Upcoming Events Around Boston

·         New! December 12: Webinar: Improving Quality & Safety for Diverse Populations: An Innovative Interprofessional Curriculum. 12-1pm. Education for medical and nursing students on strategies to improve quality, address disparities, and achieve equity will be essential in a time of rapid healthcare system change. The Disparities Solutions Center at Massachusetts General Hospital and the MGH Institute of Health Professions are hosting this webinar in an effort to provide the latest tools and guidance on these efforts. The webinar will highlight the development and implementation of an innovative, interprofessional curriculum for medical and nursing students. Visit https://live.blueskybroadcast.com/bsb/client/CL_DEFAULT.asp?Client=231897&PCAT=1917&CAT=1917 to register and for more information.
 
·         December 13: Harvard Global Health Institute Talk: An Informal Conversation with Sophie Delaunay. 12:00-1:30 pm. Harvard Global Health Institute, 104 Mt Auburn Street, 3rd Floor, Cambridge. Ms. Delaunay, Executive Director of Doctors Without Borders, will discuss the role of an international humanitarian aid organization in the chemical weapons debate in Syria.
 
·         December 16: “Working with Faith-Based Organizations to Provide Cancer Control Interventions for Underserved Latinos” by Jennifer Allen PhD, Tufts University. 12:30PM. HSPH, Kresge G3. The goal of the study was to develop and test an organizational-level intervention to enable faith-based organizations (FBOs) to adopt, adapt, implement and sustain evidence-based interventions (EBls) to address cancer disparities among Latinos.
 
·         December 19: Good Spirits and Strong Bodies:  Mental Health Treatment in Syria 1903-1961. 4:00-5:30pm, Ballard Room, fifth floor, Countway Library of Medicine. Speaker: Beverly Tsacoyianis, Assistant Professor of History, University of Memphis; Doctoral Candidate, Washington University in St. Louis. For further information contact David G. Satin, M.D., Colloquium Director, phone/fax 617-332-0032, e-mail:david_satin@hms.harvard.edu. CHoM Web: https://www.countway.harvard.edu/chom.

What are your plans for this summer? Are you looking for a unique global health experience?

If so, the 3-week course “Beyond the Biological Basis for Disease” offered by Physicians for Haiti and taking place in Port-Au-Prince, Haiti, may be the perfect fit for you! Below are the course objectives, eligibility criteria, and application process. These and all that you need to know about the course can be found by clicking this link to the handout.

Course Objectives

1.   To promote international solidarity and partnership for generating solutions to global health challenges facing societies throughout the world

2.  To foster reflective dialogue between Haitian and international medical students as a means of strengthening ties between the next generation of Haitian health professionals and a global network of their peers.

3.   To provide a structured global health experience for medical students with dedicated supervision and teaching in clinical medicine and social medicine

4.   To study issues related to global health in a resource-poor setting with an emphasis on local and global context

5.   To foster critical analysis of global health interventions in resource-poor settings

6.   To facilitate the development of a clinical approach to disease and illness using a biosocial model through structured supervision and teaching

7.   To build an understanding and skill set associated with physician advocacy

Eligibility criteria for applicants

  • Medical student of any year
  • Fluent in French
  • Available for the entire length of the course (July 14-August 1, 2014)

Application Process

Applications are due January 15, 2014.

Credit for away electives can usually be arranged with a student’s home institution.

**To complete an application or for more information, please visit www.socmedglobal.org or www.physiciansforhaiti.org**

Recap: October/November Grand Rounds: What doctors should know about the SNAP/Food Stamp Program

Our October/November Grand Rounds focused on the SNAP/Food Stamp program. Victoria Negus, an AmeriCorps serving at the Massachusetts Law Reform Institute, gave a talk about the basics of SNAP/Food Stamp eligibility, the application process, common myths surrounding the program, and the role of health care professionals in fighting hunger in Massachusetts.

Her take-home message for medical students and physicians? SNAP is a key component in gaining access to healthy, nutritious food, and it has been shown to have a positive impact on the health of families and individuals –a fact that is especially important to emphasize in light of the recent ARRA cuts. While SNAP is a complex program whose eligibility is based on many criteria, in the end it boils down to consistently asking low-income patients if they receive SNAP. If they do not, they should then be referred to the Department of Transitional Assistance (DTA), Project Bread, or outreach partners.

Please refer to the very helpful, straightforward, and Massachusetts-specific handbook Hunger in the Community – Ways Hospitals can Help for more details about the different ways in which you can help patients get nutritional support.

And here are other resources that Victoria Negus shared… and that we would now like to share with you!

1. Resources for the medical community

a) Project Bread: www.gettingfoodstamps.org

 The Food Source Hotline: 1-800-645-8333

**Patients can call this number to be screened for SNAP eligibility**

b) Children’s Health Watch: http://www.childrenshealthwatch.org

The SNAP Vaccine—Boosting Children’s Health

2. General resources

a) 2013 SNAP Advocacy Guide

b) Online resources: MassLegalServices.org and Masslegalhelp.org

c) Food SNAP Coalition: listserv and monthly meetings in Boston –email Victoria Negus at vnegus@mlri.org if you are interested!

d) MCLE Basic Benefits Trainings: Thursday, February 6, 2014, 9:30am – 12:15pm

e) Food Stamps/SNAP client screening through Project Bread: www.gettingfoodstamps.org

 

**Again, if you would like to receive email updates about SNAP from the MA SNAP Coalition, email Victoria Negus at vnegus@mlri.org and she will add you to the listserv. Also do not hesitate to contact her if you have any question about the SNAP program!**

Juliette Flam, BUSM, buATP

Governor Michael Dukakis Speaks at SPA2!

This past Wednesday, November 6, our SPA 2 class completed their final lecture with a visit from Michael Dukakis, the former governor of Massachusetts and an expert on health care reform.  Governor Dukakis shared a number of his experiences, taught about the history of health care reform, and allowed students the opportunity to ask numerous questions about health care reform and Obamacare. We are so grateful to Governor Dukakis for taking the time to visit us at BUSM and share his expertise!

From left: Katelyn Fritzges (buATP Student Director), Gov Dukakis, Brittany Hasty (SPA2 Leader), Lauren Fiechtner (buATP Alumni Director)

Street Medicine Conference

Here is information on an exciting opportunity to attend the International Street Medicine Symposium in Boston on October 24-26!

Recap: September Grand Rounds: Interview Screening Questions

We hold our monthly Grand Rounds in Medical Advocacy on the 27th of
September and despite the many (many!) events that were going on at the
same time, we were happy to have a great turnout! The students who came were mostly 1st years, and we also had two 2nd year students. Unlike the other Grand Rounds that consist primarily in listening to a speaker, these September Grand Rounds consisted of a workshop led by two 4th year students, namely Katelyn Fritzges and Hugo Carmona. The purpose of the workshop was to teach medical students ways to effectively and respectfully screen patients for social determinants of health such as poverty, homelessness, hunger, immigration status, fear of deportation, social support or lack thereof, inability to read, and background information about potential traumatic past events. The students who participated in the workshop raised a lot of interesting questions and we hope that the workshop has enhanced their ability to confidently and professionally screen patients for sensitive issues that go well beyond the biological basis of disease and are critical to successful patient care.

 

*Thanks to Juliette Flam for this summary!

Advocacy Grand Rounds Feedback

We have been so excited to see the excellent turnout at each of our Advocacy Grand Rounds sessions so far. It’s great to see so many students interested in advocacy, and we hope you will all continue to get involved with buATP this year!

That being said, we want to make our Advocacy Grand Rounds sessions even better and to try to bring in speakers to address topics you’re all interested in, but we need your help! This quick survey gives you a chance to tell us what you thought of our first two Grand Rounds sessions… or to tell us why you did not attend! We also welcome any suggestions you may have for other topics or speakers!

Thanks in advance for your feedback! We hope to see you on Tuesday, October 29 at 11:30 AM when Victoria Negus of the Massachusetts Law Reform Institute will be speaking about food stamp policies!

The Mismeasure of Poverty

Check out this article from the New York Times this month reflecting on the current poverty levels in the US.

Thanks to Matt for sharing!

Getting to Know the First Years!

Our ATP Leaders had a wonderful time meeting some of the new first year medical students interested in getting involved with ATP over dinner at Fire and Ice this past Monday. They offered great new ideas and lots of enthusiasm, and we’re hopeful we’ll see them all again at SPA 1 this year!

Getting to know first years interested in ATP over dinner!

 

 
*Missed the dinner? Keep track of all of the buATP events via our calendar, linked above!

Nepal & Water: A Complex Stream

Several of our ATP leaders have had exciting opportunities to spend this year abroad working on global health projects. Here’s a reflection on access to clean water written by Matt Fleming, who is spending his year in Nepal.

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Nepal & Water: A Complex Stream

Matthew Fleming

 

Nepal, according to the signs that greet you at Tribhuvan International Airport in Kathmandu, has the second (!) largest supply of natural water resources in the world. Then why is it so difficult to find water here in Nepal? I’ll attempt to expand on this theme using some personal anecdotes and data referenced below. Bear with me, this will be quite a bumpy and potentially emotional ride.

 

During my short time here in Achham I have learned that water is one of the most sought after resources for all people, all day, every single day. Currently the monsoons are going strong (including the loudest and brightest 3 hour absolute raining cats and dogs thunder and lightning storm I’ve ever seen) and will last for several more weeks. Even during this season, when water stores are theoretically high, the Director of Facilities here at the hospital mentions the water supply level and how long it will last at the weekly hospital update. This information is as important as the number of patients currently in house, systemic issues identified during the last week, and any new developments pertinent to patient care or operations of the hospital.

 

A Quick Tributary: Some Background on Nepal

 

This is a country in which the World Bank estimates that 25% of the population lives below the international poverty line (~$1.25/day). Two out of 3 people live in rural areas and mostly depend on agriculture for their livelihoods (ref: here). Additionally, the United Nation’s Human Development Index (a calculation that includes life expectancy at birth, mean years of schooling and expected years of schooling, and gross national income per capita) ranks Nepal 157th out of 187 ranked (ref: here). It’s estimated that 19.8 million Nepalese, in a country of around 30 million, don’t have access to proper sanitation.  Official figures note that 80% of the population has access to clean water; however, when functionality of water sources is taken into account, it’s more like 53%.  WaterAid, an organization working in Nepal to improve access to clean water and improved sanitation and hygiene, estimates that the budget for water and sanitation (currently 1 million USD) would need to be increased 14 times to accomplish the millennium development goal of 100% water access by 2017 (ref: here).  After a decade long civil war between Maoist supporters and the government in Kathmandu that ended in 2006, the public sector was left without clear leadership. As a result of this, and many other political and social factors, public services have lacked strong advocates and financial backing by a fractious central leadership.  Back to water. . .

 

Harsh Realities

 

On the jeep ride from Dhanghadi to Achham, driving past mud and tin topped houses nestled in the hilly terrain, I saw kids and adults washing from the pipes on the side of the main road, collecting water for cooking and drinking, and cleaning their clothes, all from the same source. From what the locals here have told me “the government” turns on public water supplies for a few hours in the morning everyday. Each morning, starting with the cry of the hens and the light of sunrise you can see locals- usually moms and children- walking up and down steep and slippery hillside trails carrying large pails. As an aside, these pails bear a strange resemblance to those I associate with carrying gasoline in the US. From what I understand, during the dry season that begins towards the end of winter, the “government” controls the on/off switch for these public water supplies. There is no announcement or warning of when or where there will be water shutoffs or shortages. For the people of rural Nepal when these water shortages occur there is no supermarket to purchase clean water at, no secret stores of water to fall back on, and no guarantee that tomorrow the faucet will turn on.

 

Economics: Scope and Tragedy

 

40% of Nepal’s GDP is attributed to agriculture and most of this is rain fed. As a result, agricultural production and many families’ livelihoods are subject to frequent devastation from droughts and floods. Estimates suggest that 17% of cultivated lands in Nepal have year round irrigation (Ref: here) while just under 50% have ‘some kind of irrigation.’  Clearly, water is an issue of national importance, affects rural communities disproportionately compared with urban ones, and plays a large role in the national economy, as demonstrated by the nation’s reliance on agriculture.

 

I will use the tragedy of the Kosi River flood of 2008 to help elucidate the complexity in the management and distribution of water in Nepal and India. Poor construction of river embankments and poor communication among different branches along the Kosi river lead to the devastating flood of 2008, ultimately affecting over 2.5 million people in southern Nepal and northern India. This disaster was exacerbated by the fact that when dam officials realized there was a leak in a stretch of the Nepal embankments and faxed a report downstream- apparently animals had been eating away at the banks causing the leaks- there was no one in the office to receive the fax (the appointed official for that station was on leave/vacation and no one had replaced him).  Some news reports suggest that the central government of India was unaware of the flood for up to 5-7 days after it began. The breach in the embankment caused 95% of the water from the river to leave via what would eventually measure greater than a 3km wide breach (References: here, here, here). Millions lost there homes, land, medicines, and food stores, the Indian government declared a state of emergency and eventually enlisted the help of the Air Force to deliver supplies and rescue those in need.

 

Another example of the intricate relationship Nepal has with water is India’s plan to build a hydroelectric dam within the borders of Nepal. This dam will provide power, irrigation, and flood control for India while displacing an estimated 75,000 Nepalis (homes, land, businesses, and culturally significant sights) (ref: here). As the horrible cholera outbreak in Haiti demonstrated, water sanitation and safe waste management solutions can affect global communities (NYT article on cholera epidemic in Haiti originating in Nepal here), not only those who live within the confines Nepal’s border. As evidenced by these stories above and the data previously cited, there have been massive public sector failures, poor leadership from governmental and non-governmental organizations (the UN in the case of the Haiti cholera outbreak), and great difficulty in supplying native Nepalese with sufficient water for their health and sustenance. As we’ll see below, the private sector also shoulders great responsibility in not improving water access to Nepalese citizens.

 

The Melamchi River Project: Improving Access for the Urban

 

In an effort to supply water to the over 2 million residents who live in the Kathmandu Valley, the central government started the Melamchi Project. The Melamchi Project (Melamchi Water Supply Project), when complete, will divert 170 million liters of water per day to the Kathmandu Valley. The project consists of a 27km long pipeline that will divert river water from the Melamchi river to a water treatment plant (part of the project) that will then supply the Kathmandu Valley. The project, started in 2000, was supposed to be completed in 2007, but in late 2012 the government terminated the contract of the Chinese contractor hired to build the pipeline and treatment plant. The project has been delayed twice now, first until 2013, and now until 2016. The government has initiated bidding for contractors and hopes to restart the project within a few years.

 

The KTM valley requires approximately 320 million liters of water per day. Currently, the Valley is supplied with 90 million liters per day during the dry season and 150 million liters during the rainy season. With the completion of the Melamchi River Project, Valley residents will have significantly improved access to almost sufficient supplies of water. Now, strong public sector and non-governmental advocates need to leverage their political clout to partner with a professional contracting company to deliver basic human rights to a population in need. Here’s to hoping construction begins again soon and the project is completed on time. Note: this will not improve water access in the Far Western Region, where Achham District is located.

 

Bringing it Back to Achham

 

Frequently when I go to use the restroom here at Bayalpata Hospital in Achham I encounter women and children filling their plastic pails with water. Often, they have a worried look in their face as if to say “please don’t tell anyone.” I have extraordinarily mixed feelings about Nepalese from communities near and far using the clean water resources of the hospital.

 

On the one hand, some may argue that folks like those mentioned above, who are not patients at the hospital and do not work with Nyaya Health, are taking away resources from patients whose treatment and health may depend on clean water. These folks are, one may say, using a resource and infrastructure that was not meant for their use. In a boardroom, a strategic planning meeting, or development conference it may be easy to use these arguments to explain why we should not let these Nepalese use the hospital’s water resources.

 

On the other hand, and allow me to be rhetorical for a moment, did anyone teach me (or likely you) to have access to clean water (many of you are likely familiar with a favorite global health idiom “don’t give a man a fish, teach him to fish”)? How about access to medical care, dental care, appropriate sanitation facilities, a reliable source of food, and so on?

 

I have never had to think about where I was going to get food and clean water from, where I was going to bathe or use the restroom, whether I could afford the prescription from my pediatrician or emergency department. In reflecting on these truths, and the fact that there are basic human rights that we (Westerners, Americans, NGO workers, healthcare professionals, compassionate people, ‘do gooders’, whomever) cannot teach populations to have access to. Perhaps the old global health adage “give a man a fish and you feed him for a day, teach a man to fish and he eats for life” needs a more modern adaptation to accurately assess the rights of individuals and the responsibilities shared by the intersection of the public, private, and non-government sectors.

 

In summary, what right do I have tell someone that they don’t have a right to access the clean water that comes from the hospital? How do I have any more authority than an average Nepali to determine who receives access to this resource? If anything, the people of Achham have more of a right to the hospital’s water supply than perhaps I do- they have lived here, and will continue to live here, for generations to come.

All I can muster when entering the restrooms in the hospital, which have faucets and running water most of the time, is a quiet “Namaste,” a small head node, and a quick smile.