Brown in the Lesser Developed World
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Volume 90 No. 11 November 2007 Brown In the Lesser Developed World UNDER THE JOINT VOLUME 90 NO. 11 November 2007 EDITORIAL SPONSORSHIP OF: Medicine Health The Warren Alpert Medical School of Brown University HODE SLAND Eli Y. Adashi, MD, Dean of Medicine R I & Biological Science PUBLICATION OF THE RHODE ISLAND MEDICAL SOCIETY Rhode Island Department of Health David R. Gifford, MD, MPH, Director COMMENTARIES Quality Partners of Rhode Island 338 Personal Reflections On This Issue Richard W. Besdine, MD, Chief Medical Officer Joseph H. Friedman, MD Rhode Island Medical Society 339 The Serendipitous Gift of Epiphany Barry W. Wall, MD, President Stanley M. Aronson, MD EDITORIAL STAFF Joseph H. Friedman, MD CONTRIBUTIONS Editor-in-Chief Joan M. Retsinas, PhD Brown In the Less Developed World Managing Editor Guest Editors: Susan Cu-Uvin, MD, and David Pugatch, MD Stanley M. Aronson, MD, MPH 340 A Message From the Dean Editor Emeritus Eli Y. Adashi, MD EDITORIAL BOARD 340 Brown’s Involvement In the Health of Less Developed Countries Stanley M. Aronson, MD, MPH Susan Cu-Uvin, MD, and David Pugatch, MD Jay S. Buechner, PhD John J. Cronan, MD 342 Brown’’s Fogarty International Center AIDS International Research and James P. Crowley, MD Training Program: Building Capacity and New Collaborations Edward R. Feller, MD John P. Fulton, PhD Kenneth H. Mayer, MD, and Eileen Caffrey Peter A. Hollmann, MD 346 The Dual Burden of Infectious and Non-Communicable Diseases in the Sharon L. Marable, MD, MPH Anthony E. Mega, MD Asia-Pacific Region: Examples from The Philippines and the Samoan Islands Marguerite A. Neill, MD Jennifer F. Friedman, MD, MPH, PhD, Jonathan D. Kurtis, MD, PhD, and Frank J. Schaberg, Jr., MD Stephen T. McGarvey, PhD, MPH Lawrence W. Vernaglia, JD, MPH Newell E. Warde, PhD 351 Perspectives From Brown Medical Students and a Medical Resident David Sears, MD, E. John Ly, BMS IV, Natasha Rybak, MD OFFICERS Nick Tsiongas, MD, MPH 358 Brown In Kenya President Edward J. Wing, MD Diane R. Siedlecki, MD President-Elect 360 Caring for HIV-Infected Refugees In Rhode Island Vera A. DePalo, MD Simon Dejardins, Curt G. Beckwith, MD, Heather Ross, LCSW, Vice President Lauri Bazerman, MS, Jennifer A. Mitty, MD, MPH Margaret A. Sun, MD Secretary Mark S. Ridlen, MD COLUMNS Treasurer 363 THE CREATIVE CLINICIAN – Tuberculosis Peritonitis Barry Wall, MD Joseph D. DiMase, MD, FACG, FACP, and Deepak Agrawal, MD Immediate Past President 365 HEALTH INSURANCE UPDATE – HEALTHpact Plans for Small Employer: DISTRICT & COUNTY PRESIDENTS Physician’s Role Geoffrey R. Hamilton, MD Matthew Stark Bristol County Medical Society Herbert J. Brennan, DO 367 HEALTH BY NUMBERS – Refugee Health Update: Lead Exposure in Kent County Medical Society Refugee Children Rafael E. Padilla, MD Pawtucket Medical Association Maria-Luisa Vallejo, MA, MEd, MPH, Carries Bridges, MPH, Patrick J. Sweeney, MD, MPH, PhD Magaly Angeloni, MBA, and Peter R. Simon, MD, MPH Providence Medical Association Nitin S. Damle, MD 369 LETTERS Washington County Medical Society 370 PHYSICIAN’S LEXICON – The French Connection Jacques L. Bonnet-Eymard, MD Woonsocket District Medical Society Stanley M. Aronson, MD Cover: “Marché Mouffetrard,” by Areg 370 Vital Statistics Elibekian, Oil on Canvas, 8 x 10 inches. The artist graduated from Yerevan’s Institute of 372 November Heritage Drama & Fine Arts in 1992. His works were part of the Elibekian family exhibitions at the Medicine and Health/Rhode Island (USPS 464-820), a monthly publication, is owned and published by the Rhode Island Medical Society, 235 International Art Center in Beirut, Lebanon, Promenade St., Suite 500, Providence, RI 02908, Phone: (401) 331-3207. Single copies $5.00, individual subscriptions $50.00 per year, and $100 ALMA Gallery in Boston, Massachusetts, per year for institutional subscriptions. Published articles represent opinions of the authors and do not necessarily reflect the official policy of the Rhode Island Gallery L’Oeil Reno Berg, in Brussels, and Stu- Medical Society, unless clearly specified. Advertisements do not imply sponsorship or endorsement by the Rhode Island Medical Society. Periodicals postage dio 22, in Antwerp, Belgium. In 1998, he had a paid at Providence, Rhode Island. ISSN 1086-5462. POSTMASTER: Send address changes to Medicine and Health/Rhode Island, 235 Promenade St., solo exhibition at the Gallery Hai Cie in Paris. Suite 500, Providence, RI 02908. Classified Information: RI Medical Journal Marketing Department, P.O. Box 91055, Johnston, RI 02919, He was recently a part of the Three Genera- phone: (401) 383-4711, fax: (401) 383-4477, e-mail: [email protected]. Production/Layout Design: John Teehan, e-mail: [email protected]. tions of Armenian Art show at Gallery Z in 337 Providence. www.galleryzprov.com VOLUME 90 NO. 11 NOVEMBER 2007 Commentaries productive doing there, which was teaching. I was a visiting professor, seeing patients, teach- Personal Reflections On This Issue ing housestaff and a few students the basics of neurology. It was rewarding for me, although less so for the patients who were rarely diag- I generally do not tailor my monthly column cal medicine scholarships as the previous year’s nosed, and even less commonly treated for to the topic of the journal. Since the topics that one hadn’t been used, and I increased my debt. anything. Nevertheless, neurology is an im- I choose to write about enter my consciousness It was worth every penny of the principal and portant discipline for doctors in the third in a random, uncontrolled manner, I find my- the interest, profound or not. world to know. Epilepsy, in particular is a very self unable to choose a topic, like the topic the I helped in the OR, and I “ran” a TB serious problem which leads to a large num- particular issue is devoted to. This issue was no ward for adults and one internal medicine ber of injuries, with people falling into open exception until I read the student’s article that ward, under the supervision of a British doc- cooking fires, or out of canoes. Mental illness began with a case of tetanus. tor. Since I was in the last three months of is virtually untreated. In Zambia there was a Tetanus is engraved in my memory as medical school they gave me a fair amount single psychiatrist in the country, and he was well. of responsibility after I acclimatized and they an elderly expatriot who had been trying to I first went to Africa in 1969. I spent got the measure of my capabilities. retire for several years. In a town near a major two years as a Peace Corps volunteer, teach- I also took call, which meant getting tourist attraction there is a one room hut, with ing high school math and math pedagogy at roused when someone came in after the clin- a lock, for any insane villagers to be kept until a teacher-training college in the northern re- ics closed. I remember vividly the night I was they can be sent to the single psychiatric hos- gion of Ghana, a place considered “bush” by on call and saw a young woman who couldn’t pital in the country. the people who lived in the more developed, open her mouth. In an experience that was I plan to spend a month teaching in and richer, southern regions. It was this expe- almost hallucinatory, I heard one of my medi- Kenya in one of the Brown programs in early rience that triggered my interest in medicine. cal school neurology attendings, a Ghana- 2008. I’ve reserved the month and will go I returned to Africa in 1978 to com- ian working in the US, say, “whenever you with my medical student daughter. I wish I plete my last three months of medical school. see someone who can’t open their mouth, could stay longer. I plan, when I have no chil- I worked/studied in the bush of Tanzania, at think of lockjaw and look for a sore.” I looked dren in college, to create a job where I spend the hospital of the Medical Missionaries of for the sore, and found it on the leg. I then part time in Rhode Island and part time some- Mary, a wonderful group of Irish nuns. As noticed not only the lockjaw, but the where in Africa. I don’t know where. To be my teaching assignment in Ghana was at the opisthotonus as well. She died, of course. honest, I can probably do more “good” by Men’s Evangelical Presbyterian Teacher Back in the days before AIDS, we making as much money here as I can and Training, it was ironic that I, a Jewish boy washed our hands before spinal taps but donating it to Doctors Without Borders, or from the Bronx, would now work at a hos- didn’t use gloves. We reused needles after to Paul Farmer, but there is a role, too, for pital run by nuns, after teaching at a school cleaning and autoclaving, and reused surgi- those of us who like to move into other cul- run by evangelical Presbyterians. cal gloves after washing and sterilizing as well. tures, expand our own frontiers, and hope- I first heard about the hospital from the We had a truck headlight attached to a bat- fully help some people as we do it. chief resident in internal medicine at Harlem tery for a surgical light. Patients were carried The Brown programs described in this Hospital when I was a student. It sounded by stretcher from untold miles away, down issue excited me. I am happy that we have perfect for me and I arranged a position, the cliff at the edge of the Rift Valley.