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The Catalyst

It's a small world...for six global health grads

By J. Ryne Danielson

Drs. Margaret Brown, from left, Thomas Larrew, Caroline West, Rachel Reynolds, Eliza Barnwell and Melissa Hite will graduate from MUSC with certificates in global health.

2016 College of Medicine graduates will step into a brave new world, one in which issues thousands of miles away can affect patients sitting right in front of them. The principal health challenges of the 21st century — war, human migration, climate change, economic development, international health policy, pandemic disease — all transcend state and national borders, and to keep up, doctors are increasingly learning to think and act at the global level.

“The world is becoming smaller, even as it’s getting more complex due to social, cultural, political and economic issues,” said Andrea Summer, M.D., associate professor of pediatrics, who serves as program director for MUSC’s Global Health Certificate Program. “Infections in one part of the world are just a plane ride away. In addition, our patient population continues to become more diverse.”

Summer believes anyone entering the health professions should have at least basic training and education in global health issues. In 2011, she created a global health certificate program for just that reason. The program’s four courses cover topics ranging from infectious diseases to epidemiology and public policy, incorporating interprofessional perspectives and emphasizing case-based discussions instead of lectures.
“Students must also complete a field study, either overseas or locally,” Summer said. “They work with faculty to plan a project, and we try to equip them to carry it out in a sustainable way.”

This year, six students will graduate from MUSC having completed the program. Summer believes they will be well prepared to face tomorrow’s global health challenges, no matter where their careers take them.

Caroline West
Caroline West, M.D., is one of those students. After graduating this spring, she will go to the University of Utah for a residency in dermatology. “I’ve always been interested in global health,” she said. “I wanted to take the program as soon as it was announced.”

West said she felt conflicted when she first became interested in dermatology. “I didn’t like the idea of going into dermatology because I didn’t think there would be much global health application. I wanted to find an expertise I could use globally. But I did some research, and found a doctor at the University of Utah, Bethany Lewis, who specialized in global health and dermatology.”

West emailed Lewis and was surprised when Lewis invited her to go to Ghana.

West’s previous field work was in Tanzania, working with Michael Sweat, Ph.D., director of the Center for Global Health, to conduct preventative care screenings and study the prevalence of hypertension, diabetes and chronic kidney disease in rural villages west of Dar es Salaam, a port city on the country’s eastern coast. She was thrilled to be able to travel abroad again, this time working in her future specialty.

“Dermatology doesn’t get a lot of attention globally because skin diseases don’t kill as many as HIV and AIDS, for example, but people suffer from skin diseases all around the world. And there is a tremendous need. We think we don’t have enough dermatologists here, but in Ghana there might be one for every million people. So, I was thrilled to see not only that dermatology could be applied globally, but that it was desperately needed.”

Thomas Larrew
Another student who will graduate with a global health certificate, Thomas Larrew, M.D., chose not to go abroad, but to instead work with underserved communities closer to home. “I worked to increase our medical outreach to the Hispanic community,” he said. “The project felt sort of like coming full circle to me because I had first gotten interested in global health after working at a Hispanic clinic in college.”

Larrew’s specialty is neurosurgery, and he will be staying at MUSC for his residency. “Early on I fell in love with the complexity of the brain,” he said. “I knew I had to do something with it, but I didn’t decide on neurosurgery until I got into the operating room. I really enjoyed the environment.”

He believes neurosurgery provides unique opportunities for growth as a physician and surgeon, and that incorporating a global perspective can be useful to that growth. “As a neurosurgeon, you get to study unique diseases that still have a huge gap in terms of our understanding and treatment options,” he explained. “Most people who have traveled would agree that exposure to new cultures helps to expand your mind and how you perceive the world. I think exposure to how people practice medicine abroad does something similar, casting old challenges in a new light and giving us inspiration to solve new problems.”

Dr. Rachel Reynolds poses with children at a rural clinic outside the town of Masindi, Uganda.

Rachel Reynolds
Rachel Reynolds, M.D., will be doing her residency in pediatrics at Greenville Health Systems in upstate South Carolina. “Working with younger patients is so rewarding,” she said. “I love the atmosphere.”

Reynolds traveled on a medical mission trip to Honduras her senior year of high school. “I believe that experience helped define my future path in medicine,” she said. “I was so inspired and motivated by the doctors on our team, and I could see what a difference basic medical care makes in people’s lives.”

That trip cemented her love of global health, she explained. “I was in the middle of nowhere, sleeping on the floor, working long, tiring days, and I had never been happier.”

Reynolds was able to accompany the same medical team to Honduras twice more in the following years and also traveled to Uganda with a team from Palmetto Medical Initiative during the summer after her first year of medical school. These trips opened her eyes to the profound impact that location and access to resources can have on a patient’s quality of care and their overall health and well–being. “When I heard about MUSC’s global health program, I knew it would be a wonderful opportunity to learn more about the field of global health and what it takes to develop global organizations and health care programs,” she said.

Those experiences abroad helped Reynolds keep long hours spent studying and agonizing over tests in perspective. She knew it would be worth every second, she said.

For her capstone project, Reynolds applied those experiences to help develop a telehealth program for clinical and educational use, allowing doctors and other health care providers to build collaborative partnerships with colleagues worlds away.

One example, last year MUSC carried out a pilot meeting between doctors in Charleston and a clinic in Masindi, Uganda — the same clinic where Reynolds has worked. Doctors in Uganda consulted with MUSC Health specialists to diagnose and recommend treatment for patients with complex conditions.

“We have a wonderful telehealth program at MUSC that is constantly expanding,” she said. She hopes this program, and others like it, may one day revolutionize global health care.

Eliza Barnwell, Margaret Brown, Melissa Hite
Three more graduating medical students, Eliza Barnwell, M.D., Margaret Brown, M.D., and Melissa Hite, M.D., traveled together to Haiti for a weeklong medical mission trip with Service Learners International.

They were accompanied by Barnwell’s brother, Parker, who will graduate next year.

Barnwell explained their field study was a project on hypertension. “It was my first time in a developing country. It was eye–opening to see people living every day without running water or electricity. I’d never seen poverty like that before.”

Barnwell, who will specialize in ophthalmology, said building a sustainable model for care is important for ensuring a patient’s health after they leave the clinic. “There’s a special challenge with chronic health problems. People can come into the clinic and maybe get medicine — maybe not — but you don’t know when they will get more. It’s hard for them to come back again, and there might not be a supply left when they do.”

Brown, who decided on a medical career only after completing an MBA with an emphasis in international business, is also going into ophthalmology. She had traveled abroad in Asia before medical school and wished to incorporate global outreach into her future practice. “Seeing the prevalence of eye diseases and their impact on quality of life in places like Nepal and China was one of the reasons I originally became interested in the field.”

The topics covered in her global health classes, and the discussion-based seminars, provided a welcome balance to the basic science focus of her pre-clinical years, she said. “I would highly recommend the certificate program to interested students or staff in any of MUSC’s six colleges. During my time at MUSC, these courses were definitely the most sustained and practical application of interdisciplinary education that I experienced. I really benefitted from hearing the experiences of my classmates.”

The hypertension project in Haiti was Brown’s first experience with designing a study to be carried out beyond the borders of the United States. “It was a great learning opportunity that I hope to build upon in the future to better understand patient populations, both in the U.S. and abroad.”

Hite will begin a general surgery residency at MUSC Health in July. “Originally, I thought I’d end up in primary care, but after my surgery rotation and some exploration of surgery’s role in global health, I realized it was the right path for me.”

Dr. Caroline West, right, with Tanzanian ambassador Liberata Mulamula. Mulamula visited Charleston in 2015 to express gratitude for the work MUSC has done in her country.

She was interested in global health from the start and saw the certificate program as a unique opportunity to enhance her education and help her stay focused on her long–term goal of practicing medicine in a global context. “The first few years of medical school, I felt a little lost,” she said. “But, the global health classes helped remind me why I started medical school to begin with, and gave me encouragement to keep working toward the end goal.”

Hite said she especially enjoyed the mix of hard science with economics and the humanities. “I felt that not only did I learn concrete information, I also grew my analytical and critical thinking skills as well.”

She enjoyed the opportunity to apply what she’d learned firsthand with the medical service trip to Haiti. “Four of us were already going to Haiti, so we decided to work together to create a patient survey about hypertension and its management via mobile clinics, which are a large part of the primary care delivery system in developing nations worldwide.

“Several of us had already been to Haiti, so we had a good understanding of what the trip would be like and what our patient population looked like. This helped us design a feasible research project we could carry out in a one-week period.”

Barnwell, Brown, and Hite’s project turned out more successfully than they could have anticipated. Their abstract was accepted for presentation at the Global Health and Innovation Conference, held at Yale University in April.

“We are all very proud of this project, and we learned a lot from it,” Hite said. “Research doesn’t have to be complicated. Answering a few simple questions can make a huge impact.”

All of these students have taken one thing away from their courses in global health and fieldwork at home and abroad. West, who is looking forward to working in dermatology, spoke for them all: “We have no right to complain about EPIC or any of the minor problems we face here. I spent two years working on my project, figuring out how to screen for diabetes in Tanzania. Every little bit was complicated — just printing the questionnaire was a challenge, let alone testing and treatment. Here, all you have to do is press a button. We are so lucky, and it’s easy to take that for granted if you don’t have a global perspective.”

MUSC Global Health faculty
Anbesaw Selassie, PhD
Terry Dixon, MD
Patty Coker-Bolt, PhD, OTR/L
Deborah Williamson, DHA, MSN, CNM
Preston Church, MD
Kathleen White, MSN, RN
Suparna Qanungo, PhD
Dulaney Wilson, PhD
Jennifer Shearer, PhD, RN
Romina McCandless, MPH
Kenton Holden, MD

May 23, 2016



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