Developing a Successful Interdepartmental Global Health Track Tochi

Developing a Successful Interdepartmental Global Health Track Tochi Iroku-Malize, MD MPH Neubert Philippe, MD Omolara Thomas Uwemedimo MD MPH Hofstra North Shore LIJ School of Medicine Dept of Family Medicine Long Island, NY September 2014

Activity Disclaimer ACTIVITY DISCLAIMER It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. Tochi Iroku-Malize, MD MPH & Neubert Philippe, MD are employed by NSLIJHS Toch Iroku-Malize is on the AAFP COCPD 2

Learning Objectives • Develop an action plan for creating an elective/track curriculum in GH • List resources available for financing GH elective/track • Prepare an evaluation tool for a GH elective/track 3

Who We Are 4

• Medical students and residents are requesting exposure and education • DOFM at the Hofstra-North Shore LIJ School of Medicine in 2011 decided to align the educational programs of our 3 separate FMRPs • In 2013 partnered with the department of pediatrics to create a global health track • In 2014 -15 creating program expansion to include RN/PA/NPs 5

Hofstra North Shore-LIJ GH Training Program MISSION STATEMENT: To improve health and well-being for children and families living in medically underserved communities in low and middle-income countries through global partnerships and program development in the key areas of clinical service, education and research. 6

Global Health Training Program Structure Hofstra North Shore-LIJ Global Health Training Program Hofstra University North Shore-LIJ Health System School of Medicine Department of Pediatrics MPH Program (School of Health Sciences and Human Services) Department of Family Medicine

NSLIJ Global Health Training Program Framework • Components – Faculty – Curriculum • Scholarly global health • Local experience • Overseas experience What resources did we have to make this work? ? 8

Global Health Faculty • • Omolara Uwemedimo (general pediatrics) Tochi Iroku-Malize (family medicine) Neubert Philippe (family medicine) Sunil Sood (infectious disease) • • • Brinda Doraiswamy (infectious disease) Loanne Tran (neonatology) Claudette Poole (hospitalist pediatrics) Maria Vesey (family medicine) Mayur Rali (family medicine)

Faculty Roles • • Curriculum Development & Revisions Individualized Educational Plans Pre and post-trip debriefing Guidance and supervision of scholarly project Travel to sites – monitoring Scouting for funds Advice on post-residency career options Revisions, revisions… 10

YOUR TURN • Write down 2 people besides yourself, that are possible recruits for core faculty in your program. • Now write down 2 people that could be extended faculty supporters. 11

Curriculum Content: Basics that Needed to be Covered ACGME Competency areas 1: Patient Care 2: Medical Knowledge 3: Interpersonal Skills and Communication 4: Practice-based Learning and Improvement 5: Professionalism 6: Systems-based Practice – Traditional: tropical medicine/infectious disease (TB, HIV, Malaria, Helminthic infections), Malnutrition/Micronutrient deficiencies, Neonatal care – Cultural competency – Beliefs surrounding health and illness, Child human rights, Ethics, Traditional medical practices – Immigrants and Refugees - Primary care, legal issues/advocacy for immigrants, travel medicine – Basic clinical research skills - Epidemiology – Health care systems in resource-poor settings, roles of physician and other health care workers – The Bigger picture: Health inequity, Economics/politics of health care, Current topics (e. g. genocide in Sudan)

YOUR TURN • What topics would you need for your curriculum? – AAFP GH Curric Reprint #287 • What are your goals and/or learning objectives? • Will you have both local and overseas experiences? • Where should these occur? 13

Local GH Experience • Immigrant/Refugee health educational modules • Ambulatory care in predominantly immigrant clinic • Outpatient clinic experiences in general infectious disease, tuberculosis, and travel medicine 14

Overseas GH Experience • International partner sites – Dominican Republic, Haiti, Kenya, India – Nigeria, Mexico, Russia? ? ? 15

Strategic Approach to Overseas Rotations • Phase 1 – Build partnerships with institutions located in key lowmiddle income countries for clinical and public health rotations • Phase 2 – Develop research collaborations with existing partner sites and also build collaborations with dedicated research institutions in resource limited countries • Phase 3 – Initiate opportunities for faculty exchanges, telemedicine and long-term educational interventions 16

How Much Time? Every resident has 12 weeks total for elective time. – 4 weeks in PGY 2 (two 2 wk) – 8 weeks in PGY 3 (two 2 wk + one 4 wk) Plan: 12 weeks total for track 2 -4 weeks for electives 17

Who Gets to go Abroad? • Global Health Track residents – 4 weeks combined pretravel GH training & local experience – 8 weeks combined abroad • Non GH track residents (Electives Only) – 2 week experiences 18

YOUR TURN • How many weeks are available for your track? • Will both residents on electives and tracks be allowed to travel? • Will this education be longitudinal or rotational? • Should all residents be exposed? 19

BASIC EDUCATION (All residents) – Longitudinal Curriculum • One lecture a month over an 18 month cycle (live or webinar) • Two journal club topics a year (one on the underserved US population topic, the other on an international topic) • Quarterly evening symposiums (notmandatory) 20

Block 1: Global Health in the World Today/ Vulnerable Populations Session 1: Immigrant and Refugee Health Session 2: Overview- Social Determinants of Health and Health care Delivery Session 3: Overview of Social Services for Vulnerable Populations in the US Session 4: State of the World’s Children- Overview of UNICEF Report Session 5: Child Health/ Mortality Session 6: Maternal/ Newborn Health and Mortality in Low-Income Countries 21

Block 2: Global Health Practice: Tropical Medicine- Communicable Disease Session 7: Tuberculosis and Acute Respiratory Infections Session 8: Intestinal Protozoal Infections Session 9: Malaria Session 10: HIV/AIDS: Basics Session 11: Global Vaccine Prevenatble Illness- An Overview Session 12: Arthropod transmitted Illnesses 22

Block 3: Global Health Practice: Tropical Medicine- Non Communicable Disease Session 13: Malnutrition/ Micronutrient Deficiencies/ Dehydration Session 14: Clean Water and Sanitation Session 15: Dermatologic Disease in Low –Income Countries Session 16: Practicing Emergency Medicine in Low- Income Countries Session 17: Environmental Health in Low-Income Countries Session 18: Humanitarian Emergencies in Global Health 23

Global Health Evening Symposiums (18 month cycle) • Evening symposiums every 3 months; coordinated by peds and family medicine residents • Joined at one site • Open to residents, attendings and other clinical staff interested in GH. 24

Evening Symposiums PM Symposium 1: Special Populations/ Advocacy - Displaced Children: Orphans, Children in Trafficking, Child Labor and Conflict - International Adoption Medicine PM Symposium 2: Global Emergencies - Disaster Relief Management - Global Epidemics/ Emerging Diseases PM Symposium 3: Global Disability - Disability and Rehabilitation; - Global Orthopedics and musculoskeletal Injury PM Symposium 4: Working in Resource Limited Countries - Practical Considerations for Overseas Fieldwork Electives - Developing a Career in Global Health PM Symposium 5: Health Systems and Human Resources for Health - Issues in Health Service Delivery in Low-Income Countries - Task Shifting and Health Worker Shortages PM Symposium 6: Traditional Medicine and Health Practices - Task Shifting and Health Worker Shortages - Training Community Health Workers 25

GH Evening Symposium • 30 minutes dinner • 30 minute Guest Speaker • 30 minute PGY 3 resident presentation • 30 minute Interactive Workshop 26

ADVANCED EDUCATION (Residents in GH Track) • Individualized Education Plan (IEP) with assigned faculty mentor and monthly one- • GH curriculum series to-one sessions – Completion of online global health modules in PGY 2 – Complete (live or video) majority of the GH noon conferences (18 sessions) • Electives – 2 wk local immersion elective in PGY 2/3 – 2 wk international immersion elective in PGY 2/3 (or alternative 2 nd local immersion) – 4 wk international elective in PGY 3 • Presentations – – – Participation in GH evening symposiums & workshops Presentation at the GH journal clubs Completion and presentation of a GH project Formal presentation during 3 rd year at academic day (poster/oral) Abstract submission to ≥ 1 national/ international academic meeting 27

2 nd 2 week Elective (Alternative – No Travel) Domestic Immersion Elective • They are doing the "local GH elective" which is focused on immigrant/refugee health. • These residents use their independent study time to complete a presentation at the end of their elective. • The modules done with mentor include: – CDC/ UMN modules – Other resources listed prior 28

PGY 3 Four Week Elective • Travel for a 4 week elective (may be 4 -6 weeks for pediatrics) to a partner site – – – – Dominican Republic Haiti Kenya India Nigeria Mexico Russia • Participate in the Global Health Blog at least weekly • Post trip photo journal and Power. Point/Prezi presentation 29

Dominican Republic • La Romana • San Pedro 30

La Romana, Dominican Republic • Clinical care of patients at El Buen Samaritano Hospital (2 days/wk) • Education of general health practitioners at Guaymate Hospital (1 day/wk) • Preventive health education with mothers in 4 bateyes using the Care Group Model (first 2 days of the elective with follow up messaging the last 2 days of the elective) 31

Dominican Republic • Rotation with FM residents at Hospital Jaime Oliver Pino (San Pedro) • Central Romano Centro Medico mobile units • Clinical work in local Batey Aleman and/or Batey La Chuga • Preventive health education with mothers in hospital clinic • Gonzalvo Hospital - “Helping Babies Breathe” • Joined by MPH students for research project – Vaccination status of <5 yr – Nutritional status <5 32

Jaime Oliver Pino • Public hospital with unopposed FM residency program in San Pedro • Inpatient and outpatient clinics and batey sessions • Supervisor – Dr. Ana Perez (Program Director) • Resident experience within partnership – Morning inpatient rounds – Afternoon outpatient clinic/batey sessions – Provide didactic teaching to clinical staff 33

Centro Medico Central Romana • Private tertiary care center in la Romana owned by Central Romana • Inpatient and outpatient care, satellite clinics in bateys, mobile van • Supervisors – Dr. Jose Lopez Larache (director) – Dr. Carlos Dominguez (deputy director) – Dr. Fernandez (director for outreach) • Resident experience – Work at batey clinic for 1 week – Didactic teaching to clinical staff 34

Francisco Gonzalvo Provincial Hospital • Public hospital serving as referral site from smaller 1 st level hospitals within La Romana • Inpatient and outpatient • Supervisor – Dr. Giselina Pierret (Asst Med Dir) • Resident experience within partnership – Work for 2 weeks • Morning inpatient rounds • Afternoon outpatient clinic 35

Guaymate Hospital • Public primary health center in Guaymate (30 minutes from La Romana with >30 bateyes) • Inpatient delivery and postpartum; outpatient pediatric care • Supervisor – Dr. Oscar Estevez (director) Resident experience within partnership • Monitoring and evaluation of ongoing Helping Babies Breathe initiative • Didactic teacing to clinical staff 36

Clinica de Familia/MAMI Clinic • Comprehensive HIV care center founded through partnership with Columbia Univ • Outpatient HIV and general care, MAMI clinic –adolescent for HIV/STD testing, care and antenatal care • Community outreach • Supervisor – Mina Halpern MPH (exec dir) – Dr. Leonel Lerebours (Asst dir) • Resident experience within partnership – Observe and participate in community outreach activities 37

Haiti Pilot project from mid April to mid June 2012 for national vaccination with two oral cholera vaccines available, Dukoral and Shan. Chol. Two groups of community health workers door to administer vaccines in Port au Prince slums and tiny villages. Plan for better canalization of rain water in Haiti and education of the population on precaution to avoid cholera via the medias , churches and schools. 38

Educating Health Agents

Haiti Consolidated • Partners in Health • Heart to Heart International • AAFP Foundation – Family Medicine Cares International • Ministry of Public Health and Population 40

Haiti Cazale Haiti q. Malaria q. Thyfoid fever q. Tropical diseases q. Moblie clinic q. Prenatal q. Care q. Health Agents

Clinical Rotation: Haiti Duration: 2 weeks of 4 weeks Dates • August /September • October • February/March • May On site supervising Physicians: Kerling Israel MD, MPH Patrick Jouissance MD, MPH 42

St. Nicholas Hospital 43

Kenya 44

Kiambu, Kenya • Type: District Hospital Owner: Ministry of Health Status: Operational Province: Central County: Kiambu District: Gatundu, Kiambu Division: Gatundu South Location: Ngenda Sub. Location: Githuguchu Constituency: GATUNDU SOUTH Contact In Charge: Dr Toro Medical Superintendant 45

Research Projects • Monitoring health outcomes via EMR surveillance • Using community health workers to reduce neonatal mortality 46

India 47

Chenai, India • Inpatient rounds and outpatient care at Voluntary Health Services Multi-Specialty and Teaching Hospital • Outpatient care management of acute illness in rural clinics 48

Research Projects and Other initiatives The AIDS Prevention and Control (APAC) project is administered by the Voluntary Health Services (VHS), Chennai with financial assistance from the United States Agency for International Development (USAID), under a tripartite agreement with the Government of India. APAC project has been implementing STI/HIV/AIDS prevention and control programs in Tamil Nadu since 1995 and in Puducherry from 2002. TAI / VHS Project The Project was initiated in July 2004. ARCOD has been working with female sex workers in Krishnagiri District towards prevention of HIV/AIDS. The project is being successfully implemented in Krishnagiri, Kaveripattinam, Uthangarai, Barugur, Veppanapalli, Kelamangalam and Mathur blocks of Krishnagiri district. ARCOD identified about 2800 sex workers in these 7 blocks of the district. ARCOD has established a field team and clinics to provide health education and treatment for STI to the sex workers. We have one clinic in Uthangarai with trained medical team. VHS-YRG Care Medical Centre The VHS-YRG Care Medical Centre, set up in VHS with the support of the Y. R. Gaitonde Centre for AIDS Research and Education, has a 24 -bed ward and a day care centre that treats AIDS patients. Other than Government Hospitals, VHS is the one of the very few private hospitals to take care of HIV / AIDS patients. Rotary Central-TTK-VHS Blood Bank The idea of a non-commercial blood bank run purely on voluntary blood donation was conceived by VHS in 1962, and it started working in 1963 with voluntary blood donors. Over the years, the Blood Bank has widened its scope of activities by supplying quality and safe blood to outside hospitals as well. 49

Future Sites in Development • Nigeria? • Mexico • Russia? 50

New Mexico • Northern Navajo Medical Center – Full spectrum care – Underserved population – 3 day orientation 51

Scheduling • Each year max 3 residents per department – total 6 on GH Track • Max 3 PGY 2/3 s on 2 week international elective at a time • Only PGY 3 s on 4 week international elective • Throughout the year non track residents may do 2 week DR/Haiti elective and local 2 week electives 52

Elective Type Dates RESIDENT 1 (Clinic Day) RESIDENT 2 (Clinic Day) RESIDENT 3 (Clinic Day) PREFERRED DAYS FOR MODULES Local 7/8 -7/21 JK(Tue) TT(Wed) N/A Local 9/2 -9/15 VB(Mon) AA(Thu) N/A Pre-travel 9/16 -9/29 ER(Tue) CC(Wed) N/A Local 9/30 -10/13 CH(Wed) s. S(Mon) Tuesday PM, Thursday AM Pre-travel 10/14 -10/27 JH(Thu) CD(Mon) Tuesday AM, Tuesday PM Pre-travel 11/11 -11/24 DD(Mon) ER(Wed) Tuesday PM, Thursday AM Local 11/25 -12/8 NI(Wed) WE(Tue) FF(Fri) Monday PM, Thursday AM Pre-travel 1/6 -1/19 LK (Wed) DE(Mon) AA(Wed)- Local Tuesday PM, Thursday AM Pre-travel 2/3 -2/16 MB (Mon) SA(Mon) ZZ(Wed) Tuesday PM, Thursday AM Pre-travel 3/3 -3/16 MI (Thu) WW(Tue) Monday AM, Monday PM Local 3/17 -3/30 AD (Thu) CS(Tue) Monday AM, Monday PM Pre-travel 3/31 -4/13 NS (Mon) WE(Mon) QQ(Tue) Tuesday PM, Thursday AM Pre-travel 4/28 -5/11 CC (Tue) KK(Thu) Monday AM, Monday PM Pre-travel 5/26 -6/8 VS(Tue) PP(Mon) AX(Thu)-Local Tuesday PM, Thursday AM 53

Dominican Republic Schedule Week Mon Tue Wed Thu Fri 1 JOP JOP JOP 2 JOP JOP JOP 3 FG B/CR GH 4 Cd. F GH JOP- Jaime Oliver Pino FG – Francisco Gonzalvo Cd. F – Clinica de Familia B/CR – Batey Clinic Central Romana GH – Guaymate Hospital 54

Budget • For those in the GH track, fully subsidized. • Non GH track PGY 3 s will have 2/3 rds cost subsidized – as available 55

Dominican Republic • Airfare $550 • Accommodations $600 • Transportation $160 • Food $300 • Interpreters $150 • Supervising Staff $250 • International SOS $115 Total per resident: $2125 for 4 wk elective or $1062. 5 for 2 wk elective New cost $2030 per month 56

Haiti • • Airfare All inclusive room & board Supervision Interpreters $500 $800/wk $125/wk $50/wk Total per resident: $3700 for 4 wk elective or $2100 for 2 wk elective or $1300 for 1 wk experience New Cost $2740 per month 57

Kenya • Airfare $1500 • Accommodation $1350 • Transportation $575 • Food $300 • Travel Insurance $190 • Supervision $375 • Administration $950 Total per resident: $5240 for 4 wk elective or $3370 for 2 wk elective New cost $6600 per month 58

India • Airfare $1500 • Accommodation $1350 • Transportation $575 • Food $300 • Travel Insurance $190 • Supervision $375 • Administration $950 Total per resident: $5240 for 4 wk elective or $3370 for 2 wk elective New cost $5250 per month 59

Faculty Training • • • Online modules GH courses (live and online) Facilitator’s Guides Diversity training (via Hofstra NSLIJ SOM) Harvard Global Health Institute http: //globalhealth. harvard. edu/curricula-slides-reading#DV • PBS http: //www. pbs. org/wgbh/rxforsurvival/series/teachers/index. html • Articles http: //www. nejm. org/page/global-health Cost $1500 - $2500 60

Resources • • • 61 Mission money Grants Residency Program Fundraising Donors

Who do you know? • • • 62 Finance Dept Local places of worship Partnership organizations Grateful patients Faculty Other departments

Reflection Technology Learning 63

Resident Photos 64

Website

Creation of Blog • Cell Phone – unlocked • Server $85/year – eg. Go. Daddy, institute server, etc • Wordpress – Download & install (5 min) use video tutorial • Editors – faculty & resident to monitor content – HIPPA & Social Media Policies – Stay updated on revisions!! 67

Blogs

Evaluation • Core Faculty – Residents use current faculty evaluation for rotations on New Innovation • Site Preceptor/Director – Resident: Similar form with added elements for supervision, feedback, access – Core Faculty Site Visit biannually • Residents – Core Faculty & Site Preceptor/Director evaluation • Program – Faculty, Site Preceptor/Director (in works) – Resident via Reflective Narrative – Outcome metrics for community served (via MPH team) 69

YOUR TURN • What tools do you have already that can be used for evaluation of residents, faculty and the program? 70

Benefits • Increased number of trainees choosing to work with underserved populations in US and abroad • Increased interest and exposure to residency program and possibly fellowship programs • Source of research opportunities in areas that would not be feasible otherwise • Faculty opportunities to participate at an educational or clinical level outside the US 71

Outstanding Issues • Recruitment of global health faculty & faculty development • Continuity • Research • Website development with online donation capability • Budgets!!! 72

Next Steps • Creating a Boot Camp for GH (stay tuned) • Learn from best practices • Continue to grow and develop relationships with other organizations and departments • New collaboration with nursing - IPE teams • Raise $$$$ 73

THANK YOU Tweet @tilimd Email tmalize@nshs. edu nphilippe@nshs. edu 74