Coverage of LMU activities!

http://msutoday.msu.edu/news/2013/challenges-abroad-build-better-doctors/

Great thoughts by Justin, Lynn, Angela and Erin highlighted in MSU publication.  Check them out and see if you can find faces you recognize in the article!

Puppies are cute but not worth it

Hello from Mbale! Late last week, we got to take turns going with Richard, one of the health educators at the clinic, to do some assessments with the primary school kids that he works with. Justin and I spent approximately 5 hours hiking to 3 homes. While the hike was grueling and hot, it was really enlightening to see how far the kids have to walk each day just to get to school. This weekend, we went on safari out west, to Murchison Falls National Park. We saw hippos, elephants, giraffes, and even a leopard (a rare find)! Happy to be back home, I went for a run early this morning with our Field Ops Manager, Ryan. When we came back, there was a puppy stuck in our rubbish pit. I tried to rescue him. It backfired. He nipped me. I examined my foot and there was a small abrasion. Deciding to start the practice early of being a patient when it's appropriate instead of trying to be my own doctor when there is another available, I consulted Dr. Peter, the physician staying here at our guesthouse, who recommended that I travel to Mbale to get the vaccine. Turns out, it's 5 vaccines. And the first one hurt like the dickens. Holy Dinah! Those puppies are cute, but just not worth it. The physician that I saw at the clinic patiently listened to all of my concerns about the vaccine. (The form used here is not used in the US.) He wasn't even offended (or hid his offense) when I asked to use his computer to consult the CDC and WHO websites. He also offered to let me do obstetric fistula surgery at his facility when I complete my training and gave Ryan and me a tour of hospital. He even talked about the importance of self-care as a physician, making sure that one's own needs are met in order to meet the needs of others. Such a good thing to be reminded of! In all, today turned out to be an unexpected and educational adventure. We're looking forward to working with Dr. Peter, a British physician here for a couple of weeks along with his wife, Helen, a veteran of the British NHS. They brought an electronic medical records system that was custom made for the FIMRC clinic, and we are planning to help implement it and train the staff. Maybe we will be thankful for all the time we spent learning Epic, the system we use at Hurley. Our apologies for the spotty blog posts. We haven't had electricity for 2 weeks, and while we can charge things sometimes at the clinic, we always managed to run out of battery. We will try to do a better job, and hopefully the poles holding up the electric wires will be replaced soon (apparently, they are a hot commodity).

Hello from Mbale

Melembe!  We have been eager to update you on our trip, and can finally do so since we are in town today.  We haven't had electricity at home for the past 3 days, so our trip to Mbale to visit bigger hospitals was also turned into an opportunity to access the internet.

Our first week was great.  Some highlights included helping out during the Maternal Child Health (MCH) group, and learning more about the ins and outs of clinic.  During MCH, we each had the opportunity to work with a midwife to examine pregnant patients.  We also learned that most mothers in Uganda do deliver their babies in hospitals, but they are required to bring their own birthing supplies, like a sterile dressing, a tie to cut the umbilical cord, and antibiotic ointment.  We were told that moms can be sent away from the hospital if they don't already have these supplies.  Sometimes, this means that they have to go all the way to Mbale, which is two hours away, just to get what they need to deliver their baby!  As far as the rest of the clinic, we are all getting very comfortable with the lab tests that are run every day.  We do many blood smears to look for malaria, pregnancy tests, and HIV tests.

In Mbale today, we visited a hospital called CURE, which is a private hospital that specializes in hydrocephalus and spina bifida.  It was started by an American physician, and is funded by donors.  They are able to do 6 operations a day, and they employ many Ugandan health care workers. At this hospital, everything is provided for the patients, including all food, linens, medical supplies, and medical care.  We also saw the public hospital funded by the government.  In contrast to CURE, patients here rely on their families to bring linens and food, but health care and supplies are still free.  Private rooms are very hard to come by, and most patients share large rooms with 10-20 other patients.

This week, we are looking forward to working with the Post Test Club, which is a group of patients that are positive for HIV.  We will mainly be talking to them about what their lives are like and what questions they have so that we can prepare an educational topic for next week.  We will also be working with Community Health Educators this week, which will involve going out into the community and talking to people in their homes.  We will be focusing on people that were affected by the landslides that happened a few months ago.  We will be educating them about basic health needs, like using mosquito nets, and answering any questions that they have. 

We look forward to updating you about these things soon!

El Salvador Day 7

Hola! Day 7 of Equipo (Team) El Salvador's adventure!

Clinic news:
We found a great need for a fetal heart monitor and blood pressure cuff in the clinic - seeking avenues to purchase these with all of the generous donations!

The new doctor has been settling in wonderfully, the villagers love her, and she has been very welcoming to us! She has an excellent understanding of the unique health needs surrounding the community, and is in the unique position of also being a government employee so she works in both realms, so she will be giving some insights into both her worlds!

Everyone's excited about the supplies we brought in! Children's tylenol and glucose test strips were especially welcomed.

Micro-insurance: We had the opportunity to shadow Jessica-of-FIMRC as she went house-to-house as part of the micro-insurance program, as well as sit in on an education session on diabetes for Level 2 micro-insurance participants. In Las Delicias, community members part of the micro-insurance program ca nparticipate in house visits (to check for health conditions such as wearing shoes, burning trash away from the house, animals kept in a separate area, mosquito larvae in the water supply) or education sessions (on diabetes, and other health topics) to gain points to buy health needs for their family and the community (water filters, mosquito nets). Participants go through 3 levels, eventually becoming community leaders who teach the education sessions to earlier levels and organize healthcare in the community. More details to follow!

Baby weighing: We took a walk up and down the hills to pay house visits, recording the weight of month-old newborns! Got to meet community members and play with cute babies. Awesome!

Other activities: Spanish lessons have begun- we are all different levels, but our instructor is great! We have been practicing how to do an H&P, as well as discussing terms surrounding reproductive health.

We met with the director of the high school where we will be giving a series of reproductive health classes. We discussed our lesson plan with him - we will be giving one session to the parents, three sessions to grades 4-9 on subjects such as "what is sex?" "how does a baby develop?" "how can I prevent STDs?". The meeting went well - we hope to expand the curriculum established by last year's amazing MSU group. Their session went so well that we were invited back to do this, so we hope to live up to standard.

In our free time, we have kept busy, as well! We've been eating delicious pupusas, platanos and frijoles ,visited Mayan ruins, ran in the beautiful jungle/forest/park of San Salvador, and visited Lago Coatepeque. Not to mention tapas and dancing to Raggaeton in a San Salvadorian nightclub!

There was also an emergency hat-buying trip to combat the extra-strength (mas fuerte!) sun of El Salvador!  

          

Here we are by a replica of the Mayan 'sauna' At Las Ruinas "Joya de Ceren"

Here Dalila, Nabil, and our adopted LMU member Sonya are working hard putting together the lesson plan to present to the director of the high school!

Equipe El Salvador signing out - for now !

Uganda: First Few Days

After a couple of long flights and a 5 hour drive, we made it to Bumwalukani last night. We are staying at a simple but comfortable guesthouse about a 15 minute walk from the FIMRC site along with Ryan, the Field Operations Manager.

It is the end of the rainy season here and with the dry season coming, our well is nearly dry. This means that we will soon start fetching water for daily use, including for our bucket baths that are currently supplied by the tap. Fortunately, this will not affect our toilet situation since we are already using a pit latrine.

As you might guess, many daily activities take much longer here than in the US. Procuring water involves carrying it some distance instead of turning on a tap. Clothes are washed by hand instead of in a washing machine. And everything is cooked from fresh ingredients. Even the coffee is grown and roasted here. It’s refreshing to feel connected to the earth in these ways. Connected to the water. Connected to our food. But it’s also time consuming, and we fortunately have Alice, who cooks, cleans, and washes our clothes for us. 

This morning, after being woken up by the rooster who resides in our yard, we went to the clinic to unpack the supplies that we brought, meet the staff, and get a general feel for the layout of the clinic. The staff and patients were great. One patients’ husbands told Angela that she is small, but she has a biiiiig heart. The clinic is arranged into 5 stations. The patients check in at station 1, where general demographic and patient identification information is obtained. Vital signs are taken at station 2, and the clinicians see patients at station 3. Station 4 is the dispensary/pharmacy/injection/procedure room. This is where Justin got to irrigate a woman’s ear for a cerumen impaction (Angie ;) ). At station 5, the patients check out with a staff member who makes sure that they know how they are to take their medications and when they should follow up.

There is also a laboratory, where the technician does blood smears for malaria, HIV tests, urinalyses, and pregnancy tests, to name a few. A couple of highlights from our first day came from the lab. Erin was excited to see 2 blood smears under the microscope which were positive for malaria. Lynn’s favorite moment was when we were unpacking the supplies we brought.

Upon seeing the glucometers, the lab tech hugged her and thanked her for thinking of his department. And we pass that thank you along to everyone who has donated money and supplies for the clinic. We are grateful, but those who feel the pinch when supplies are short are even more thankful. Here are some stats on Uganda that we read on our way over: Average life expectancy: 39.5 years Under 5 mortality: 13.7% Access to safe water: 45% Access to electricity: 4% HIV rate: 8-10% (estimated) Primary school completion: 38% Secondary school enrollment: 13% Adult literacy: 65%

Saludos departe del equipo El Salvador (Nabil, Emily, Angie, y yo, Dalila)!
(Greetings from Team El Salvador!)

Our adventure started on Saturday when all four of us boarded the plane with a handful of personal carry-ons and about 5 full, 50 lbs. luggages of supplies for our clinics in Las Delicias! This is us leaving Flint, MI on Saturday morning. Snow was still on the ground though melting from the rain.

Since then, we have transitioned to a hot and sticky climate, needing sunblock, sunhats, sunglasses, plenty of water (and lots of mosquito repellant for me). It is green, beautiful, charming and El Salvador has been treating us well!

When we first arrived, getting through customs was tricky. We ended up each of us talking to our own customs agent. Mine asked me the usual questions of why I was there and how long I was staying when I noticed the parade of people just outside the door. I had to ask and the customs agent explained that they are not allowed inside the airport and that during the day the mass of people is much larger than the few 100 or so chattering and cheering all of us arriving at 9pm! The customs agent made me push a button, which caused the stop-light contraption to turn Green and that meant that my baggage was not selected to be checked. That is how the supplies and I got into El Salavador, offiically! Apparently, if the light had turned red, my luggage would have been searched and I would have to answer more questions, so I am glad I got the green light!

First stop from the airport was this eatery that sold tacos, burritos, and tortas for about $5. El Salvador's currency is the US Dollar, the tortas were pretty good and no one got sick, which was even better! Here is the shop who was crazy enough to be open so late for us starving travelers to eat!

We arrived to a warm welcome by our FIMRC director, who made us feel at home and usually manages to mix in a funny story to share. We are sharing the house with another medical student from Ohio and a recent university graduate looking into applying to medical school. We hear next week we will be sharing the house with 5 other people, so there is definitely never a dull moment!

• This is the outside of our guesthouse.

• This is our street view. It is in a gated community where there is a man standing with a gun who allows our driver to enter in and out as we please as he waves to our driver a friendly hello!

• This is our (Emily, Angie, and my) view in the morning.

• This is our bathroom and interestingly I learned that not all toilets have the super-duper flushing abilities of those I am used to, so all the toilets here cannot accept tissue paper! This location is also where I saw my first insect as I was about to shower. An ant about 1cm long!

• Here is the upstairs of our living quarters where we have a couple of bathrooms, multiple donated books, movies, and a shelf of scrubs for borrowing!

The next day we saw some sights as we went shopping for food and then visited a mall. Some areas looked quite different than others.

• Most of El Salvador seems to have beautiful plants everywhere, just a little dustier than normal, and of course over 20 volcanoes!

• For those people who happen to be very lucky, or save up to buy something here, there is a mall with very fancy shopping.

Where do indebted med students go to shop for food and supplies in El Salvador? Let's just say that I have seen many familiar companies that I know from the US.

With all of the shopping done and our stuff more-or-less unpacked. We prepared for our first day in clinic.

I would say it took us about 30 minutes to get from our guesthouse to the clinic, which doesn't include the time we drove to carpool with others today.

• Beautiful view and someone (of many people) selling land on the way up to the clinic.

• Our local clinic neighborhood landscape.

We followed a nutritionist who evaluated whether children were malnourished or not. She listened to the parents, and then taught the parents the importance of teaching children the value of eating vegetables and fruits daily, while emphasizing that sweets were off limits. Luckily the children that day turned out to be small, but making progress towards better health.

• Here is our nutritionist giving parents strict instructions on how to weigh their babies accurately! They are undressed to their dry diapers, put in a harness that is attached to the scale. The scale is activated as the baby is pulled down by gravity, which triggers the spring to move the needle that gives the reading, similar to what I have used to measure fruit in the US.

• The very non-private clinic office where we hear all of the noise going on outside and the patients waiting can hear everything we are saying inside!

• This is the exam room where we measure the height of the very adorable and overall-progressing-well-babies we saw today! That is also their supply shelf for the whole clinic!

• This is me and Eric-the-14-year-old-soccer-player who was nice enough to take some pictures of us.

• After that we walked to a different clinic. This was us sharing the road with a truck who was sharing the road with a cow and another pedestrian on the other side. Very busy street for an unpaved road!

We ate lunch at the other clinic.

• Beautiful flower-like plants outside the clinic.

• This wonderful lady cooked and served our lunch and we enjoyed our ground beef, rice, vegetables with lemon seasoning, and pupusa-like tortillas sitting on the bleachers.

• We made friends with the Iguanas. They are endangered here so they are captured to be released into the wild, though some residents joked that they were the nights menu! 

Once that break was over, the Dr. arrived with our patients. It was also her first day, but she definitely hit the ground running! She saw many babies for follow-up and referred grandparents for potential surgery, while we got to practice some of our Spanish by gathering and explaining information. From this experience we can tell you that chickenpox is definitely not cured around the world yet, so make sure to encourage vaccinations!!

We ended the day with our favorite food of the day called Pupusas. These are traditional Salvadorean food that resemble pita bread, but chewier. They are made of rice or corn and stuffed with cheese, beans, mushrooms, spinach, "chipilin," and ayote, fried and topped with a delicious cabbage and vinegar sauce and a flavorfull tomato-based dressing.

• Here was part of the operation in progress.

Unfortunately, there was no room for dessert, but there is always room for a picture of a beautiful tree decorated with paper lanterns as we walked off our dinner. :)

Looking forward to tomorrow!!

P.S. Thank you to all of you who helped us advertise, spread the word, obtain funds, supplies! This includes our very own local Flint businesses of Target and Grill of India who also helped contribute to make this possible!

packing pics before trip to Uganda and El Salvador

 

 

Rae Schnuth, PhD

Assistant Dean

Director, Leadership in Medicine for the Underserved Program

Michigan State University/College of Human Medicine

East Fee Hall A104

965 Fee Road

East Lansing, MI  48824

 

(o) 517-355-0264  (f) 517-355-0342

schnuth@msu.edu

 

 

New Blog

Welcome to the NEW Leadership in Medicine for the Underserved blog! To view our old blog please use the link on the left hand side.

We currently are finishing up packing and set to head out this year to Uganda and El Salvador. Please stay tuned for updates in the next few days!