The 10th annual Global Health Center Student Symposium was held on Oct. 17. At the Symposium, the 2012 Global Health Center competitive travel scholarship award winners shared experiences from their projects in Latin America, Africa, and the Western Pacific. Since the Symposium's inception in 2002, students from OHSU's programs have conducted clinical and research projects in more than 20 countries on five continents.
Since its inception in 2008 and with the aid of a National Institutes of Health Fogarty Framework grant, the OHSU Global Health Center has served as a catalyst to promote education, research, communication and advocacy in global health university-wide. The goal is to harness global health awareness to action; to kindle and support a quest for knowledge, understanding and discovery about our ever-shrinking, complicated, and increasingly interdependent world.
Financial support for the Center's scholarship program comes from the R. Bradley Sack family and the Ruben W. Hills III Medical Ambassador Program.
"The four medical students featured in this news article represent the vision of these generous donors. While Inger, Dani, Jennifer, and Michelle have completed their physical journeys, their personal and professional explorations continue," said Jay Kravitz, M.D., M.P.H., assistant professor of public health and preventive medicine. "We truly believe their future careers have been positively and permanently influenced by their willingness to seek knowledge amongst different cultures and geographic locations – with a bit of adventure thrown in."
Learn more about the Conversations in Global Health series.
Pictured above (from left): Inger Appanaitis (MPH student); Danielle Babbell (SOM); Jessica Cruz (SON Midwifery Program); Christen O'Haire (SON Midwifery Program); Michelle DeChant (SOM); and Jennifer Jacobs (SOM).
STUDENT PROJECT OVERVIEWS
Inger Appanaitis, an M.P.H. student, traveled to Koror, Palau, an island country located in Western Micronesia (500 miles east of the Philippines). Under the Ministry of Health, she worked in the Office of Health Policy, Research and Development with senior epidemiologist Berrymoon Watson, MPH.
Her initial assignment included analyzing data from school health surveys to asses risk factors associated with dental caries. She then coordinated a larger project which included creating a national oral health database and calculating specific indicators that measure disease severity (i.e. DMFT index). The results from this second project motivated the Ministry of Health to update their school health and well-baby screening forms to include these measurements.
"My three months in Palau was an incredible learning experience on both a personal and professional level," said Inger. "From the broader, public health perspective, I gained a greater appreciation for oral health and how integral and essential it is to general health and well-being."
This experience also gave Inger the opportunity to apply her epidemiology/biostatistics training at OHSU to a real population. During her internship, she got to experience each step of the process from data collection to final analysis and proposing future interventions.
"One unique aspect of working in Palau is working with a smaller population," she said. "In public health, you aren't often able to see the fruits of your labor due to the large scale which you typically operate on. That being said, when the population is shrunk to the size of Palau, those effects are amplified. All in all, this was a very rewarding experience."
Inger's interest in global health stems from a love of travel and experiencing new cultures. In graduate school, she worked in public health research with Native Americans and was able to connect health disparities in this population (in the US) with those experienced by native peoples around the globe.
"Focusing on global health helps you appreciate differences as well as similarities with our global neighbors," she said. "It's my conviction that people in the United States need to be more informed and engaged with world affairs whether it's politics, economics, or health. Our world is increasingly interconnected and no man is an island."
Danielle Babbell, MS 2, traveled to Medellin, Colombia, the second-largest city in Colombia, and one of the most northerly of the Andes in South America.
Her research examined attitudes towards and knowledge about tobacco exposure in pregnancy held among prenatal care providers and patients at four different medical institutions in the city. As part of this, she interviewed patients with surveys, and promoted survey completion by providers (which was being conducted online) by visiting various study sites and giving PowerPoint presentations. She also had clinical exposure: observing prenatal care appointments and gynecological surgeries, and rounding with attendings/residents on a high-risk OB/GYN floor.
"I learned a great deal about the research process, including how to adapt when changes become necessary and when things don't occur according to an envisioned timeline," said Danielle. "I also feel more knowledgeable about designing surveys."
Danielle's clinical time in Medellin allowed her to contrast prenatal care across institutions and among different populations in the city, as well as with prenatal care in the United States. Talking to prenatal care patients in underserved communities made her realize the value of education in preventative medicine. "I realized I take for granted a lot of health information that I consider basic, like avoiding tobacco use in pregnancy, as individuals growing up in different populations and in different circumstances may not have access to the same information I was raised with."
"Each time I leave the country, I learn more about myself and the greater world that I am a part of," Danielle said. "There is so much to gain from the cross-cultural exchange, as humans have adapted different ways of living in different parts of the globe throughout history. As a former Anthropology major, I am fascinated by the globe's biological and cultural diversity."
Michelle DeChant, MS 2, traveled to Rukungiri, Uganda (southwestern Uganda, near border with northern Rwanda) to conduct research at the Karoli Lwanga "Nyakibale" Hospital.
She volunteered as a Research Assistant for Global Emergency Care Collaborative (GECC), a physician-run 501(c)3 working to create sustainable scalable emergency care systems in underserved areas. For six weeks, she worked with the GECC team and Ugandan staff at "Nyakibale" Hospital's Emergency Department (ED) to gather raw data on patients seen in the ED and to use that data, along with a literature review, to develop a deeper understanding of intimate partner violence (IPV) in the surrounding community. In addition to helping with the day-to-day routine in the ED, she worked on the development of a research project to improve injury surveillance and prevention of IPV in the population of patients they serve.
During Michelle's time at Nyakibale Hospital, she met with GECC staff, hospital staff, local government officials, and other non-governmental organizations in the area to learn where, when, and how IPV occurs in the surrounding community.
With the information she gained from these discussions, in addition to a comprehensive literature review of the prevalence of IPV, she has formulated a summary of IPV and of injury surveillance tools in East Africa. Additionally, she used this review to study the multitude of risk factors associated with IPV in East Africa, including: education of both partners, occupation, socioeconomic status, HIV status, pregnancy status, marriage status, polygamy in the relationship, and alcohol use by the victim and/or partner. This review will help guide the surveillance of patients presenting to the Nyakibale ED in the future.
"I have always been fascinated by how patients in underserved areas access quality care both here in the US and internationally," Michelle said. "In rural Uganda, improving access to quality care was particularly complicated because of cultural, political, environmental, and financial constraints. I enjoy how dynamic the work is in rural areas abroad, and I am confident that global health research can guide policy and improve healthcare delivery."
Jennifer Jacobs, MS 2, travelled toWest Wollega, Ethiopia, a town about 450 kilometers west of the capital, Addis Ababa. Her research was based out of Gimbie Adventist Hospital (GAH) in Gimbie Town (located in West Wollega).
She conducted a provider-based needs assessment of family planning, interviewing providers in satellite clinics affiliated with GAH as well as providers in government health centers in the same localities. She gathered data on provider knowledge and acceptability of family planning (and specifically IUDs) in order to inform future outreach and training projects.
"Conducting research abroad can be difficult," said Jennifer. "There are unexpected hurdles, delays and transportation issues. But there are also a lot of people along the way who will help you to achieve what you have set out to accomplish."
Jennifer said she worked with some amazing translators in Ethiopia. They were students at the midwifery school affiliated with GAH. They not only translated for me, but helped with getting around and taught me a lot about Ethiopian culture. I learned a lot from them.
"I have been interested in global health since college and spent several years before I started medical school traveling and working in global health," Jennifer said. "Part of my interest is just a natural extension of that initial interest and my previous experience. I also love to travel and learn about new countries and cultures. But ultimately I think my interest in global health comes from a sense of interconnectedness. It sounds sort of cliche but the world is not as big as it seems; we are more connected than we might realize. From that sense of connectedness comes a desire for shared experiences with others, as well as a responsibility to learn from and support one another."