Student: Syed Adil
Mentor: Dr. Michael Haglund
Site: Mugalo, Kampala, Uganda Project: Uganda, along with many other low- and middle-income countries, does not have enough neurosurgeons or equipment to adequately handle the high volume of traumatic brain injury suffered by the population. In this setting, effective surgical triage and resource allocation is essential for optimizing patient outcomes. We spent the first part of MS3 at Duke creating machine-learning models to predict patient outcomes after TBI, with the goal of learning how to best utilize surgery to have the greatest impact on this patient population. Through DukeMed Engage, I will travel to Uganda for one month to now assess the efficacy of the tool we create, including 1) testing its on-the-ground feasibility and 2) performing detailed surveys of local physicians and other healthcare professionals about how the tool may impact clinical practice, what barriers exist to its implementation, and how it may be improved in future iterations.The Burden of Musculoskeletal Injury
Student: Alexandra Paul
Mentor: Dr. Catherine Staton
Site: Moshi, TanzaniaProject: Orthopedic injuries are large source of mortality, morbidity and disability, especially in lower and lower middle income countries. Death from injuries now account for more deaths than tuberculosis, malaria and HIV/AIDS combined. This project will aim to look at disability and quality of life after patients with orthopedic injuries present to Kilimanjaro Christian Medical Center in Moshi, Tanzania. Dr. Staton was recently awarded an R21 in order to create a transition of care plan for injury patients who are leaving the hospital after their acute event. This research will look at data collected through this registry to answer questions patients quality of life and barriers to care after their musculoskeletal injuries. Another aim of the project will be to evaluate what type of injuries the hospital is capable of treating, what surgeries are being performed, and which injuries are going untreated.
Outcomes of Pediatric Patients with Burkitt Lymphoma and Retinoblastoma Treated at Bugando Medical Centre in Northern Tanzania
Students: Caitlin Penny & Elana Horwitz
Mentor: Dr. Kristin Schroeder
Site: Moshi, Tanzania
Project: We spent a month at Bugando Medical Centre (BMC) compiling data from the medical records of pediatric oncology patients diagnosed with either Burkitt lymphoma or retinoblastoma over the past several years. For each patient we recorded demographic information, time to diagnosis and treatment, chemotherapy regimens received, reasons for treatment interruption or abandonment, and health outcomes. By identifying specific barriers to care, delays in treatment time, and deviation from treatment protocols we will better be able to characterize opportunities for improving access to care for these patients. Historically many of the pediatric oncology patients at BMC have faced delays in diagnosis, a high rate of care abandonment, and a much higher mortality rate compared to pediatric oncology patients in the United States. The goal of our project is to identify information that will help facilitate access to care and improve the treatment protocols being used for each diagnosis, increasing rates of survival and treatment tolerance. https://medschool.duke.edu/about-us/news-and-communications/som-magnify/curing-pediatric-cancer-tanzania-kristin-schroeder-breaks-through-barriers-help-families
Cervical Cancer Prevention Program in Haiti through Education, HPV Screening, and Thermoablation
Student: Sara Grundy & Jenna Armstrong
Mentor: Drs. David and Kathy Walmer
Site: Leogane, Haiti
Project: Family Health Ministries started and operated by Drs. David and Kathy Walmer from Duke is located in Leogane, Haiti and has provided healthcare for women in the region for over 20 years. They offer a variety of services but focus on HPV screening and treatment of early stage cancers as well as research for development of technologies to improve screening practices in the community. Many women they see have advanced cervical cancer which would not respond to treatment. Currently there are no established programs to refer these patients to specifically addressing their palliative needs and little is known about the community preferences for such a program. Our project was going to include an assessment of community resources, practices and beliefs surrounding palliative care and the dying process for eventual development of this type of program.
An mHealth Case Management System for Reducing Pediatric Cancer Treatment Abandonment
Student: Kunal Goel
Mentor: Lavanya Vasudevan, PhD
Site: Mwanza, Tanzania
Project: We created a mobile application to help screen for and treat three forms of pediatric cancer at the Bugando Medical Centre in Mwanza, Tanzania. Specifically, the app will be used by healthcare providers to record patient information, automatically generate chemotherapy recommendations and proper dosing, set up follow-up appointments, and help coordinate care with allied health providers (nurses, pharmacists, etc.). On the ground in Tanzania, I trained staff at the pediatric oncology ward of Bugando Medical Centre on how to use the platform and demonstrate how it can improve their documentation. The app is now launched at the hospital, and we can quantitatively evaluate the success of our implementation by analyzing metrics such as daily utilization, patient follow-up return rate, and cancer-specific patient outcomes compared to the previous paper-based system.2017-2018 DukeMed Engage Award Recipients: Duke Med Elementary
Student(s): Meghan Price and Alexis Wilsey
Mentor(s): Douglass Coleman
Site: Durham, North Carolina Project: Duke Med Elementary (DME) is a well established student run organization at Duke Med that works with 3rd and 4th graders in the Durham community with a focus on outreach to socioeconomically disadvantaged student populations. Our goal is to engage these children in active learning about science and medicine with the hope of motivating them to be more diligent with their studies and to consider potential careers in the health sciences. Since 2008 DME has engaged with multiple schools within the Durham Public School system and has had positive responses from both students and teachers. This is evidenced by both subjective feedback and greatly improved scores on “What did you learn” quizzes that the students take before and after each session. While this immediate impact is a great first step, we would like to set up a program that tracks students who are involved with DME more longitudinally to further promote and encourage an interest in science and medicine. A primary goal of the longitudinal DME program is to partner with BOOST ((Building Opportunities Overtures in Science & Technology), a science outreach program for middle school students, to engage students starting from 3rd grade on and track/ quantitatively measure the impact these programs have on students. It is not well understood or reported how early engagement programs such as DME affect career goals and interests long term. Data from this longitudinal could fill this knowledge gap and provide information that can be used to promote programs like DME/ BOOST in Durham and other communities of need. Refining Surveillance for Zoonotic Respiratory Viruses on Borneo Island (Bass Connections
Student(s): Karen Lin
Bass Connections Team: Jessica Choi, Julie Zemke, Gina Kovalik, David Chen
Mentor: Dr. Gregory Gray of the One Health Lab, Dr. Teck-Hock Toh of Sibu Hospital
Project: I spent a month on Borneo Island with a team out of Duke’s One Health Lab working on a cross-cultural collaborative team with researchers from Sibu Hospital and local health authorities. We worked to refine surveillance techniques for zoonotic diseases, understand the etiology of such diseases through a One Health perspective, and to build the surveillance and diagnostic capacity of collaborators. For this project, we conducted bioaerosol sampling at pig abattoirs (otherwise known as slaughter houses!), poultry farms, as well as kindergartens. Due to increasing and dynamic interactions between humans, animals, and the environment, Southeast Asia is a hotspot for emerging infectious diseases.HIV Rates in Trauma Registry Patients
Student(s): Shay Behrens
Mentor(s): Dr. Catherine Staton
Site: Moshi, Tanzania Project: Dr. Staton was recently awarded an R21 in order to create a transition of care plan for injury patients who are leaving the hospital after their acute event. A key portion in developing comprehensive transitional care plans is understanding the barriers and associations to suboptimal outcomes. My proposed project will look at the rates of HIV amongst injury patients. As mentioned previously, East and Southern Africa are home to the highest number of people living with HIV in the world with an estimated of 19.4 million infected individuals, and 1.4 million people living with HIV in Tanzania (UNAIDS, 2017). In understanding the rates among injury patients, we can better understand the factors impeding a healthy recovery. Not only can we contribute to a better understanding of injury and improving outcomes, we may inevitably find patients with undiagnosed HIV and increase knowledge of HIV status. This has the incredible potential to provide an “opt-out” approach versus an “opt-in” HIV testing approach. This is especially valuable in Tanzania, given a low 35% testing rate in 2012 (UNAIDS 2014, Tanzania). Additionally, we may see an association between HIV status and decreased family support which may hinder the ability to return for hospital follow-up appointments following an injury. In understanding these associations, this project can contribute to the overall goal of her current Fogarty R21 Transitions of Care project: to define the areas of morbidity and mortality in injury patients. In doing so, her team can ultimately understand and develop appropriate transitional care interventions likely to be the most successful in this target population. Mental Health Services for Refugee Populations in Beirut, LebanonStudent(s): Hannah Cunningham and Nali Gillespie
Mentor(s): Suzanne Shanahan, PhD
Site: Beirut, Lebanon Project: We spent our project based in Beirut, Lebanon meeting key stakeholders involved in providing mental health services to three different refugee populations throughout Lebanon. Lebanon’s already large refugee population has grown dramatically in recent years and resources are stretched thin. Our goals were to better understand how mental health fits into the complex landscape of health and human services and what specific mental health services and programs available for Iraqi, Syrian, and Palestinian refugee communities. We worked to analyze the barriers to providing these services and to better understand the mental health policies and practices from the health systems perspective. To achieve these goals we conducted semi-structured interviews with policy makers, medical providers, psychologists, social workers, community leaders, and international aid workers. We also worked with a local NGO, which allowed us interview their providers and to tour their clinics within different refugee camps in West Bekaa, serving Syrian refugees. 2014-2015 DukeMed Engage Award Recipients:
Duke Hotspotting Initiative
Student(s): Jerry Lee and Morgan Hardy
Mentor(s): Dr. Natasha Cunningham
Site: Durham, North Carolina
Project: Duke Hotspotting Initiative identified “high utilizing” patients at the Duke Outpatient Clinic and coordinated their care through the work of medical student teams. Students were paired with pairs of patients and followed them over the course of 10 weeks, such as attending their primary and specialty care appointments, conducting medication reconciliation during home visits, and managing, referring, and educating patients about how to prevent and treat some medical and social issues.
Mentor(s): Dr. Titus G. Ng’eno
Site: Moi Referral Hospital, Eldoret, Kenya
Project: This past July I spent 7 days at Moi Referral Hospital in Eldoret collecting data for a research project titled “Knowledge, attitudes and practices of Sepsis Management: Survey of the medical staff in the pediatrics department.” The survey was filled out by the pediatrics staff at various levels (consultants, registrars, medical officers, interns and clinical officers). The goal of this study was to understand sepsis-related interventions and in doing so identify the main attitudinal and health system barriers to adequate care of septic patients. Grow with Nigeria
Student(s): Temini Ajayi
Mentor(s): Dr. Adeyemi J. Olufolabi
Site: Lagos, Nigeria
Project: Grow With Nigeria (www.growwithnigeria.org) STEM Field Experience was a 3 day academic program that served to expose students to future careers and stimulate their interest in STEM fields through exciting hands-on activities and interactive learning platforms. During this program, students participated in various seminars including coding sessions, crash anatomy courses and health professions skills courses. The program was focused on high school students and featured 61 students and 4 participating schools. The program was hosted at Queens College in Lagos, Nigeria. 2013-2014 DukeMed Engage Award Recipients:
India: March 28 – April 5, 2014
Student(s): 10 MS1s lead by Rajvi Mehta
Mentor(s): Dr. Dennis Clements, Dr. Mukesh Desai, Let’s Be Well Red (LBWR) board of directors
Site: Mumbai, India
Project: Our group started a three-month longitudinal study to test efficacy of LBWR’s proprietary iron-rich GudNeSs bars in increasing hemoglobin and hematocrit levels. Rajvi Mehta trained the medical students in conducting anemia testing and treating camps, and with the delivery of awareness presentations and nutritional guidance. At the anemia testing and treating camps, the group consented and tested 400 women and returned blood reports. Anemic women were divided into a control and experimental group. LBWR has employed study coordinators for the three-month follow-up period of the study.
One-liner: LBWR’s goal is to make GudNeSs available to every single anemic Indian and our efforts will help make GudNeSs more accessible–once efficacy is proven, government agencies, NGOs, and other institutes in India will make GudNeSs available to anemic individuals under their jurisdiction.
Honduras: March 26 – April 5, 2014
Students: Heather Burrell and Kun Wei Song
Mentor: Dennis Clements, MD, PhD, MPH
Site: Las Mercedes, Intibucá, Honduras
Project: A Qualitative Survey of Trash Disposal in Rural Honduran Communities
Every spring, Duke offers a weekly interdisciplinary class “Exploring Medicine in Other Cultures” that culminates in a medical outreach trip to rural Honduras. For over a decade, this outreach trip has provided health care access to the villages of Intibucá, which are 20-80 kilometers away from La Esperanza, the closest permanent clinic. The purpose of the class is to appreciate the cultural framework within which medicine is practiced both in the United States and in Hispanic culture. This combined with a medical spanish component prepared students for the trip.
In Honduras, we worked as members of small groups with nurses, nurse practitioners, physician’s assistants, and physical therapists to interview patients and provide basic medical treatment. Students helped to dispense and explain prescribed medication. Students also performed public health education skits at local schools.
We conducted an independent research project to survey community members’ trash practices and opinions on trash disposal. Because non-biodegradable trash has been a recent influx into these communities, there is little established infrastructure for waste disposal, specifically for plastic trash. We surveyed community members to see if they would like to change their waste disposal practices in the future.
Due to the continuity and stability of the trip, there are ample opportunities for students to pursue their own interests and design their own independent project. Click for Honduras course information. Contact Dr. Dennis Clements with additional questions/comments.
Previous Projects by DukeMed students, non-DukeMed Engage Affiliated:
Haiti: March 24, 2011 – March 31, 2011
Student(s): 7 MS1s lead by Mark Dakkak (email@example.com)
– Kate Wiegert, Duke MS3/UNC MPH
– David Walmer, Duke Global Health Institute faculty, OB/GYN.
Site: Fondwa, Haiti
Project: MS1s traveled to Fondwa to assist Kate Wiegert with her research on maternal and child health by training traditional birth attendants and surveying mothers in the rural community to better understand birth practices. To prepare, trip participants spent many hours learning the skills needed for the training sessions and designing a survey. The training sessions focused on teaching the traditional birth attendants how to monitor for signs of preeclampsia, such as monitoring blood pressure, measuring protein in the urine, and how to assess for edema. Survey questions assessed past childbearing experiences with a emphasis on understanding a woman’s options and desires when it comes to childbirth. The project directly benefited the community by contributing to the building of a birthing center in Fondwa that took into account the community’s desires and needs.
Future directions: Mark Dakkak is now pursuing a Masters in Public Health in Health Policy.
Dominican Republic, MS1 Spring Break 2009
Student(s): 10 MS1s – lead by Tripper Sauer
Mentor(s): Dr. Phillip McKinley, Duke ophthalmologist; Dr. Juan Battle, Dominican ophthalmologist
Site: Elias Santana Hospital, Santo Domingo
Project: 1 week volunteerism trip at the charity hospital Elias Santana and local orphanage. At Elias Santana, students shadowed in several clinics, including ophthalmology, general surgery, neonatology and audiometry. Those with Spanish speaking skills helped out with exams and translation. In the orphanage students taught English and math, and played games with the kids.
Future directions: Tripper Sauer went on to spend his 3rd year research (2010-2011) evaluating vision impairment in Peruvian children under the mentorship of Dr. Joseph Zunt (U. of Washington) at San Marcos University in Lima, Peru.
For an archive of third year global health projects, please visit this Duke Global Health Institute page.