OPENING EYES AND HEARTS

Andrew Claff ey, Class of 2021, holding infant during his trip to Malawi with classmates Jennifer George and Korinne Thorne in the summer of 2018.

GLOBAL HEALTH INITIATIVES AT UB ARE CHANGING LIVES

BY GROVE POTTER

Photo by Korinne Thorne

uring his fi rst-year of medical school, Aaron Van Dyne served as a team leader on a medical trip to Fontaine, Haiti, where he helped triage patients. The experience opened his eyes and inspired him to return with another team in December 2018. D

“It is really humbling,” Van Dyne says. “You come back with a new perspective and a new appreciation for what you have and what we can do in terms of practicing medicine.” That experience—and what it represents in today’s interconnected world—goes to the heart of global health, a fast-growing fi eld that encompasses many disciplines, from medicine to engineering to public health, in an eff ort to understand and improve health worldwide. The opportunity for medical students, residents and faculty to travel and treat people in impoverished countries is emerging as a powerful movement nationwide, and the Jacobs School of Medicine and Biomedical Sciences has a grassroots program garnering attention. David Holmes, MD, clinical associate professor of family medicine and director of Global Health Education leads this burgeoning global health program in the Jacobs School and makes regular trips abroad with students. In 2017, he went to Ghana and Panama. Earlier his year he traveled to Haiti and in April he will go to Nepal with a team of UB medical students and members of the Jericho Road Community Health Center in Buff alo (see related story on page 18). UB medical students have an array of global health opportunities from which to choose. Fourth-year students can participate in an elective program where they join existing clinics or programs abroad run by other institutions. First- and second-year students can avail themselves of opportunities that are being developed by the students themselves with the assistance of UB faculty experienced in global health. “We really want to go where the students want to go,” Holmes says. “And we want to foster student leadership in this, so we try to be fl exible.” That openness led to the creation of the school’s primary overseas medical destination: Fontaine,

UB health sciences team and translators, Fontaine, Haiti, December 2018.

Haiti. Five years ago, a fi rst-year medical student named Vincenzo Polsinelli came to Holmes and said he had a friend opening a school in Haiti and he wanted to take a group of his fellow students there to help treat people. “I said OK, and he organized the trip himself,” Holmes recalls. “Fourteen people went that fi rst year, and we have been going back twice a year since then, during winter and spring breaks.” (See related story on page 22.) Students in the Jacobs School have welcomed the opportunity to take the lead in planning other trips and expanding the off erings. They fundraise, gather medicines and organize the logistics. To date, the medical students—joined by other health sciences students and faculty at UB—have completed trips to the Dominican Republic, Costa Rica, Peru and Panama, where they worked with a group called Floating Doctors. The most recent trip to Haiti included fi ve physicians, eight medical students, two pharmacists, two pharmacy students, a dental hygienist, a public health doctoral student, a premed college student and the 10th-grade daughter of one of the physicians.

GAINING SKILLS AND CONFIDENCE The trips are challenging, and they can be life changing. Students learn about cultural diff erences and about the hardships endured by people needing health care in lowresource environments. “The students get a much broader understanding of what it means to be culturally sensitive,” Holmes says. “And they learn so much about medicine—from taking a patient’s history, to doing physical exams, diagnosing and making assessments. There are preceptors and upper-level students helping, but by the end, the younger students learn a lot about how to diagnose common illnesses. “It also helps them with confi dence,” Holmes adds, “and reminds them about why they went to medical school in the fi rst place.” For Lisa Saffi re, now a third-year student, the trip to Haiti taught her several important medical lessons. When interviewing a 20-year-old patient with an enlarged abdomen, she thought that the woman might be pregnant, but the patient said she wasn’t. Tests confi rmed this, so Saffi re and the other students called a colleague studying cardiology who said that postpartum cardiomyopathy is not uncommon in Haiti. The woman was treated for the condition and the students arranged for her to meet a cardiologist scheduled to visit Fontaine a few months later. On a subsequent visit, Saffi re saw the woman and she was completely recovered and caring for her family. “She taught me three really important things,” Saffi re explained during a presentation at a Global Health dinner reception held last fall in the Jacobs School. “First we have to really listen to our patients. Second, we must work on our physical history and exam skills. And, fi nally, it’s OK to phone a friend—to ask questions and ask for help.”

A PRIORITY FOR TODAY’S STUDENTS Given the strong interest students, residents and faculty are showing in global health, Jacobs School administrators are exploring ways to more formally incorporate the initiatives into the curriculum. “Our students are very intellectually involved in and concerned about care across the U.S. and the world,” says Alan Lesse, MD, senior associate dean for medical curriculum and an infectious disease specialist. “And they see these initiatives as a way to help repay all of the good things that have been given to them.” A vibrant global health program is an increasingly important factor for students weighing where to attend medical school, Lesse further explains. “Global health has become very popular. It’s one of the things that students look for when they apply to medical schools. Prospective students will make part of their decision based on what sort of opportunities they have available to them in this area.” UB’s large international student population and the exposure that these students aff ord to diff erent cultures contributes to the Jacob School’s growing reputation in global health. Studying and socializing with friends from around the world gives students more realistic insights into health-care issues abroad, as well as within their own country, says Lesse. “And when students travel and return to UB, they have other students to talk to about their experiences.”

UB pharmacy student Hui “Hannah” Hong Lu, in maroon scrubs, dispensing albendazole to children at an orphanage to treat worms. Fontaine, Haiti in December 2018.

Pediatric surgeon David Rothstein, MD, MS, left, associate professor of surgery at UB, has volunteered with Doctors Without Borders for a decade, mostly in sub-Saharan Africa.

Melany Garcia, PhD candidate in public health, seated, providing health education to a mother with the help of a translator, standing, in Fontaine, Haiti, December 2018.

FACULTY LEAD BY EXAMPLE David Rothstein, MD, MS, associate professor of surgery, has been involved in global health ever since he was a medical student. Each year for the past decade, he has spent a month with Doctors Without Borders, volunteering as a surgeon in resource-poor regions, mostly in sub-Saharan Africa. “I’ve been lucky to have chiefs and colleagues who have supported that,” says Rothstein, a pediatric surgeon at Kaleida Health’s John R. Oishei Children’s Hospital, a UB teaching affi liate. Currently, Rothstein is organizing an eff ort to provide training to doctors in the Democratic Republic of Congo, with the goal of improving referral patterns and surgical care. There is a high demand for pediatric surgery in most of the African continent, where half the population is under age 16, he explains. Rothstein’s initiative is supported in part by a $50,000 grant he received from UB’s Community of Global Health Equity to help start a program in two hospitals in Goma in the Congo. “Our goal is not to come in with donated equipment and supplant care that is already being provided,” he says. “Our goal is to train local providers to extend their knowledge and skill sets, whether they are surgeons or medical doctors who, out of necessity, are doing a lot of surgical procedures.” For medical students interested in working in global health, Rothstein recommends they keep their training as broad as possible and learn languages other than English in order to better communicate with patients and other professionals. He also tells them that the lessons and benefi ts of providing such care are profound. “It’s a reset—you regain thankfulness for being alive and well,” he says. “It’s a cliché, but you learn a lot that applies back here in the States.”

EMBRACING THE WORLD Global health trips at the Jacobs School began in earnest in the late 1980s, when the late Richard V. Lee, MD, professor of medicine, obstetrics-gynecology, pediatrics and social and preventive medicine, started taking groups of students to China for a month. They would watch and learn at the Capital Medical University in Beijing, but not perform clinical work themselves. That trip continues to this day. Kim Griswold, MD ’94, MPH, RN, professor of family medicine, psychiatry, and public health and health professions, went on one such trip while in medical school at UB in the 1990s. Today she is a leader in global health at the Jacobs School. Her strong interest in the fi eld has taken her to Ethiopia, Kenya and, recently, Ghana. She is quick to point out, however, that there is a large international refugee population in Buff alo that is in need of medical care as well. “There are a lot of asylum seekers in Buff alo,” she explains, “and, subsequently, there are many global health opportunities available to address their needs.”

abroad. This support for the global health program at the Jacobs School is greatly appreciated, says Griswold, who reports that several students working with the Human Rights Initiative have received the scholarships to help the asylum seekers. Griswold sees a notable growth in interest in global health among students, many of whom are attracted by the local work with refugees. “These students are not tied down anymore,” she says. “They are ready to embrace the world.”

MEDICINE AND FOOD Third-year medical student Kyle Zittel traveled to the Republic of Malawi in southeast Africa with his cousin Kristina the summer before medical school to work in wound care clinics sponsored by Naturally Africa Volunteers. He returned for a second visit the summer aft er his fi rst year. Zittel’s family owns a vegetable farm in Eden, N.Y., and during his fi rst visit he was curious about why the villagers did not irrigate

Kim Griswold, MD ’94, MPH, RN, professor of family medicine, psychiatry and public health, right, examining a young patient in Accra, Ghana, in January 2019, assisted by a Ghanaian health worker.

One such opportunity is the Human Rights Initiative. Established and operated by UB medical students under the guidance of Griswold, the group helps to provide medical and psychiatric forensic evaluations for asylum-seekers. This involves scheduling and organizing interviews and serving as scribes for long and oft en emotionally draining sessions conducted by attending physicians. The training the students receive through Physicians for Human Rights includes cultural competency and how to work with interpreters. “They write down the story of someone who, for example, has been tortured and then prepare the legal affi davit and send it to me. Aft er completing a review and clinical summary, I send it to the attorney,” Griswold explains. The students follow the Istanbul Protocol— international standards for the structure of a forensic exam and report—which makes the data they gather valuable to immigration courts. To date, some 70 medical students have been trained to prepare the affi davits. The Dr. Franz E. and Elizabeth Glasauer Externship Fund provides four $3,500 scholarships a year to UB medical students a year who treat refugees in the local community or who participate in a global health trip

fi elds in the dry season, despite their village being located close to Lake Malawi, a large freshwater lake. Because the impoverished region has limited sources of good nutrition, the lack of irrigation had health implications. “I returned from that trip thinking that fresh produce might be an attainable goal if the villagers were educated about irrigation,” Zittel says, “so I reached out to the director of Naturally Africa Volunteers and asked if we could start an agriculture program.” Zittel and Kristina (the daughter of Jacobs School alumni Greg and Colleen Zittel) established a 501(c)(3) called Harvest Malawi and raised about $40,000 to establish irrigation techniques and help buy farmland in the village. To date, about two and a half acres are irrigated using solar-powered pumps, and a farm manager is testing the techniques and helping villagers grow vegetables and fruit trees during the dry season. In the future, Zittel plans to research whether village health is improved by the increased growing capacity. ANTIDOTE TO BURNOUT Following in Zittel’s footsteps, second-year students Korinne Thorne, Andrew Claff ey and Jennifer George— co-presidents of the Global Health Interest Group at the Jacobs School and Glasauer Scholars— traveled to Malawi last summer to work with Naturally Africa Volunteers. Their goal was to implement an epidemiological study they had prepared during their fi rst year of medical school. The trio taught home-based care groups, assisted in wound clinics and established height-weight clinics. In these settings, they gathered data on nutrition and on villagers’ comprehension of basic health tenets. Also, in “It’s a reset—you regain thankfulness for being alive and well. It’s a cliché, but you learn a lot that applies back here in the States.” — DAVID ROTHSTEIN, MD, MS, ASSOCIATE PROFESSOR

OF SURGERY

Kyle Zittel, Class of 2020, and his cousin, Kristina Zittel, pictured with villagers in Malawi after an educational session on nutrition and general health topics. The villagers are members of a Home Based Care group, a community health-based initiative.

Korrine Thorne, Class of 2021, enjoying time with village children after working in the clinic in Malawi, summer 2018.

conjunction with the Malawian government, they helped plan a survey to assess hygiene and seasonal nourishment, which was approved to begin in Nkope in January 2019. The trip profoundly infl uenced their views of medical care and may even impact their career choices. George recalls helping a girl whose growth had been stunted by malnutrition. The experience, she says, reinforced her commitment to medicine. “There are millions of kids like her out there. Just working with her made me realize that this is what we are supposed to do. This is why we are in medical school. This is why we are health professionals.” For Claff ey, the trip was humbling and challenged many of his assumptions. “I think we went in a little naïve, thinking we could change so much in such a little time.” In addition to learning that adjusting to local customs and government delays was part of his education, Claff ey discovered that primary care appealed to him. “I had been thinking about surgery as a career. Now I’m considering emergency medicine, which has a big overlap with global medicine.” For Thorne, the experience in Malawi confi rmed what she hopes to accomplish as a physician. “Going abroad and working to support the health of underresourced communities is what I feel I was meant to do. The fi ve weeks living in Malawi—getting to know the families, being invited to their homes and sharing meals—was such an eye opener, and it affi rmed why I started medical school in the fi rst place.” Reactions such as these are not a surprise to Holmes, who says the trips are rejuvenating and an antidote for physician burnout. “It really challenges us, but it helps us grow,” he says. “And we become more interested in helping others. When we see the need, it’s hard to walk away and remain calloused.” “Going abroad and working to support the health of under-resourced communities is what I feel I was meant to do.” — KORINNE THORNE, CLASS OF 2021 To support the global health initiative in the Jacobs School, visit medicine.buff alo.edu/alumni and click on “Get-Involved” and “Global Medicine Program”.