurocystercircosis
bacterial meningitis
cerebral malaria
pseudotumor cerebri
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.)
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7. Taenia solium (pork tapeworm)
7/24/2016
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7. Taenia solium (pork tapeworm)
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2. Definition (i.e., definition, cause & epidemiology)
•
Sources (for slides 4 – 8):
1.
Emedicine on-line article on Cystercircosis:
2.
Merck manual on-line article on Cystercircosis:
http://emedicine.medscape.com/article/215589-overview
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):
o Neurocysticercosis is the most common parasitic infection of the central
nervous system.
o Approximately 2.5 million people worldwide carry the adult tapeworm.
o Globally, neurocysticercosis is endemic in Central and South America, subSaharan 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.
o In the United States, neurocysticercosis is mainly a disease of immigrants, and
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the disease is prevalent in CA, TX, NM (especially in Hispanic population.
3. Symptoms
• Symptoms depend on where the infection is found.
o
o
o
o
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
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4. Diagnosis
(i.e., diagnosis, labs, tests)
• Microscopic examination of stool (to find tapeworm eggs):
o Taenia solium eggs are present in ≤ 50% of stool samples from patients with
cysticercosis.
• Imaging and serologic testing for patients with CNS symptoms
o Diagnosis is usually made when CT or MRI is done to evaluate neurologic
symptoms.
o Scans may show solid nodules, cysts, calcified cysts, ring-enhancing
lesions, or hydrocephalus.
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5. Treatment
• Antiparasitic medication:
albendazole po bid x 8-30 days,
or praziquantel po tid x 30 days (Source: Sanford guide, 2003))
• Steroids:
o
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
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6. Outcomes, prognosis & prevention (optional)
• Outcomes, prognosis:
o The prognosis is generally good, unless the lesion has caused blindness,
heart failure, or brain damage. These are rare complications.
• Prevention:
o Avoid unclean foods, avoid uncooked foods while traveling, and always
wash fruits and vegetables well.
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7. Quick self-quiz
1.
Q: What is the pathogen that causes cystercircosis and
neurocystercircosis?
A: Taenia solium (the pork tapeworm) which can cause cysts in various
parts of the body
2. Q: How do people get cystercircosis?
A: By ingesting eggs from contaminated food or stool
35
Global health cases:
You will be asked to do at least one global health case during
the next 4 years
Global health diseases:
1.
2.
3.
4.
5.
6.
ID: malaria, HIV, TB, leishmaniasis, dracunculiasis, measles, polio
Peds: trachoma, asthma, diarrheal diseases
OB/GYN: vaginal fistulas
Heme/Onc: Burkitt’s lymphoma
Surgery: cleft palate, cataracts
Other: kwashiorkor
36
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)
37
Community Engagement Program (CEP) &
Patient Advocacy Program (PAP):
1.
WRAP (Worcester Refugee Assistance Program)
o be a mentor a Burmese youth
o ten 1st years; ten 2nd years
2.
ACE (African Community Education)
o be a Volunteer Health Educator, for Saturday program
o three 1st years; three 2nd years
3.
Health from an Immigrant Perspective (HIP)
o paired with an immigrant family
o Four 1st years
4.
Other
o Help establish a refugee health assessment program
o Help establish visits to financial counselors at UMMHC, CHC, or HCFA
o Profile & present Community-Based Organizations or Faith-Based Organizations
addressing immigrant or refugee health in the US
o Profile & present organizations addressing global health internationally
o Student-identified CEP or PAP activity
o Zero to five 1st years
38
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)
39
Next sessions:
1st year 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
40
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
41
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
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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
o
o
o
o
o
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.
o
o
o
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)
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 Capstone project.
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?