GH2DP Participants Present at ASTMH Conference in Washington, DC

Dr. Wang, Kate Pearson, Dr. Donovan, at the ASTMH
conference in Washington, DC

Congratulations to Dr. Jeff Wang, Dr. Summer Donovan and to Kate Pearson (a 4th year medical student at VCU) who presented their research at the annual conference of the American Society of Tropical Medicine and Hygiene in Washington, DC, yesterday. Jeff, Kate and Summer all worked on GH2DP-related projects in Honduras this past June.

Kate and Jeff looked at satisfaction with brigade care on our last medical outreach trip to Yoro, Honduras.

Town of La Hicaca; this is one of the sites where we see
patients in Honduras; Chagas disease is a major problem in the area

Our group provides medical and public health services to approximately 2,000 people living in 17 villages in the Yoro area of northern Honduras. Because of logistical issues (lack of road access) our primary clinical site is in the village of La Hicaca; people from the surrounding villages come see us there. Unfortunately, distance to the clinic is a significant barrier for many people, with some people having to walk upwards of 6 hours to come and see us.

Kate and Jeff found that satisfaction with brigade care differed on whether survey respondents were

Data from Jeff and Kate's survey

from La Hicaca or one of the surrounding villages (with the former group more satisfied with the services we provide, on the whole). Also, their work identified differences in the services requested, with mental health services being the second most commonly requested service in the surrounding villages (this was the 4th most requested service in La Hicaca).

Their work will significantly impact our future efforts to reach more individuals at remote village sites. It will also help us to tailor and expand the services we provide moving forward.

Dr. Donovan's work focused on knowledge and perceptions of Chagas disease in the communities we serve; we were asked to undertake this project by our local contacts in the health ministry.

Chagas disease is one of the neglected tropical diseases, and is an insect-borne parasitic infection that affects people in the Americas, especially parts of rural Latin America.

The insect vectors for the disease are known as "kissing bugs." They live in the walls and roofs of houses made of adobe, mud, straw and thatch, and emerge at night to feed on people's faces (I am not making this up). The insects thereafter defecate and the parasite (Trypanosoma cruzi), which is in the stool, gets inoculated through the skin when a person scratches.

It is estimated that 11 million people are currently living with this infection, and untreated these diseases persist for life. Chagas disease is associated with major morbidity: over time the infection can lead to heart failure and death from arrhythmias, as well as dilatation of the esophagus and colon with attendant gastrointestinal issues.

Dr. Donovan found that many people reported the presence of the vector in their homes (65% for people in La Hicaca, 76% for people in the surrounding villages) and that although general awareness about the disease was good (around 90% of survey respondents) understanding how the disease is transmitted was low (0%). This has implications for future control and educational efforts in the region. 

Chagas disease survey findings (LH: La Hicaca, SV:
surrounding villages) 

Again, congratulations to Jeff, Kate and Summer! They are phenomenal young researchers whose work will significantly impact the people we serve in Honduras. We look forward to more great things from them moving forward. 

VCU Medical Student Presents on Satisfaction with Brigade Care at CUGH Annual Conference

Kate Pearson, presenting at the Consortium
of Universities for Global Health's Annual
Conference, Washington, DC, March 14, 2013

Congratulations are in order to Kate Pearson, a third year VCU medical school student who presented her research on satisfaction with short-term medical brigade care at the Consortium of Universities for Global Health's annual conference in Washington, DC, yesterday.

Kate surveyed patients who received care at the Honduras Outreach Medical Brigada Relief Effort (HOMBRE)/ VCU Global Health and Health Disparities Program (GH2DP) clinics in the Department of Yoro, Honduras, in 2011. Her survey was a pilot project designed to identify key areas where we can improve the care we provide on our annual medical relief trips, as well as identify areas where we can bolster our health education efforts.

Twenty-three surveys were collected. Although the majority of patients noted satisfaction with the care provided, the survey helped to identify some key areas for future improvement. The majority of patients (70%, 16/23) desired more frequent clinics (2-3 times/ year), and the following were noted as areas to provide more health education: water purification (68%, 15/23), dental care (61%, 14/23), mental and emotional health (52%, 12/23) and nutrition (52%, 12/23).

Kate's data will help us target our health education messages on our upcoming May-June 2013 brigade, and will serve as a platform for a larger survey that will help us improve the care we provide.

Great work Kate!

Ethical Issues in Global Health Outreach Work: A Call for Formalized Medical Student Education

VCU Medical Students Assessing a Patient in Coyoles, Honduras

This is an interesting article published earlier this year by Timothy Lahey in the journal Academic Medicine. In this perspective piece Lahey discusses some of the ethical issues associated with short-term global health outreach work, especially as faced by medical students. He outlines the key components of a medical school curriculum in global health, noting this is important for all learners as "global rightly includes local because healing the sick has the same worth in inner-city Detroit as it does on the outskirts of Dar es Salaam, even if geography and culture alter the manifestations of illness and need."

Lahey notes that the principles of biomedical research should can be applied to global health outreach work: nonmaleficence, beneficence, patient autonomy and justice. Short-term medical trips are rife with pitfalls in all of these areas, as providers often provide sub-standard care without understanding the health needs of the population they are serving, or the greater context of the health pressures faced by these communities or the health disparities that drive illness.

Lahey notes a medical curriculum for global health must include an exploration of health disparities, and notes that faculty mentorship and post-trip debriefing are important components of medical student education in global health.

Over the past 6 years working on short-term medical relief missions in Honduras I personally have struggled with many of the issues Lahey brings up, and have watched many medical students and residents struggle with these issues, as well. Our group has worked to address these issues via close community partnerships, an emphasis on high-yield public health interventions, and providing logistical support to help bolster the longitudinal health efforts of the local ministry of health (find out more about the evolution of our program here).

 In terms of working with students, we have found the following:

1) Pre-trip counseling/ education of learners is essential
2) Providing learners a context for their work (e.g., how their work contributes to the longitudinal/ overall health work performed by the group) is critical
3) Continuous 'checking in' with learners/ helping learners process their experience before, during and after the brigades is very important

As "global health" truly includes addressing health issues/ disparities both internationally and domestically, Lahey's call for integration of global health education into medical school curricula is an excellent one. This 'call' should be extended to residents' curricula, as well.