Humanitarian Medical Outreach

Rice: Beauty and the Geek! 2006 Application

2006-04-04T13:57:00.000-07:00

Rice: Beauty and the Geek! 2006

Applications now available...

http://www.owlnet.rice.edu/~dianes/beautygeek.html

Deadline- April 14
Event date- April 20 (Thursday), 10pm-2am

Not Your Average MD- Service Abroad w/ Paula Hertel and George Ferry

2006-04-04T13:46:00.000-07:00

April 3, 2006
Not Your Average MD- Service Abroad- Paula Hertel (Zambia and Sri Lanka) and George Ferry (Bolivia)

Dr. Paula Hertel,
Gastroenterology, Hepatology, and Nutrition, Texas Children’s Hospital pmhertel@texaschildrenshospital.org

Background

She’s gone on 6 1/2 mths-2wk service trips

§ Undergrad: music/psych/research assistant with sleep disorders=stimulus for being a doctor

§ Med school (Uof MN): 1yr basic science research in Houston; clerkship 2mth in Zambia= permanent effect “formative experience”

§ Baylor TCH residency: 1 mth Rio Hondo, Guatemala (two docs from there set up a hospital, still ongoing program for TCH residents); 2wks Montero, Bolivia; 1 mth in Gaborone Botswana: city hospital, mostly AIDS work

§ Fellowship: GI/Hepatology/Nutrition- good mix of different levels of illness; good specialty to work overseas in; good people; 1yr flight transport physician at TCH (1992-3); 1yr overseas with MSF, studied Spanish in Guatemala 6wks then 6.5 mths in Sri Lanka. (they’re very picky about placing new volunteers)

§ Motives for Service:

1. learn about life for other people in other places

2. help where it’s greatly needed= feel indispensable

3. learn about diseases not common to US

4. broaden sense of world outside US

5. decrease guilt about living an affluent lifestyle in US

6. be an ambassador for the US

Senanga, Zambia: Rural Public Hospital

-high AIDS rate, orphaned kids, TB, drug-resistant malaria; no treatment for AIDS was available and diagnosis of AIDS carried huge stigma= pts refused blood test for HIV

-was wealthy until 70s, copper industry went downhill

-government frustrating; 2 exhausted physicians; high amt morbidity and mortality “I was horrified the first time I walked in”;

Lessons from Zambia:

1. need to be part of a team, by yourself, you’re not very much good

2. resources need to be used appropriately; having them not enough

3. corruption is the biggest enemy of most poor people in the world

4. doing your best, even if it doesn’t save a life, is often very meaningful to a grieving family

5. stigma of AIDS is a huge barrier to solving the aDIS problem

6. the guys that take dugout canoes down the crocodile-infested Zambezi are extremely skilled and brave

7. “I gave my heart and soul, but I still gained more than I gave”

Sri Lanka with Doctors Without Borders (MSF for Medecins Sans Frontieres)

- totally different, very good team that reacts quickly (MSF); ceasefire in 2002 after almost 20yrs civil war b/n a Tamilese Liberation mvmt (Tamil Tigers) and the government;

-hospitals gone, electricity gone;

-country has potential b/c people educated with good work ethic and resources; lots of refugees

-minimal pathology (normal illnesses; not like Zambia)

-local staff very honest and well-educated

-MSF: France, Belgium, spain, US offices (relatively independently); usually work in conflict-ridden areas, esp. underserved; in Sri Lanka for 17yrs

-mobile clinics: meds, etc. in car, go see pts at house or old clinics, get permission to use it and go!, drive back; some work in a hospital

Lessons from Sri Lanka

§ it’s awkward sometimes to be a “Have” in the “have not” world; efforts can also seem like just a drop in the bucket

§ working in a team (ex. MSF) magnifies effect of person alone

§ don’t worry about getting murdered; danger is in car accidents

Questions-

Q. What’s it like for volunteers in Doctors Without Borders with families?

A. Those volunteers can work in cities with amenities needed;

General Advice-

Infectious Disease is very useful in international medicine
It’s great to have training in common procedures like obstetric surgery, etc.
Avoid medical tourism: think about making a sustainable impact; teaching people how to care for patients or making a return visit
Be humble; remember that you’re a guest in someone else’s country

Dr. George Ferry
Gastroenterology, Chief of IBD (Inflammatory Bowel Disease) Clinic, Texas Children’s Hospital
gdferry@texaschildrenshospital.org

Background

-He didn’t have any opportunities to go abroad in med school or residency; his daughter was in Public Health in International Health and Nutrition; she worked with the Mennonite Central Committee in Bolivia (jungle community in central Bolivia- they worked on latrines, wells, nutritional projects, etc.)

-His daughter became the regional director after 4 yrs there. She brought Dr. Ferry down 10 years ago

-1^st trip: survey of communities in central Bolivia to see what a pediatrician could do that was sustainable

Working in Bolivia

-Problems in central Bolivia, especially in jungle communities: no medications dispensed, no treatment for chronic illnesses; people can’t go to cities for treatment b/c property would be stolen or b/c they had no transportation; people had drastic health problems that received no attention; example: woman with broken clavicle/dislocated shoulder for 3yrs

-Jungle communities: a chieftain’s hut with families scattered remotely in the jungle; they could set up clinic in chief’s hut

-Lowland communities (Montero): crowded barrios, water was clean but no other basic amenities. No health service available except for kids to receive immunizations for a month. However, one clinic had a director who was very involved in surveillance but many people move in and out of his community, so he had no control on the reintroduction of TB, for example.

-First trip after survey trip: didn’t want to return for a third trip because the 2nd trip was too short and he didn’t have time to connect or interact with patients; 3rd time, took more time and found that interaction with patients greatly increased his enjoyment of the trip and desire to return

- 2006=9^th year to make the annual Bolivia trip; they take about 20volunteers/yr: Rice students, med students, nurses, nurse practitioners, doctors…all specialties were useful; one neurologist made a huge impact with amount of diagnoses he made. (doctors in Bolivia had a hard time giving pts negative diagnoses; this neurologist was able to honestly communicate the difficult problems he saw)

- Eventually they had to start fundraising.

The Bolivia Annual Trip Grows

- Non-physicians got involved: they made new projects like building brick homes to get rid of Chagas’ disease after getting clean water supplies and some health education (clean water reduced 50-person community infant death toll to 0); the non-medical volunteers also share in medical work by doing home visits

- The volunteers’ working environment: mainly work out of one clinic which has good rooms and great office staff; they all review chronic patients at day’s end and talk about how to care for them when Ferry’s group leaves

- Sugarcane is a large industry there; burning and pollution of factory are problematic; they took a eco-tourism jungle trip but the blood-sucking insects left them dripping (good anti-coagulant); accidents still high;

Programs

- About 1/3 pts need chronic care; Dr. Ferry’s group is starting to see patterns such as a high rate of asthma, no preventive asthma care there; they started a preventive program with huge success; it was very gratifying to see patients a year later with positive results

- They began some ambulatory service to get patients from the jungle

- They work with a girls orphanage: most were abandoned, some parents can’t afford to take care of their girls but still visit them in the orphanage. Dr. Ferry’s group takes down books, makes parties, etc. They’ve worked in the orphanage on construction, started a sewing project, and more.

The Good, the Bad, the Ugly

- a boy with cleft palate received plastic surgery in a larger community (they paid for it); 3mths later, surgery was infected and destroyed the lining of his mouth and exacerbated his condition greatly (can’t speak, more problems eating, more embarrassment, etc.). he met visiting US plastic surgeons, had 5 sponsored surgeries and he’s finally talking “sometimes you want to do so much good, but you can’t”

- some patients try to manipulate the system (so listen to groups you’re working with)

- (Paula Hertel speaks of a woman in Sri Lanka who absolutely convinced her to cut into her toe because she felt a piece of shrapnel there, there was nothing as Dr. Hertel thought; the women later asked her to sign papers allowing her compensation from the government for a war casualty)

- (Dr. Ferry again) one husband refused the tube-feeding of his baby b/c tube-feeding took away from mother’s working time; no legal child protective services system are available (and girls aren’t really valued); the clinic tried to convince the dad, no effect, baby died

- With every trip, “I get more out of it then I give” it’s a joy to work with people there and to share projects with others.

- Giving free medicine is a problem b/c most people are superstitious, so clinic charges nominal fee; bringing medicines is worse than putting dollars into Bolivia than buying meds there, so they buy what they can in Bolivia (b/c they’re able to get most common meds)

Questions

Who funds your trips?

Most people pay their own way; if he has extra (personal or departmental) funds, he uses them to help students go. The clinic there is connected with a US NGO, Curamericas, that works in Bolivia, Mexico, and more; now Curamerica charges too much for trips so the volunteers organize their own trips independent of Curamericas. They are going out the first 12 days of July this year. If interested, email gdferry@bcm.tmc.edu to discuss possibilities.

how did you clean the water of one community?

By digging deep enough and chlorinating the water and delivering clean water.

Foreign volunteers lead communities in discussion of needs and organization to address them.

So what was the water like before?

It was tap water from the city, collected rainwater (but dry season); the water was kept in dirty receptacles on floor, etc.

General Advice

There are lots of opportunities for multi-faceted medicine: committees, clinics, book chapters, teaching
Interact with your patients
Have a very open mind and adapt yourself to the way your host community works

Not Your Average MD- Lecture II

2006-03-28T13:10:00.000-08:00

Mark your calendars! Not Your Average MD-Part II comes this Monday, April 3, 7pm in Huma 119. Dr. George Ferry and Dr. Paula Hertel will speak about their ongoing and temporary service abroad in Bolivia and more!

Brought to you by HuMed (formerly "HMO") and the RPMS.

Not Your Average MD- Lecture I: February 2006: Anna Malinow, Public Policy and Simon Whitney, Bioethicist

2006-02-24T19:55:00.000-08:00

Dr. Whitney and Dr. Malinow spoke briefly about their career paths and then answered questions regarding current healthcare and health policy, pursuing an MPH or JD, and more:

Simon Whitney, MD, JD. Baylor College of Medicine. Bioethicist: research, clinic, and teaching

Whitney went from private practice to law school then to a fellowship in medical ethics (Stanford) then to Baylor, 6 yrs. ago. Now does 50% practice, 50% ethics research.

His interest is in how patients and doctors make decisions. He says: “some decisions aren’t suitable for sharing”

Dr. Whitney’s Wisdom

Be a doctor if you have nothing else you want to do
medicine requires facility with intellectual problems, teamwork, working with hands, and responsibility
Doctors are seen increasingly for problems that their grandmas would have taken care of in the past
“Remember that there are a million ways to shape your practice so it meets your life’s needs”

on kids: both he and his wife changed from full to part-time and hared one nanny. They negotiated with their bosses for what the part-time positions.

on specialization: Do what you have fun with; ex. if you need your sleep, don’t do Ob/Gyn
On the JD: Knew he wanted to do ethics but didn’t want to be an attorney.

learned in law school: to think and write clearly
to think outside the “medical box” i.e., flexible thinking

Ana Malinow, MD amalinow@bcm.tmc.edu Pediatrician at Ben Taub with Baylor College of Medicine Co-Founded Healthcare for All Texas

www.healthcareforalltexas.org

Life story:

Born Argentina, moved age 9 to Portland (went to the same high school as Rice senior David Axel J). Dad was doc/scientist. She wanted to be doc since age 5. Went pre-med to UCDavis. in Senior year, changed her mind. Traveled abroad, learned languages, did grad school in creative writing. Taught Medical Spanish until a student asked why she wasn’t a doctor. She had no reason not to be, so off she went to med school. Went to Zimbabwe during Pediatrics residency, which was “life-changing.” She wanted to return to Zimbabwe but then had 3 children (during residency) and so put that on hold. Her family support was her in-laws; her mom-in-law raised the kids. They all lived together (her in-laws and her own family) in a one-bedroom apartment. She realized she could practice third-world medicine in the first-world USA. Was in Cleveland, which has a doctor: patient ratio of 1:10,000 (wow). After 5 yrs there, her husband got a job at Baylor and “strapped me onto the roof of the car to get me out of Cleveland.” She was able to find meaningful work in Pediatrics at Ben Taub, though (60-70% of patients are uninsured). She teaches lots and sees patients. Started the group Healthcare for All Texas four years ago with a med student.

Q & A

on US Healthcare.

Whitney: “Our system is no system.”

Q. What effect do MDs have on changing healthcare?

A. We have respect as MDs on a variety of topics, but we’re not trained in policy. It’s a handicap that MDs are poorly prepared for policy changes (like in using advocacy and lobbying).

Q. How should we prepare if we want to get involved in Health Policy?

A. Economics, Public Health, Public Policy are all great fields to study. You can get an internship in something you’re interested in (ex. Public Health in urban US); you don’t necessarily need an MPH.

Q. What is the solution to our healthcare problem?

A. Malinow: We need to recognize and care about the problem. Healthcare should be a public good. We need to agree first on guiding principles and then actions work upon those principles: healthcare must be accessible, equitable, universal, affordable, and sustainable. We have the money to act on these principals—the government spends $1.9? (1.3?) trillion per year.

Whitney: The problem is income distribution.

Q. (to Whitney) Could you get your skills without a law degree?

A. Yes, but they wouldn’t be as strong. You could get writing skills through any advanced humanities.

Q. What else do MD/JDs do?

A. They can act as attorneys for medical cases (malpractice, etc.). I do some expert witness work. They can also work in administration.

Q. Can you apply ethics to your practice or is the transition hard?

A. The ethics isn’t theoretical. The problem is the other way around (applying real situations to academic ethics).

Q. Talk about combined degree programs.

A. UH/Baylor have a joint JD/MD program. Talk to people who are doing these programs. You can allow yourself to take some time off (to do the program).

Q. Who makes the decision in patient care—the doctor or the patient?

A. (Whitney) it depends on the decision.

(Malinow) For kids up to 18, the parents decide unless the child is an “emancipated minor”.

Q. (to Malinow) Are parents receptive to your medical advice?

A. Yes. They want what’s best for their kids. Sometimes they can’t provide what’s best.

(Whitney) With adults, lots of times you can’t find the problem or you can’t find the solution or the patient doesn’t want to listen.

Q. Do docs have a unique insider perspective on health policy?

A. (Malinow) Most MDs don’t have a clue.

Q. Do we need to get more involved?

A. Yes! That’s our job. It’s like going to law school and not learning the constitution.

Q. Is the lack of education about our healthcare system changing in med schools?

A. Patients and communication are more of the focus today.

Q. Does med school cause students to lose their idealism?

A. (Whitney) You shouldn’t be afraid and you should be able to keep your ideals.

(Malinow) Be afraid! They try to make you think in a box. Med students their first year are so idealistic

Q. So how do we keep our hope?

A. (Whitney) Always ask questions and Love your patients.

(Malinow) Be ready to swim upstream. You’ll see things that are wrong and you might be too scared to say anything, but that doesn’t mean you’re losing your ideals.

Q. Do we need an extra degree?

A. Physicians don’t make policy. What you need (to change policy) is a lot of money.

Not Your Average MD

2006-02-09T22:17:00.000-08:00

Humanitarian Medical Outreach and RPMS are bringing you a series called “Not Your Average MD.” Starting this Monday, doctors who mix medicine with other aspects of their careers will share their experiences with us! The first of these lectures is:

MONDAY (2/13)

7PM

HUMA 119

1) An MD/JD (that’s a law degree), Dr. Simon Whitney, who works as an ethicist and internist with Baylor and

2) Ana Malinow, MD, a pediatrician who also works as the head of Healthcare for All Texas

Come hear about the different ways doctors can change the world around them and ask all the questions you want! If you’ll be hungry, we’ll have a light dinner available.

Spread the word—time got the better of us and we need YOUR HELP to tell your medically-inclined peers about this fantastic opportunity.

Hope to see you there!

Kenya Applications

2006-01-20T19:36:00.000-08:00

Applications for our annual Kenya trip are available! The following message is from our Travel Committee chair:

"Ever consider what it might be like to pet a giraffe? Or travel to the opposite side of the world to volunteer in a straw-thatched hut, and make a meaningful difference in an infant's life by administering the oral polio vaccine he needs? Does the risk of getting bit by African mosquitos and possibly contracting malaria appeal to you (this will probably not happen, but there is a risk)?

Apply now to HMO's Kenya Summer Medical Service Trip 2006

Fill out the application on computer, and return it via email to tjohn@rice.edu by next Sunday, January 29! Further instructions available in the attached document. Email tjohn@rice.edu if experiencing problems."

Check your email; if you're on the listserv, you should have received this message already, with the application as an attachment. If not, email tjohn@rice.edu.

1/19/2006 Minutes - Board Meeting

2006-01-20T19:20:00.000-08:00

- Board meetings will be on Tuesday lunches at Hanszen Upper Commons from now on

- Semester goals:
member involvement
more fundraising projects
more reoccurring projects (1st annual…)
more non-fundraising projects
collaboration w/ Leadership Rice on fundraising project
collaboration w/ RPMS for lecture series

- Speaker at the end of February: the Patch Adams of Israel

- Membership involvement:
open board meeting / month (the first of the month)
1 general meeting / month

- Next meeting: Thursday, Jan. 26, 7pm
Meyer Lounge
team building activity
announce Kenya applications - now open, due Sunday, Jan. 29
announce 1st service activity - help with packaging at a warehouse

- Will not be adopting the project to raise $3000 for school uniforms for orphans in India because it’s not within the scope of Humanitarian Medical Outreach, but we will support the project (grant ideas, etc.)

- We will be submitting a club picture for the yearbook