MEDICAL STUDENTS & EXPERENTIAL LEARNING IN AFRICA

Transcription

1 MEDICAL STUDENTS & EXPERENTIAL LEARNING IN AFRICA Saifuddin T. Mama MD MPH Asst. Professor, Cooper Medical School of Rowan University Clerkship Director & Head, Section Minimally Invasive Gynecology & Robotics Dept Ob/Gyn, Cooper University Hospital

2 INTRODUCTION Lifelong interest in interdisciplinary approaches to health and disease Public health degree focused on public health systems in the developing world and infectious disease, and completed field work on malaria in the Philippines Reached a point in my medical career where I had specific knowledge & skills to apply for both patients and teaching Started medical missions working with non-profit international medical groups in different countries Niger, Eritrea, Ghana, Rwanda and Vietnam

3 MEDICAL MISSIONS VS. TOURISM Sustained annual programs with mission-specific and long term goals Building knowledge, resources, and processes in collaboration with your country partners Returning to same sites yearly Same standard of ethics applied as in the United States Informed consent Long term commitment by volunteers doctors, nurses and volunteer staff A partner site in the country that has support from the ministry of health, local community and tribal leaders

4 CHOOSING A MISSION SITE Political stability and considerations for safety Medical needs identified specific to the location Medical facilities: assessment of capacity Connections to the community Appropriate preparation: individual, group and hospital or health center Flexibility towards changing circumstances

5 HOSPITAL PREPARATION Hospital preparation: depending on hospital leadership and infrastructure prescreening of patients before arrival of mission team by medical students or physicians in country planning for number and type of patients arriving: number of rooms, availability, space constraints, toilet facilities, personnel to maintain order, extra tents and cots planning for food, medicine and supplies and constraints planning for transportation to and from hospital and constraints planning for amount of equipment and constraints: time needed to sterilize, disposable vs. non disposable equipment, trash removal planning for translation to overcome language barriers

6 MEDICAL MISSION GROUP PREPARATION goal of mission: number and type of patients, common disease presentation, expected medical and surgical management, in coordination with the Ministry of Health assignment of team leader(s) chain of command and communication emergency evacuation protocol behavior norms expectations of -- group, individual, patient, local hospital personnel & Ministry of Health protocols defining predetermined roles within the team protocols for pre-screening of patients and collection of history and physicals prior to mission team arrival

7 MEDICAL MISSION GROUP PREPARATION Protocols for outpatient and inpatient evaluation and management: creation of teams comprising local personnel and mission members: combined shared responsibility for taking history and physical exams, with questions geared to the goal of the mission, consenting procedures, educational fact sheets translators needed data collection: laptops with premade standardized forms and data collection questions geared to the goal of the mission, consents, educational fact sheets levels assigned based on severity of disease ability to evaluate and complete surgery local physician and nursing personnel availability and participation based on their prior knowledge and expertise post-op care needs after team departure arrangement of long term follow up of patients after mission team departure shared OR experience as teams daily plan with location, time, type of work, individuals assigned to specific roles for the day approximate weekly plan based on leveling of patients

8 MEDICAL MISSION GROUP PREPARATION preplanned lectures: daily, building over two weeks on previous topics, geared to knowledge level of local staffstudents, residents and physician and their needs all day teaching on rounds, bedside, OR, etc. geared to the local individual student, resident or physician organization of rounds in the hospital: team approach with roles, eg. scribe, examiner, dispenser of meds, etc. Use of pre made, standardized post op forms. Data entry in laptop creation of a working template outlining plan of care of patients 1-2 days before team departure for the local hospital personnel to execute

9 INDIVIDUAL PREPARATION vaccinations: country specific, eg. yellow fever, cholera, typhoid, malaria prophylaxis etc. air travel: tickets, luggage rules, airport rules including transfers passport: expiration date > 6 months past mission visas: return receipt to embassy with passport photos lodging: location, safety, mosquito nets, toilet and shower facilities food: nutrition bars, non perishable food items, powered gatorade personal packing list including personal, daily and prophylactic meds, enough money mission packing list head lamp, OR instruments, OR supplies, medications, vaccines, outpatient supplies (stethoscope, blood pressure cuff, etc), coordinate with team members to obtain all equipment needed that might be lacking in the country team is visiting local ground transportation: from airport to lodging, and lodging to hospital website reading: history, politics, culture, social norms, country specific perceptions of health and disease, food, geography with maps, safety, taboos, languages (simple phrases); use CDC, State Department, CIA Factsheet, country tourism website, etc. gifts for local hospital personnel and hosts

10 GHANA MEDICAL MISSION International Health Care Volunteers (IHCV) Not-for-Profit Organization Founder Dr. James Aikins at Cooper Univ. Hospital Yearly missions to Ghana, West Africa at multiple sites in country Support comes from individuals, organizations, hospitals and corporations Goals: Provide free access to healthcare services to underserved women and their families. Participate in the education of medical faculty, staff & students

11 IHCV IN GHANA US team: consists of doctors from multiple specialties, residents in training, medical students and nurses Ghana team: consists of doctors, residents, medical students and nurses Medical conditions treated include fibroid tumours and cancers, fistula, prolapse, & hernias to name a few. Medical students from the US team act as sub interns and are integral in patient evaluation, history taking, physical examination, dispensing of meds and assisting in the operating room

12 RWANDA MEDICAL MISSION International Organization for Women and Development (IOWD) A Not-for-Profit organization, founded by Barbara and Ira Margolies Missions 3 times a year to Kigali, Rwanda Support comes from individuals, organizations, hospitals and corporations Goals: Providing patients with obstetric fistula with free access to surgical repair. Provide education to local physicians, residents and medical students in the evaluation, management and prevention of obstetric fistula

13 OBSTETRIC FISTULA: HOW DOES IT OCCUR? Obstetric fistula - injury in childbirth, relatively neglected, despite the devastating impact it has on the lives of girls and women. Cause - Unattended obstructed labour lasting for up to 6-7 days, although the fetus usually dies after 2-3 days without timely medical intervention i,.e. Caesarean section. During the prolonged labour, the soft tissues of the pelvis are compressed between the descending fetus s head and the mother's pelvis. The lack of blood flow causes tissue pressure necrosis, causing a vesicovaginal fistula or a rectovaginal fistula, or both. Consequences if the mother does not die she is left with chronic incontinence, leaking urine or stool. the mother is often abandoned or neglected by her husband and family and ostracized by her community. She is often reliant entirely on charity. In 1989, the WHO estimated that more than two million women remain untreated in developing countries and that at least 50,000 to 100,000 new cases occur each year

14 IOWD IN RWANDA US Team: gynecologists, urogynecologists, anesthesiologists, nurses, fellows, and residents Rwanda team: physicians, residents, and medical students Medical students in Rwanda act as translators, and are integral in every aspect of the mission including pre-arrival gathering of patient information, history taking, assisting in the physical exam and evaluation of fistulas and post-operatively on in patient rounds in the hospital

15 IHCV IN GHANA

16 Medical missions require several things: Flexibility structure in Africa is not the same as the US Ghana Rwanda

17 Working within the local culture is essential Ghana Rwanda

18 You must have an open mind about everything. Willingness to let go of your preconceived notions of what health care should look like or be. Ghana Rwanda

19 Willingness to be creative and inventive

20 Appreciate that you will learn more about yourself and medicine when you are on a mission trip

21 You will receive more from patients and staff than you can give to them

22 You will come back to the US a changed person Ghana Rwanda