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International health assignments improve skills for caring for the underserved at home

This article first appeared in the St. Louis Beacon, Sept. 23, 2013 -  Dr. Arielle Yang, a Washington University Global Health Scholar and third-year Internal Medicine resident, says she learned the importance of primary care in a month-long rotation in a Guatemalan hospital earlier this year.

“There’s really not much primary care in Guatemala,” Yang said. “People will present at very, very late stage for diseases that would be diagnosed very early in the U.S. I really learned the consequence of a lack of a primary care system.”

She gave an example of a patient who came in with a potassium level of 9, indicating kidney failure. The public hospital where she was, Roosevelt Hospital in Guatemala City, is used primarily by Guatemalans without private insurance. The hospital didn’t have the resources to treat the patient.

“We didn’t have the medications and we couldn’t dialyze him,” she said.

The patient arrived late in the day and the dialysis unit was closed. Yang and the other doctors could not give him the treatments he desperately needed. The patient died.

In the United States, Yang said, health care providers have drugs and technology at their fingertips at a moment’s notice.

“It was really difficult to see patients die of things we can treat,” she said.

The lack of medicines and supplies challenged her abilities as a physician and taught her to “think outside the box” when treating patients. “You really have to rely on your exam skills,” she said.

Yang says she will use these skills throughout her medical career, particularly with the underserved in the United States, who face many of the same problems.

“In the U.S. we see the consequences of a lot of patients who haven’t (received) primary care services. The ER here tends to be their primary care doctor if they’re not insured,” she said. “In Guatemala, they’ll be turned away (from the emergency room) if it’s not an emergency.”

As a result of her experience, Yang has decided to go into primary care. “It helped me to become really dedicated to providing primary care to the underserved,” she said. “I don’t feel like I can ever ignore the underserved after watching them in a resource poor environment.”

Despite the hardships she saw, Yang loved her experience there. “I got to make such good friends with so many of the residents. They really helped me to understand what (life) was like on a day to day basis,” she said.

Carolyn Arden, a Washington University sophomore studying engineering and Spanish, is an example of how the Global Health Scholars in Internal Medicine program has grown to include undergraduates. Arden and Morgan Carlile, another undergraduate, spent a week at the same Guatemalan hospital, but with a different focus: fixing respiratory ventilators. “Because they did not have a lot of working ventilators, residents would have to pump and ventilate (patients) manually,” Arden said.

Broken machines, she says, were stored in the intensive care unit.

They found that someone had already tried to fix many of the ventilators -- without success.

“A lot of them had been previously tampered with by people who did not have the knowledge (to repair them.) Morgan would open a ventilator (and find) there were bolts missing or a motherboard blown out.”

In addition to making repairs, Arden and Carlile spent time with hospital staff, teaching them how to repair and maintain the machines for optimal service.

To prepare for their trip, Arden and Carlile spent time with an engineer from the BJC Global Asset Management division.

“They have a warehouse (in Fenton) of outdated equipment,” she said. The students worked there, learning how to fix the respiratory ventilators. They brought repair kits and extra parts donated by suppliers to Guatemala.

Before leaving Guatemala, Arden and Carlile conducted a needs assessment of the hospital. They are working to raise funds in the U.S. to help meet the supply needs they identified.

Like Yang, Arden learned how to make do with less. “You develop a problem-solving mentality very readily,” she said.

Origins of the program

Dr. David Windus, former dean of curriculum at Washington University School of Medicine says the program evolved out of physician education he was doing in Eritrea and Bhutan.

“I’ve been doing global health work since 2003,” he said. Windus, working with other faculty, had developed relationships with the health ministries in Bhutan and Eritrea.

“We were doing physician education. The focus was helping them with diabetes,” he said. The next logical step was to bring Washington University residents to help teach.

Windus saw how much residents learned by working abroad, in seeing diseases they would rarely encounter here and by working in a resource-poor environment.

That was five years ago. Since then, Global Health Scholars has expanded to include six overseas sites, more residents and undergraduates from the School of Engineering. The program supports a bilateral exchange. Two medical residents from Guatemala currently are training here.

Basia Najarro, business director of the program, said collaboration with the Institute for Public Health, the Brown School of Social Work, and the School of Engineering strengthen the program and spread the message of cultural awareness. “We’re so international in St. Louis, it’s important to have a program that makes us more culturally competent,” she said.

Bringing their skills home

Now that they’ve returned to St. Louis, Yang and other Global Health Scholars are actively involved with community service throughout the school year. They urge medical students and other residents to reach out to various communities. For example, Yang organizes a “barbershop initiative,” in which medical students and residents visit local barbershops. Once there, volunteers check blood pressure, counsel people on how to quit smoking, discuss nutrition and body mass index, and provide information on clinics for people to visit.

“In a very informal setting, dressed very casually, we engage members of the community,” said Yang.

Global Health Scholars also volunteer at the Gateway Homeless Shelter and at Casa de Salud, a clinic serving uninsured and underinsured immigrants and refugees

Global Health Week

To celebrate and raise awareness of global health, Washington University School of Medicine is hosting the third annual Global Health Week, Sept. 23-27. The events at Global Health Week mirror some of the aims of the Global Health Scholars program of community service, education, and multiculturalism, and give the diverse community in St. Louis a chance to participate and celebrate this program.

Events include an International Fair in Hope Plaza outside of the BJC Institutes of Health on the medical school campus, a meet and greet at the St. Louis Zoo, a community service component, and a speaker’s series. Dr. Alfredo Palacio, former president and health minister of Ecuador, will give three lectures.

A full description of the week’s activities and schedule is at ghs.wustl.edu.

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