Global Matters
The newsletter of the Office of Global Health Volume 27, Summer 2014 Fall 2014 Global Health Lecture Series Please Join the Office of Global Health for the Annual International Programs Week Friday, October 3—Friday, October 10, 2014
12:00 Noon CT Friday, October 3 ACB 110 Beyond Borders Beyond Measure Photography Exhibit
6:00—9:00 PM Monday, August 18 Andrea Tenner, MD, MPH, FACEP Louise Hopkins Underwood Center for the Arts, Icehouse Gallery War, Disaster, and Death: Managing Complex Emergencies 511 Avenue K Wednesday, August 20 Monday, October 6 Peter Hotez, MD, PhD Breakfast Kickoff The NTDS, Blue Marble Health, and the Anitpoverty Vaccines 8:00—9:00 AM Wednesday, September 10 ACB Entrances Joel Dickens, MD Free Breakfast Burritos! Baptist Medical Center, Ghana Tuesday, October 7 Thursday, September 18 *ACB 100* Robert Gupta, TED Senior Fellow International Programs Fair The Medicine of Music Noon—1:00 PM Wednesday, October 8 *ACB 100* ACB 1st Floor Lobby Michael Russell, SOM, Class of 2017 Free Refreshments!
Friday, October 10 Wednesday, October 8 Patti Patterson, MD, MPH Global Health Lecture—Michael Russell, SOM, Class of 2017 Pediatrics in Jinotega, Nicaragua Noon—1:00 PM Wednesday, October 22 Christina Esperat, RN & Sharon ACB 100 Decker Free lunch to the first 50 people! Collaborations with Silliman University, Phillippines Thursday, October 9
Wednesday, November 5 Global Perspectives Film Series featuring A Doctor of My Own Bryan Small, CEO, ACT Holdings, Noon—1:00 PM LLC The Alabama-Coushatta Tribe ACB 240 Economic Development Efforts Free Pizza! Wednesday, November 19 Kenn Freedman, MD Friday, October 10 Opthalmology in Vietnam & Global Health Lecture—Pediatrics in Jinotega, Nicaragua Cambodia Noon—1:00 PM Wednesday, December 3 Arthur Islas, MD ACB 110 Himalayan Rescue Association- Free lunch to the first 40 people! Everest ER
Presentations with hyperlinks were recorded and can be viewed on the OGH website or checked out from the OGH library. TTUHSC Global Matters | 2
1. 5. Cameroon6. Côte d'Ivoire Available A Day in the Life of a Nursing Student in Jinotega, Nicaragua from the By Elizabeth Stephenson, School of Nursing, Class of 2015 OGH Library
“La prensa, la prensa, topics such as the spread of school. The following resources are available for check- la prensa.” The sound of the germs, nutrition, fire safety, In addition to the vari- out: newspaper man’s voice re- and the importance of exercise. ous school clinics, we also
Book cording coming out of a speak- I got to play “pato, pato, gan- conducted a women’s health
Cutting for Stone er on the front so” (duck, clinic, helped in the mission’s By Abraham Verghese of his bike cart duck, goose) clinic, toured Jinotega’s hospi- was my daily with the chil- tal and clinic, taught expectant Marion and Shiva Stone are twin brothers born of a secret wakeup call at dren, and I mothers at Casa Materna, and union between a beautiful the mission learned more trained community health Indian nun and a brash Brit- ish surgeon. Orphaned by where I stayed, about a recur- workers in topics related to their mother’s death and their located in the ring theme in reproductive health. In the father’s disappearance, middle of the Nicaraguan afternoons after finishing our bound together by a preter- natural connection and a market. Every- culture. I ob- work for the day, many of us shared fascination with medi- thing in Jinote- served during would get coffee or ice cream cine, the twins come of age ga happens about three hours the game that when a boy was and experience a more re- as Ethiopia hovers on the brink of revolution. Moving earlier than in the US. The chosen to be the laxed aspect of from Addis Ababa to New market comes alive around “ganso” first, Nicaraguan cul- York City and back again, four in the morning and every- only boys were ture. Cutting for Stone is an unfor- gettable story of love and thing shuts down when the sun chosen, but During betrayal, medicine and ordi- sets around seven. After a when a girl was the trip the implica- nary miracles – and two delicious breakfast of fresh chosen as tions of Nicaragua brothers whose fates are forever intertwined. fruit, eggs, and gallopinto (rice “ganso”, girls being the second
Movie and beans), I headed off in the and boys were poorest country in back of a truck. It was always evenly picked. the Western Hemi- The Ghost Army a surprise to see where we This represents sphere sunk in. During World War II, a hand- were going for the day. We the importance Lack of clean wa- picked group of American GI’s undertook a bizarre journeyed across rocky, steep of empowering ter is a major is- mission: create a traveling roads up into the mountains girls, helping to sue, and it, along road show of deception on usually for at least an hour. increase their with the lack of the battlefields of Europe, with the Nazi German Army This day we arrived to self-esteem, and aiding them in sanitation, is the cause of as their audience. The U.S. four small buildings with a total planning for the future. In order many of the common health 23rd Headquarters Special of five classrooms and excited to impact Nicaragua’s high issues in Jinotega such as Troops used inflatable rubber tanks, sound trucks, and children pregnancy parasites, dehydration, and dazzling performance art to who happi- and materni- infections. Another health is- bluff the enemy again and ly ty mortality sue that affects many children again, often right along the front lines. This little-known squeezed rate, girls is malnutrition. We saw sever- unit’s knack for trickery was their desks need to be al children that appeared crucial to Allied success in into anoth- made aware about half their actual age due World War II, but their top- secret mission was kept er class- of other op- to malnutrition-causing growth quiet for nearly 50 years after room so tions besides delays. the war’s end. we could Serving others is so having ba- have a bies. In Nica- much more than just giving place to ragua, edu-
set up the clinic. I started off by cation, including college, is
For more information about helping lead the children in free, but many drop-out early Continued on the top the resources available from health fair activities, covering or don’t continue after high the OGH library, visit our of page 3. website.
GLOBAL MATTERS TTUHSC Global Matters | 3
International Medicine Club Column cont. Mark Your Calendar for the Global Perspectives knowledge are being trying to “improve” them and Film Series planted on topics such as their healthcare system. reproduction, hygiene, These two weeks were full of and child development. In incredibly valuable experi- addition, basic health ences that not only humbled screenings and services me, but improved my critical to people far from thinking skills, increased my healthcare access are cultural competence, and being provided. This enhanced my desire to help
helps the underserved others. You’re invited to join the people immediately in Office of Global Health as one’s time, knowledge, and hopes that in the future the we host a screening of one effort. It includes taking in all source of many of their of the many films from our library.
one’s experiences, learning hardships will be less-
from the people you are there ened. to help, and finding ways to The trip re- 12:00 Noon enhance their culture and es- quired a fine balance CST tablished systems of living. It is of respecting the Nica- hard to see a major impact raguan culture and ACB 240 over a two week trip, but health practices and through this trip and others led working with the com- through TTUHSC, seeds of munity as opposed to Thursday September 25 Saving Face
Thursday Country Close-up* *every issue OGH will select another country to feature October 9 A Doctor of My Republic of Djibouti jority, at 94%, are Muslim. assistance. An unemployment Own French and Arabic are the rate of nearly 60% continues to Djibouti is located at the juncture official languages of Djbouti; be a major problem. As of Au- Thursday of the Red Sea and the Gulf of however, Somali and Afar are gust 11, 2014, one USD is November 13 Aden between also spoken. equal to one hundred and Silcenced Voices Eritrea and Soma- Three-fourths of eighty-two Djiboutian Francs. lia. After gaining the population live According to the Thursday, in the capital city its independence World Fact Book, life expectan- December 4 from France in due to the coun- cy at birth for males is fifty-nine try’s strategic years, while for females it is TBD 1977, Hassan location as a deep sixty-five years. Gouled Aptidon installed an au- -water port on the The World Health Attendees are welcome Red Sea. thoritarian one- Organization (WHO) reports the to bring their own Djibouti non-communicable leading party state and lunch. served as presi- has few natural causes of death to be non- dent until 1999. That same year, resources and little industry. It communicable, maternal, peria- Free snacks will be Djibouti’s first multiparty presi- provides services as nal, and nutritional provided! dential election resulted in the both a transit port for conditions; cardiovas- election of Ismail Omar Guelleh the region and an cular diseases; can- as president. Guelleh still serves international trans- cers; chronic respirato- as president today. shipment and refuel- ry diseases; and dia- With a population of ing center. The na- betes. 810,179, Djiboutian’s are 60% tion is, therefore, Somali and 35% Afar. The ma- heavily dependent on foreign TTUHSC Global Matters | 4 Clinical Decision Algorithm for Patients with “Vision Problems” in When in… the Himalayas Finland By Ryan Hassan, Paul L. Foster School of Medicine, Class of 2014
Punctuality is very im- portant, especially in One of the most common eyes. Clinicians can easily confirm gions in which we are working, even business. Arrive on time complaints in the clinics of the Him- this diagnosis by observing a yel- supplies as inexpensive as sun- to social events. lowing of the sun-exposed portions glasses. An advantage of using the alayan Health Exchange (HHE) is “vision problems.” During my rota- of the patients’ sclera (namely, the above criteria to determine who will Greet with a brief, firm handshake with direct tion with HHE, however it took me medial and lateral aspects were get sunglasses is that it is a sure- eye contact and say and my col- affected, while the fire way to avoid giving sunglasses your name. leagues a few superior and inferior to the malingering patients who just
days to figure out aspects were show up to get a cool pair of glass- When introduced to a the proper way to spared). These es, which, unfortunately, happened married couple, greet the wife first. approach these patients usually on several occasions. patients. By the required no more Do not use first names end of the rotation than education, Myopia, Presbyopia, and Hypero- until specifically invited we had designed some lubricating pia to do so. a general algo- eye drops, and a There were many patients
rithm for patient care, and I have referral to purchase a pair of sun- who complained of decreased visu- Finns will often ask you decided to provide that algorithm to glasses. al acuity rather than (or in addition what you think of their country, so do some the program in the hope that future In some of the older pa- to) tearing of the eyes. These condi- homework and bone up groups will be able to provide more tients, the long-term solar damage tions include myopia, hyperopia, on Finnish culture. productive, efficacious care. had progressed to pingueculae or and presbyopia. Myopia and hyper-
pterygiums in the eyes. These con- opia are caused by an abnormal Small talk is not im- Solar Irritation ditions are characterized by a shape of the lens of the eye, while portant and is not often used. Finns attach The first thing to consider raised and presbyopia is great importance to when seeing a patient with visual yellowed caused by a language and choosing complaints in the Himalayan regions portion of the hardening of the words carefully, making of India is that these patients are conjunctivae lens that reduces silence preferable to empty chatter. exposed to a much higher concen- over the its ability to ac- tration of UV radiation from solar sclera of the commodate. If someone is talking, rays due to the region’s high alti- eye. Pterygi- Myopia leads to the biggest contribution tude. In addition, many of these ums are difficulty seeing you can make is to patients are farmers. This means large far away because listen; don’t interrupt. pingueculae the lenses of the Always wait until the that during the day they spend most other person has fin- of their time outside. To compound that have eyes are too ished talking. the problem further, few of these invaded the cornea. Pterygiums curved and is commonly seen in patients are aware of the damage and more severe pingueculae usu- children and adolescents. Hypero- Talking to strangers in the sun’s rays can cause, and ally require surgical removal, in pia leads to difficulty seeing objects the street or on public therefore they do not wear sun- addition to the standard treatments up close because the lenses of the transportation is unusu- al, although if you ask glasses. Hence, many of the “visual for eyes with solar irritation. As eyes are too flat. Hyperopia, is for directions you will complaints” such, we referred much rarer and typically presents in usually find Finns to be turned out to be these patients to patients less than 35 years old. very helpful. solar irritation an ophthalmologist Presbyopia, on the other hand,
caused by over- and gave them eventually affects every person as Directness and honesty are important, so you exposure to UV sunglasses before they age, due to the natural loss of should only extend rays. These sending them on flexibility of the lens of the eye, and invitations or make patients typically their way. also leads to difficulty seeing ob- offers that you intend to complained of Although jects up close. All three conditions follow through. Com- ments such as “We blurry vision it would be ideal to provide all patients must do this again (worse with sun Continued on the top sometime” will be taken exposure) and watery and/or dry in this region with sunglasses, it is of page 5. literally. difficult to get supplies to the re-
GLOBAL MATTERS TTUHSC Global Matters | 5
Clinical Decision Algorithm for Patients with “Vision Problems” in the Himalayas cont. When in… Finland Cont. are treated with corrective lenses. In addition to corrective with corrective lenses. If they In the first few days of my lenses, these patients also need cannot read more comfortably Finns prefer to entertain rotation, my group made the mis- education about how to maintain with the corrective lenses then at home rather than meet in restaurants. take of attempting to treat each of their visual acuity. We found that clinicians should consider a diag- these patients with the corrective many patients, especially school- nosis of malingering. Keep your knife and fork lenses we had available to us. We aged children, were regularly read- Lastly, the Snellen in your right and left later learned that our lenses only ing in dim lighting. We advised them charts that many of us have com- hands, respectively, at correct for farsightedness (myopia). that the strain on their eyes might monly used to assess visual all times; don’t put your knife down to eat with Patients with nearsightedness also be affecting their vision. acuity only provide meaningful your fork. Don’t start (hyperopia or presbyopia), required During my rotation, we results for nearsighted patients. drinking wine until the prescription lenses from an optome- The charts only de- host has made a toast. trist, which we were unable to pro- scribe how well a pa- vide. Thus, clinicians should only tient can see an object It is forbidden to smoke in public buildings and dispense the HHE stock of correc- that a healthy eye can workplaces. tive lenses to nearsighted patients see from a distance of who typically have presbyopia and 20 feet. The charts can Although Finns aren’t commonly present complaining of be helpful to determine big talkers, cell phone difficulty reading, knitting, or stitch- whether presbyopic or use in Finland is greater ing. Patients who complain of diffi- hyperopic patients than in most other plac- es in the world. Howev- culty seeing far objects do not re- have difficulty reading er, they are used with quire further work-up and can simp- up close, but they considerable discretion ly be referred to an optometrist. should not be used to and respect for others. Due to the limited supply of correc- define a visual acuity tive lenses, we also implemented a for these patients. The If your phone rings when you are at the policy of not prescribing corrective found that corrective lenses were charts can be used to determine theater, a restaurant, lenses to patients who were both just as fashionable as sunglasses, the visual acuity of myopic pa- the library, or even a near- and farsighted, as they would and as such many patients came to tients; however, as these patients sports stadium, you may eventually need bifocal lenses to the clinic simply to obtain a pair. For will be referred to an optometrist be asked to leave. fully correct their vision. These this reason it is important to careful- regardless of the results, this is Finnish sauna is a way patients should also be referred to ly examine patients to determine if largely an academic exercise. of life, and everyone has an optometrist. their visual acuity actually improves one at least once a week. The ratio of peo- ple to saunas in this country is about two to one. You will definitely be invited to share the experience during your visit—no clothes al- lowed.
Dress conservatively in good-quality, stylish clothes. Take your shoes off when entering a home.
Tipping is not custom- ary.
Taken from Behave Your- self! By Michael Powell TTUHSC Global Matters | 6
International Which Way Home Flavor A Movie Review by Karla A. Arredondo, School of Allied Health Sciences, Class of 2015
On top of a train, ex- pens, and it happens daily in un- posed, unprotected, and com- imaginable numbers. pletely driven, are children, sib- When Rebecca Cammisa, lings, abandoned toddlers, and the film’s director, met the Hondu- Chorizo con courageous teens who all share ran boy named Jose at a deten- Huevos one common goal: to ride a cargo tion center in southern Mexico, he recipe provided by train known as The Beast and was alone, scared, and crying. He Esther Salazar, make it to the United States. In is one of tens of thousands of Lat- Institutional the Emmy-winning and Oscar- in American children who annually Advancement nominated documentary “Which attempt to cross illegally into the Way Home,” the filmmakers track United States on top of La Bestia. Ingredients: several children from Central Most children go in search of work America and Mexico on their jour- or missing parents. Cammisa’s 1/2 pound Ramirez Chorizo ney to the United States in search work in directing this documentary 1 white onion chopped (add de- of a better future. For many, the deserves admiration. The sired amount) journey ends badly, if filmmakers capture the 4 eggs not tragically. Menaced subtleties that make these Pepper (desired amount) by predatory smug- kids kids, while immersing 4 flour tortillas glers and corrupt po- themselves aboard The lice, the children must Beast to film and interview Instructions: contend with dodgy the children along the jour- weather, hunger, and ney and show the dangers Fry the chorizo in a skillet over the constant danger of they encounter. They are medium heat until browned. falling off the trains and the unheard, invisible chil- Drain off any excess oil. being killed or losing dren. These are stories of Add the amount of onion desired. limbs. hope and courage, disap- Cook 3 to 5 minutes “Which Way pointment and sorrow. Stir in the four eggs and cook Home” presents the invisible side They are eye-opening and very along with the chorizo and on- of immigration. It is hard to imag- worth watching. ions until the eggs are fully ine how a five-year-old child trav- Currently the Rio Grande cooked. els by himself on top of a train, Valley in South Texas is facing surviving on the compassion of great challenges as hundreds of Add pepper as desired. many women and non-profit or- children are being detained daily Heat the tortillas. ganizations who set up along the by immigration officials. Civil rights Serve on a plate or on a tortilla tracks to care for these young lawyers have been monitoring the as a burrito. travelers. It is such a huge prob- facilities to make sure the housing You can add your choice of salsa lem that humanitarian organiza- conditions are adequate, as the as well. tions in Mexico are specifically children wait to be processed in Desfruta! dedicated to stopping the delin- the international legal limbo. This quency and crimes committed matter, unknown to many until against immigrants as they make recently, is a heartbreaking and their way across Mexico. It hap- disturbing problem.
GLOBAL MATTERS TTUHSC Global Matters | 7
In the News, Around the World
Embracing the New Globalism: a Challenge to Rethink Study Abroad If overseas programs aren’t revamped for a generation of globally minded students, they risk becoming marginalized. FBI Movie Warns Students Going Abroad of Being Drawn Into ‘Game of Pawns’ The law-enforcement agency says more American study-abroad participants are being targeted by foreign intelligence services. The 23-year-old with 24 kids: Genocide Orphans Form Their Own Families Young genocide survivors are coming together to form “artificial families” in Rwanda. They help each other financially and offer emotional support. Book News: Each Page of ‘A Drinkable Book” Kills Bacteria in Drinking Water The organization WaterisLife is developing a “Drinkable Book” that not only teaches water safety but can actually be used to treat drink- ing water. Each page, coated in bacteria-killing silver nanoparticles, can be torn out and used as a filter. Ghana Bamboo Bikes Initiative The Ghana Bamboo Bikes is a socio ecological green initiative that addresses the quadruple problems of climate change, poverty, rural- urban migration and high unemployment amongst the youth in rural Ghana. Mysterious Kidney Disease Plagues Central America CKDu is a complex health problem with unknown origins especially prevalent among sugarcane workers in Central America. Chikungunya Virus Spreads to U.S., Cuba Experts say American tourists are bringing chikungunya back home, and it’s just a matter of time before it starts to spread within the Unit- ed States. U.N.: Number of Displaced People Hits Mark Not Seen Since World War II At least 51.2 million people are now living under forced displacement, a U.N. agency says, announcing its tally of people who are seeking refuge or asylum, or who are internally displaced. It’s the first time this number has topped 50 million since World War II. Measles Hits Amish Communities, And U.S. Cases Reach 20-Year High Members of Amish communities in Ohio traveled to the Philippines for heartfelt reasons: They were there on a service project to help less fortunate people. Unfortunately, they came home with unwelcomed hitchhikers: measles viruses. Visualizing Brazil’s Score on Health and Equity Goals While soccer fans globally have been following the excitement of the World cup matches in Brazil, riots in the country have thrust its pov- erty and inequality into the international spotlight. This Paper Cup Can Be Recycled—Unlike the 50 Billion That End Up in Landfills 50 billion cups in the U.S. end up in landfills every year—enough that if placed end to end, they would go to the moon and back roughly rive times. British inventor Martin Myerscough was puzzled by this and has now come up with an alternative to make the recycling pro- cess easier. Peru to Provide Free Solar Power to 2 Million of Its Poorest Residents by 2016 Peru has initiated programs that will provide more than 2 million of its poorest residents with electricity—for free. Three Maps That Explain America The United States of America is a young country, but it’s still big and complicated and fascinating. It can be tough to distill all that down to a few maps, but here are three that capture the story of America about as well as anything. This Kenyan Runner Can’t See But He Has a Far-Reaching Vision When Henry Wanyoike and Joseph Kibunja first started running, it was out of necessity. The childhood friends had no other way to travel the three miles from their Kenyan village to school. Thirty years later, Wanyoike and Kibunja are still running together, only now, they're headed to the finish lines of races around the world—and often getting there first. Volunteer Recap: A Bumpy (and Itchy) Ride Through Tanzania Nick Stadlberger, a fourth-year medical student at Dartmouth College spent four weeks this spring in Dar es Salaam, Tanzania, working in the infectious disease ward at Muhimbili Hospital as part of his school’s global health program. Universities Strive to Make Sure Researchers Are Included in Global Efforts Amie K. Lund, a biologist at the U. of North Texas, traveled to France this spring to work directly with a colleague there as part of a uni- versity program to encourage global research. Doctors Aren’t Sure How to Stop Africa’s Deadliest Ebola Outbreak An outbreak that started in Guinea last February has surged in the past few weeks. It’s now the deadliest outbreak since the virus was first detected in 1976. More than 500 cases have been reported in three West African countries. Pathogens On a Plane: How to Stay Healthy in Flight How easily do bacteria and viruses spread on commercial jets? And is there anything we can do to cut our risk? As ‘Voluntourism” Explodes In Popularity, Who’s It Helping Most? More young adults and teens are swapping sun tanning and sightseeing for working in orphanages, building schools and teaching Eng- lish abroad. Fist Bumps Pass Along Fewer Germs Than Hand Shakes That strong, sturdy handshake your grandpa taught you isn’t the cleanest way to greet someone, scientists say. So should doctors and nurses in hospitals start bumping fists?
June July August
02—Children’s Day; Cambodia 04—Fisher Man’s Day; 01—Parent’s Day; Congo 06—Labor Day; Bahamas Marshall Islands 04—Farmer’s Day; Zambia 09—Community Day; Spain 07—Gospel Day; Kiribati 05—August Festival; British Virgin 10— Reconciliation Day; Congo 08—Carnival Tuesday; Saint Vincent Islands & Grenadines 12—Russia Day; Russia 09—Women’s Day; South Africa 12—Orangeman’s Day; 16—Youth Day; South Africa United Kingdom 11—Hero’s Day; Zimbabwe 20—World Refugee Day; Nauru 20—Peace and Freedom Day; 18—Parsi New Year; India 22—Anti-Fascist Resistance Day; North Cyprus 25—National Hero’s Day; Philippines Croatia 21—Marine Day; Japan 26—National Day of Repentance; 23—Discovery Day; Canada 23—National Remembrance Day; 27—Day of National Unity; Tajikistan Papua New Guinea Papua New Guinea 28—Start of Ramadan; Afghanistan 24—Children’s Day; Vanuatu 31—National Language Day; Moldova 30—Prayer Day; Central African 28—End of Ramadan; Albania Republic International Holidays and Celebrations
Language Lesson: Where are you from?
Afrikaans Waarvandaan kom jy? Portuguese É de onde? Albanian Nga jeni? Russian Otkuda vy? Basque Nongoa zara? Samoan Ofea e te sau ai? Bosnian Odakle dolazite? Scots Whaur d’ye come frae? Croatian Odakle si? Somali Xagee ayaad ka timid? Danish Hvor er du fra? Spanish ¿De dónde es usted? Fijian O ni lako mai vei? Swahili Unatoka wapi? German Woher kommst du? Tagalog Tagasaan ka? Hawaiian No hea mai ‘oe? Tahitian Nohea mai oe? Igbo Olee ebe i si? Turkish Nerelisin? Indonesian Anda berasal dari mana? Uzbek Siz qay yerdansiz? Italian Da dove vieni? Wolof Fan nga joge? Japanese Shusshin wa doko desu ka? Yiddish Fun vanent kumstu? Luxembourgish Vun wou kennst de? Xhosa Uvela phi? Malay Dari mana asai saudara? Zulu Uphumaphi? Maltese Minn fejn int? Nepali tapaaiikii ghara kaaham ho?