International Experiences
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Africa
AngolaRobert Riviello, MD and Beth Riviello, MD
Evangelical Medical Center of Lubango, Angola
The Blog, "Riviellos in Angola", is intended to share our journey. Beth and Robert are physicians who have the privilege of working at the Lubango Evangelical Medical Center during 2006-2007.
Riviellos in Angola
Abigail Foust, A&S, Class of 2006
Lwala Clinic and Manna Project International
Lwala Diaries is Abigail's blog about her experiences in Lwala, Kenya, where she assisted in conducting health surveys as part of Vanderbilt Medical Student Milton Ochieng’s effort to create a community health clinic in his hometown in 2006. She is back in Lwala with a group of students in 2007. Read also about her other experiences with the Manna Project International in Nicaragua.
Lwala Diaries
Lt. Col. Debby Booth, RN, CPSN
After dreaming for many years of going to a foreign country to share my nursing knowledge with those in a limited healthcare system, I was offered the opportunity to go to Madagascar with a physician and his family who had lived there for about ten years. I arrived ready to train nursing students and quickly realized that I needed to start with the basics. Because I spoke little French, I taught the nursing students through an interpreter. Among the clinical skills we covered were simple debridement and application of silvadene to treat burns, as skin grafts were not possible in that resource-limited setting.
My time in Madagascar was among the highlights of my life. I strongly recommend taking the time to go overseas in a healthcare capacity, as it can truly make a difference in people's lives. I came away changed; those that I served undoubtedly gave me far more than I was able gave to them.
George C. Hill, PhD
Professor, Department of Microbiology and Immunology;
Levi Watkins, Jr. Professor and
Associate Dean for Diversity in Medical Education
Our research is focused on the identification of antitrypanosomal drugs that would be effective against African trypanosomiasis. We are targeting the trypanosome alternative oxidase, an essential enzyme to the trypanosomes that is absent in humans. Through international collaborations, currently with Dr. Kelly Chibale at the University of Cape Town in South Africa we are investigating different classes of compounds to evaluate their effectiveness. In addition to research, international collaborations have provided excellent opportunities for medical and graduate students to observe the devastating effects of tropical diseases in sub-Sahara Africa. We are also devoting efforts to understanding the structure-function of this enzyme.
Gregory Barz, PhD
Associate Professor of Musicology (Ethnomusicology), Anthropology, and Religion
I will never grow accustomed to the everyday pain and hopelessness in East Africa, particularly in grassroots areas where disadvantaged women have little input concerning decisions they must make in their daily lives. I have encountered women in confusing, seemingly abusive relationships in which everyday despair and poverty frequently necessitate engagement in unwanted sexual relationships. I have watched women enter into such cultural abuse out of necessity in order to help clothe children, pay school fees, or provide their children with the food to survive until the following morning.
That many in Uganda use music, dance, and drama to address medical issues such as HIV/AIDS no longer shocks me as it once did - it inspires me now more than ever. The sounds of children singing, the experiences of women dancing with their disease, and the knowledge that more men and women are learning to live positively with HIV/AIDS continues to move me and motivate me in my field research in East African communities.
Emily Hazan
Vanderbilt Fogarty-Ellison Fellow in Zambia
Jason D. Goldman of the School of Medicine, University of Pennsylvania and Emily Hazan started this blog to document their experiences in Zambia. Click below for link to blog.
Emily Hazan's blog
Asia
ChinaRaymond F. Burk, MD
Professor of Medicine and Pathology
My major research interest is selenium, an essential micronutrient. The soil in some areas of China is selenium deficient, and people living there become selenium deficient. My group has carried out several studies of those selenium deficient people with the aim of determining the human selenium requirement.
The studies have been carried out in Sichuan Province beginning in 1987 with the close collaboration of Chinese colleagues at the Chinese Center for Disease Control (formerly Anti-Epidemic Stations).
I have traveled to China many times and have gotten to know a number of people there. Developing these personal relations has been gratifying, as has the chance to advance knowledge in selenium nutrition.
Xiao-Ou Shu, MD, PhD
Professor of Medicine
Although cancer is the leading cause of morbidity and mortality in most nations, the spectrum of cancer incidence varies greatly worldwide. Lifestyle and environmental factors are thought to account for 70-80% of international variations in incidence rates. International studies conducted in countries with contrasting lifestyles and environments provide an unparalleled, and often neglected, opportunity for studies directed toward understanding the mechanisms of environmental carcinogenesis. Our on-going research in China and Europe focuses on investigating the complex relations between lifestyle, environment and genetic make-up in the development of cancer and other major chronic diseases. This kind of research will generate important information for the development of effective disease prevention strategies, eventually leading to improvements in global health.
Wei Zheng, MD, PhD, MPH
Professor of Medicine
With a rapid increase in incidence over the past few decades, cancer is now a major cause of death in many developing countries, affecting the lives of millions of people. Treatment for most cancers, particularly those diagnosed at a late stage, remains ineffective.
Currently, we are conducting several large population-based studies in China and United States with a common goal to develop cost-effective strategies for the prevention of cancer and other chronic diseases in both developed and developing countries. These cross-cultural studies are powerful in investigating etiologic hypotheses and evaluating prevention strategies to further our goal to reduce the morbidity and mortality of these common diseases.
Neena Agarwal, VMS
As an emphasis project this year, I spent the summer in Pune, India working with an NGO on HIV/AIDS, specifically with women and the prevention of mother to child transmission of the virus. We had learned about the disease in Microbiology during my first year of medical school, but nothing prepared me for the experience and the things I learned in India. I think the biggest thing that caught me was that in India, with women, it’s a totally different disease and takes on a totally different scope. Because women are not given the same status as men socially or economically, their healthcare and the approach to their healthcare have to be totally different too. For example, there was one woman there who was seropositive and felt that socially she had to breastfeed her child or risk the censure of the other women in the village. Even though it would have been easy for us to say, "No, you have to formula feed your child," I quickly learned that if you want to be truly helpful and truly effective, you have to learn to care for the individual’s needs in THEIR specific circumstances...
Latin America/Caribbean
GuatemalaWilliam Lowrance, MD
The healthcare system in the United States has its problems, but for the most part it provides Americans with contemporary medical care, facilities, and medications. The same cannot be said for many third world countries, where there is a tremendous need for healthcare.
I recently traveled to Guatemala City, Guatemala, to participate in a pediatric urology medical mission trip, and I was astounded by the overall lack of medical care available to many Guatemalan children and adults. Practicing medicine in this underdeveloped country gave me a glimpse of some of the global healthcare problems facing us all, and it alerted me to the real need for medical service trips outside of the United States. Personally, the trip was extremely rewarding because the patients were so appreciative of our care. Hopefully my experiences in Guatemala will help make me a better physician and give me a better understanding of healthcare needs outside of our borders.
Lori Graves, RN
I feel very privileged to have been asked to coordinate the first Children's Hospital Mission Trip. This was my first experience at mission work. It was a little daunting to think about moving our Operating Room operation to Guatemala City. With the help of Susan Kohari, our trip coordinator, we were able to contact doctors and nurses who had worked previously at the hospital in which we were scheduled to operate. They gave us some helpful insights, making planning for the trip a little easier.
We hit the ground running when we arrived in Guatemala. Our first full day was spent screening patients for surgery and preparing the O.R.'s and recovery areas for a large influx of patients. Our Guatemalan patients and their families were charming and grateful for our help. The San Sebastian Hospital staff was hardworking, helpful and thankful that we had come to their country to help their countrymen. These factors added to my satisfaction - we had accomplished a necessary service to people who otherwise would not have had access to health care.
Jeffrey Miller, RN, BSN, MBA, CNOR
In February 2006, I was part of a team that traveled to Guatemala for the purpose of performing pediatric urological surgery. Guatemala is one of the poorest countries in the Western Hemisphere, where medical care is sparse at best and essentially non-existent for most. The surgical team consisted of 4 surgeons, 2 anesthesiologists, 7 nurses and a few support personnel. While there, the team operated on 37 children who desperately needed surgical intervention. Most of the supplies and instruments were transported to Guatemala because it was the only way to guarantee the availability and serviceability of those items. Local hospital facilities were utilized for the procedures. The rooms and equipment locally procured were antiquated and in poor repair. However, most items could be made to work, if even only for short intervals.
It was a true wake-up call for most of the team who have never provided care outside of an American healthcare facility. We made good things happen in an environment that would never have been accepted in the United States. Additionally, every outcome was positive and improved the life of a Guatemalan child. The entire team felt a great sense of personal and professional achievement that could not have been realized otherwise. The experience was tiring and at times frustrating, but I'd do it again.
Honduras
Erin Keckley, RN
Being a missionary in Honduras has influenced my life profoundly. It has taught me great respect and appreciation for others, myself, environment, and opportunities. While working in a clinic in Tegucigalpa, I saw a vast spectrum of patients from neonates to geriatrics with various complaints, acute like fevers and dengue and chronic conditions like hypertension and diabetes. It is amazing to be in a place where gratitude is felt. My patients were so appreciative of any and everything - even saying thank you after a penicillin injection. While our health care system in the States isn’t perfect by any means, how blessed are we that we have one? I saw child after child with ailments that are easily eradicated here. We wouldn’t have to choose between providing food on the table from getting a child’s cleft lip repaired.
Professionally, my time abroad assisted me in increasing my nursing skills by depending on skills and not machines but personally, living and working in a foreign culture such as Honduras has opened my eyes and heart to know what good health care professionals can and should do to help those across the globe. I gain more internally than I could ever contribute physically and am much more able to weigh my wants and needs. I will continue to pursue mission trip opportunities whenever and however they arise and encourage all to do the same.
Latin America/Caribbean (Regional)
Lawrence Merin, RBP, FIMI, FOPS, FBCA
Assistant Professor of Ophthalmology
Diabetic retinopathy is the leading cause of adult blindness in America, where we have a well-established infrastructure for healthcare delivery. However, the rapidly increasing numbers of diabetics throughout the world means that millions who live in countries with scarce resources are doomed to vision loss and blindness - unless we are proactive in creating new delivery channels for quality healthcare.
For the past decade, I've been working to establish an effective telemedicine program to screen people with diabetes to detect sight-threatening conditions. To live one's life in darkness is too sad for words but to realize that such a fate is unnecessary is even more tragic. By taking our locally-obtained knowledge and establishing Latin American partnerships, I hope we can make a positive change in the future of our southern neighbors.
Patricia Foxen, PhD, MPH
Research Assistant Professor of Anthropology
Following an MPH specializing in international health and development issues, I worked for NGOs on reproductive and maternal-child health projects in Latin America. This experience led to graduate work in medical anthropology in order to better understand the needs of the populations being served and the assumptions of the institutions serving them. My doctoral and post-doctoral research shifted to psychosocial health issues in post-conflict contexts and among immigrants and refugees. I have conducted field work on these topics in Guatemala and the US and have worked in a clinical mental health setting with immigrant and refugee families in Canada. Working with people affected by poverty, war and displacement on both sides of the border has highlighted the very concrete consequences of rapid globalization on people's health and well-being. It has also shown me that anthropological approaches to health and illness can be a great complement to the broader knowledge of international health issues, and should be integrated to research, training, program design, and service provision in these areas.
