Passports for a Cause
Teaching, research focus spans the globe, and GMED graduates are well-equipped to serve overseas
by Alice Patenaude
As the one of the largest and most diverse medical schools in the United States, the College of Medicine is taking a leadership role in addressing global health issues through its Center for Global Health.
Launched in 2011, the center brings together faculty and students with a goal of improving the health of populations around the world through three primary initiatives—cutting edge multi-disciplinary research, advocacy for new innovative solutions to save lives in low resource settings (see sidebar stories), and training of the next generation of global health leaders.
To prepare physician leaders to serve global communities, the Global Medicine Education Program was initiated in 2012. GMED is a comprehensive, four-year longitudinal program that accepts 12 students annually from those admitted to the College of Medicine.
“The Center for Global Health has research, faculty, outreach and humanitarian projects, but our students are really the lifeblood of the center,” says Timothy Erickson, MD , center director and associate dean of faculty affairs. “The graduates of our program will have a
greater understanding of issues that face us in global health, not only as clinicians but also as educators, policymakers and researchers.”
The University of Illinois was one of the first medical schools to begin a Global Medicine program, and its students come from a wide variety of backgrounds. “These students are phenomenal,” says Erickson. “Some have already worked abroad or for the World Health Organization, some have master’s degrees, while others speak multiple languages or are multicultural, with ties to their mother country either through their parents or themselves. The unifying factor is their passion for global medicine.”
GMED students remain together for four years as part of a team-based cohort, completing their medical school training and participating in myriad programs outside of the medical school curriculum. Those programs focus on creating an understanding of the social, environmental, political and economic issues that contribute to world health disparities and developing skills that address the needs of international populations.
“These experiences help GMED students see global health in a much more in-depth way than other medical students,” says Valerie Dobiesz, MD, professor of emergency medicine and GMED director. “We mentor students and provide networking opportunities with faculty in many specialties who have created careers integrating global health. Our goal is to cultivate a real family atmosphere.”
That sense of community has made a real difference for M3 GMED student Ana Mauro, who was born and raised in Argentina before coming to the U.S. at age 15.
“I was a nontraditional student, deciding to attend medical school after receiving my master’s in public health and working for federally qualified health centers in Miami,” says Mauro, who plans to pursue residencies that include a global component. “The GMED faculty and staff are a source of inspiration. GMED is an incredible network of caring, committed individuals who have a passion for making a difference in the world.”
During the summer between their first and second years of medical school, GMED students have the opportunity to begin a project within their area of interest, which incorporates research and fieldwork and culminates during their final year with a summary and presentation of their project.
M2 GMED student Tsige Gebreslasse’s project focuses on an interest dating to early childhood, when she lived in a remote part of northern Ethiopia—HIV prevention. “My uncle’s ex-wife died from the disease, and I wanted to understand it,” says Gebreslasse. After coming to the U.S. at age 16, she began to explore her options after attending college. GMED was a perfect fit.
In the summer of 2014, Gebreslasse was awarded nearly $20,000 by the HIV -Vaccine Trials Network to assess HIV prevention methods in Capetown, South Africa. Gebreslasse spent each day of her two-month stay out in the field, interviewing 300 community members and talking with many more about the disease and its prevention. “It was an eye-opening, amazing experience,” she says. “There was a really low knowledge level of prevention methods. Education is so important in tackling the issue.”
Gebreslasse plans to focus the skills and knowledge gained from her global medicine degree on change in her native country. “After earning my MPH in national and health policy, I want to return to Ethiopia and help make systemic changes in the educational and health systems,” she says.
For M2 student JJ Parker, the GMED program is what set the University of Illinois apart. “The program is a great community that gives you a support structure,” he says. “I always knew I wanted to work in global medicine. The GMED program will help me reach that goal.”
Before even applying to the GMED program, Parker served in Nicaragua for 13 months with Manna Project International, which fosters young leaders who work to help break the cycle of poverty in underserved communities around the world. He returned to Nicaragua
after his first year of medical school to survey adolescents about family planning.
“Nicaragua has the highest rate of adolescent pregnancies in the Western Hemisphere, and I believe that improving maternal health and family planning resources is one of the best ways to ameliorate the cycle of poverty,” he says.
Parker surveyed 300 adolescents and found that the lower rates of contraception use among these teens may be less about access and more related to multiple social factors. In particular, the found high levels of adolescent and familial discomfort with discussing contraception and low value placed on family planning. He hopes to continue his research with interviews as part of his capstone project.
The first graduation of GMED students will take place in 2016. “The mission of the GMED program reflects the mission of our college and the university as a whole, so we are practicing what we preach,” says Erickson. “Our students have already exceeded our expectations, becoming incredible global citizens and on their way to being the global health leaders of the future.”
EAST AFRICA: NEURTRALIZING VIRUSES FOR CLEAN WATER
An interdisciplinary team from the University of Illinois in Urbana has been collaborating to help address the global need for clean water. Nearly a quarter of the world’s population (1.75 billion people) consume fecally contaminated water, resulting in a staggering impact on human health.
In fact, diarrhea and resulting dehydration from unsafe drinking water is the second leading cause of death for children under the age of 5 globally. In addition to the human cost, the World Bank estimates that lack of access to safe water and sanitation results in a global economic loss of $260 billion annually.
For the past seven years, Joanna Shisler, PhD, associate professor of microbiology, and Benito Marinas, PhD, professor of civil and environmental engineering, have been working together in communities in Uganda, Tanzania and Kenya to render viruses in drinking water inactive.
In most developed countries, free chloride or low pressure UV lamps are used to disinfect the water. “Dr. Marinas and I are performing basic research to develop technology for point-of-use water systems, like hand pumps, that will work at least as effectively as [currently used] free chlorine and UV lamps, but are inexpensive and more appropriate for use in rural Eastern Africa, where people have very little money to spend on water purification and where
centralized water systems are uncommon,” says Shisler, who also serves as associate director of water and health research at the Safe Global Water Institute.
The team, which also includes University of Illinois faculty members Yi Lu, PhD, professor of chemistry, and business professor Madhu Viswanathan, PhD, is slowly making progress in determining both how to neutralize viruses and how to determine if they have been neutralized. The goal is to develop a product that can detect contaminants and is easily adopted by the community. During their collaboration, Shisler and Marinas have trained both undergraduate and graduate students representing different disciplines.
“Our biggest success has been in building relationships with the University of Nairobi (Kenya), Nelson Mandela University (Tanzania) and Makerere University (Uganda),” says Shisler. “We are empowering the next generation of scientists to tackle the health issues their countries face. By partnering with undergraduate and graduate students on these projects, we are training future scientists who are trained in multiple disciplines and have a global view of health issues, making them better world citizens.”
Uganda: A Partnership for Health and Education
For the last five years, education and improved health care have come together at the Engeye Health Clinic in Ddegeya, Uganda, a community 25 kilometers from the nearest hospital that previously had lacked access to emergency care services.
In partnership with the College of Medicine’s Center for Global Health, the clinic aims to provide both outpatient care and health education for the local community as well as international clinical experience for COM students, residents and fellows.
Led by Janet Lin, MD, MPH, associate professor and director of health systems development in the Center for Global Health, the partnership has focused on building capacity in this rural community in emergency care systems. “The clinic is staffed year-round by Ugandans, and projects are dictated by the needs the staff has identified,” says Lin. “We have had the opportunity to develop relationships and build trust while expanding health care access and delivery.”
Together, Ugandan staff and COM students have worked to optimize mHealth—mobile health using cell phones—to link the community, clinic and government health care systems; introduce a maternal mortality improvement program; institute quality improvement processes; educate health care providers and the community about the appropriate use of antibiotics; and look at the best practices of ambulance use, since no emergency system existed previously.
Teresa Liu and Eric Foster, now M3 GMED students, were part of the efforts at Engeye in 2013. Liu conducted focus groups with Volunteer Health Team members who use mobile technology to report data on disease outbreaks and medication availability, and she identified some of the challenges they face. Foster focused on evaluating practices in diabetic care in the region, which has limited access to such care.
“It’s important for medical students to get exposure to the larger issues and social determinants that contribute to health, such as the population’s nutritional status, education, employment, health literacy and access to care,” says Lin. “Students learn about the existing health care system as well as how we can engage the community about the importance of health. The Engeye Clinic has provided a great opportunity to share and exchange knowledge; that’s what draws me to global medicine.”
Vietnam: Improving Care for Children
Ai-Xuan Holterman and Mark Holterman, both MDs, professors of surgery and pediatrics at the College of Medicine in Peoria, and husband and wife, are on a personal journey to improve surgical and emergency care for children in Vietnam.
In 2009, the couple launched the International Pediatric Specialists Alliance for the Children of Vietnam (IPSACVietnam.org) project to address three goals: education and training, academic support, and delivery of outreach surgery to the areas of greatest need. The project
was later expanded to include collaborations in pediatric emergency medicine, pediatric oncology, and simulation medicine.
Health care worker shortages present a serious problem—and surgical burden—in Vietnam. The World Health Organization suggests a minimum ratio of 2.3 health care professionals per 1,000 individuals as being necessary to provide basic adequate health care services. Vietnam averages only one per 1,000, with considerable regional variations.
“The majority of Vietnamese surgeons are just as or even more skilled from a technical standpoint as our surgeons in the U.S.,” says Ai-Xuan, who left Saigon (now Ho Chi Minh City) at age 17. “What they need is to gain a comprehensive approach to surgical care, not just performing the surgery itself. We want to help them make the right diagnosis and then have proper patient preparation and care after surgery to achieve the best outcome with the least complications.”
IPSAC Vietnam teams varying from five to 40 members make twice yearly visits to major children’s hospitals in Vietnam to help improve patient care. “We are moving toward training and providing our colleagues with clinical tools for broader health impact, including cardiac, pediatric and general trauma resuscitation skills; and eventually, I’d like to help build a
research infrastructure so they can gauge how effective their care is,” says Ai-Xuan.
“We’ve been working in Vietnam for seven years, and it’s a learning process,” she continues. “We may have direct impact on individual patients, but the education of the workforce is what’s most important for the future. We need to put measures in place so the focus is on quality rather than quantity, going beyond individual volunteer efforts to partnering
with Vietnamese medical schools in building clinical and research programs with an alternative perspective on how health care is delivered overall.”
Southern Thailand: RMED Success
Started from scratch in an underserved region of Southern Thailand where no medical
school had previously existed, the Princess of Naradhiwas University Faculty of Medicine is the first successful launch of the College of Medicine at Rockford’s Rural Medical Education Program at an international location.
“Our RMED program has been in effect since the early ‘90s and has had a 75 percent success rate in recruiting students who return to their rural communities to practice,” says Michael Glasser, PhD, associate dean of rural health at the COM in Rockford and co-director of the school’s National Center for Rural Health Professions. “Retention of health professionals in this region of Thailand had been difficult, and PNU wanted to educate local students with the intent that they would stay after graduation.”
Ouichai Pleangprasit, dean of the PNU Faculty of Medicine, had heard about RMED’s success and sought out the NCRHP in Rockford to collaborate on the project. In 2008, an agreement was signed to begin adapting the RMED model for international use in southern Thailand. The COM focused on developing the educational model and curriculum, while PNU leased office space to launch the medical school in 2009. Along with Glasser’s work on the project, Matthew Hunsaker, MD, former director of RMED and faculty member of the NCRHP, led the team from the University of Illinois in Thailand.
An additional challenge in launching the school was overcoming cultural barriers in this region of Thailand, whose population is 80 percent Muslim and 20 percent Buddhist. “Local leaders from both communities were asked to participate in the development process,” says Glasser. “The first graduating class in 2013 was comprised of 16 Muslim and Buddhist students, and their interactivity was groundbreaking from a cultural perspective.”
Twenty-five students graduated in 2014, and the collaboration will continue for the next five years. Alex Stagnaro-Green, MD, MPHE, regional dean of the COM at Rockford, joined Glasser and Vicki Weidenbacher-Hoper, MSW, assistant director for external and pipeline projects, in returning to Thailand in December 2014 to sign the agreement. Upcoming goals include evaluating the long-term outcomes of the program, analyzing the feasibility of starting another medical school in a different region of the country and encouraging both student and faculty exchange for research projects.
“The launch of the PNU medical school confirmed the transportability of the RMED program to other cultures and established that we can collaborate with other institutions and governments to make changes not only in their education process, but also in their access and quality of care,” says Glasser.