The Newsletter of St. George’s University
                                                           Grenada, West Indies                                          Fall 2010 Vol. 29 No. 2

                    St. George’s University Earns
                 US Accreditation for MPH Program
                     CEPH Approves Grenada School as Fifth Outside US

         he Council on Education for
         Public Health (CEPH) announced
         its accreditation of the Public
Health program at St. George’s Univer-
sity, Grenada, West Indies, making the
University only the fifth non-US institu-
tion approved — and the only univer-
sity in the Caribbean region holding
this distinction.
    St. George’s University’s Department
of Public Health and Preventive Medicine
is eleven years old. The Master of Public
Health (MPH) degree program is offered
within its Schools of Medicine and
Veterinary Medicine. Students may earn
independent MPH degrees or dual
                    (Continued on page 2)              St. George’s University’s Department of Public Health and Preventive Medicine

           St. George’s
                                                     erard St. Cyr has had the oppor-                 As a Principles of Epidemiology
                                                     tunity to experience St. George’s             Instructor to Master of Public Health stu-
            University’s                             University as a student, alum-
                                            nus, and more recently a faculty member.
                                                                                                   dents, the recent US accreditation by The
                                                                                                   Council of Education for Public Health
          Gerard St.Cyr                     Having graduated with a Master of Public
                                            Health (MPH) degree in 2005, he soon
                                                                                                   (CEPH) for the Master of Public Health
                                                                                                   Program is of great significance. “CEPH
                                            returned to the University holding various             accreditation reflects the excellence of
        Master of Public Health             positions and responsibilities within the              our University’s MPH program and
            Instructor/Alumnus              Department of Public Health and Preven-                secures St. George’s University’s place
             Foresees Program               tive Medicine (DPHPM) including:                       along side top institutions in the United
                Expansion with              Practicum and Alumni Relations Coordi-                 States and abroad,” said Mr. St. Cyr. He
                                            nator; Coordinator of Undergraduate                    expressed that this approval not only rec-
          CEPH Accreditation                Teaching of Public Health; and Instructor,             ognizes the dedication of the Department
                                            Principles of Epidemiology.                            and the University as a whole, but further
                                                                                                                      (Continued on page 8)

                                  SGU Launches Medical               OAS Scholarship Recipients                    KBTGSP
    IN THIS ISSUE :               Student Research Institute…3       Michelle Ash & Victoria Bethel…4              Special Edition…9
                                   St. George’s University Earns
                                   US Accreditation for MPH Program
                                   (Continued from page 1)                           work environment for its faculty, and for
                                   degrees, such as the MD/MPH and the               the pursuit of public health programs that
                                   DVM/MPH.                                          will have a positive impact on the people,
                                       “CEPH accreditation is coveted by pub-        animals, and the environment in the
                                   lic health programs across the world and          Caribbean region. Specifically:
                                   we are honored to be in such good, if select,
                                   company,” said Omur Cinar Elci, MD,               • For faculty and staff, CEPH accredita-
                                   PhD, Chair of the Department of Public              tion will encourage greater scholarly
                                   Health and Preventive Medicine at St.               outcomes through new partnerships for
                                   George’s University. “This accreditation            collaborative research and service
                                   validates the critical importance of interna-       activities.
                                   tionalism in public health education, and         • For prospective and current students,
                                   will encourage greater scholarly outcomes           accreditation provides an opportunity
                                   through new partnerships for collaborative          to participate in an acclaimed program
                                   research and service activities.”                   as well as greater access to student
                                                                                       loans and scholarships available only to
                                                                                       students enrolled in CEPH accredited
                                         CEPH accreditation is                         schools and programs.
                                       coveted by public health                      • For alumni, accreditation provides eli-
                                                                                       gibility to obtain Board Certification in
                                            programs across the                        Public Health (CPH) which provides
                                                                                       new and higher standards of employ-
                                      world and we are honored                         ment opportunities. Furthermore, vari-
                                                                                       ous medical residency programs, such
                                             to be in such good,                       as Family Medicine, Pediatrics, Occu-
THE CHRONICLE is published
                                              if select, company.                      pational Medicine, and Preventive
through the Office of University
                                                                                       Medicine require or encourage an MPH
Communications, c/o The North            —Omur Cinar Elci, MD, PhD, Chair of the       degree in their curriculum. Only the
American Correspondent:                 Department of Public Health and Preventive
                                                                                       alumni of CEPH accredited MPH pro-
                                               Medicine at St. George’s University
University Support Services, LLC                                                       grams can transfer their MPH credits
One East Main Street                                                                   into the residency training. Therefore
Bay Shore, New York 11706-8399        Dr. Charles R. Modica, Chancellor of             SGU MD/MPH alumni will not only
                                   St. George’s University, said, “The suc-            shorten their residency periods, they
US Phone: +1 (631) 665-8500                                                            will attract more and higher standard
                                   cessful accreditation outcome is a histori-
US/Canada Toll-Free:               cal moment for the University. This marks           residency programs.
1 (800) 899-6337                   our first US accreditation and adds to the        • For our community partners, accredita-
US Fax: +1 (631) 665-5590          long list of recognitions and approvals of          tion equates to an appreciation that they
                                   our School of Medicine by external bodies           are working in collaboration with a pro-
UK Free Phone: 08001 699061
                                   across the world.”                                  gram whose standards have been inter-                    CEPH is an independent agency recog-             nationally recognized.          nized by the US Department of Education
                                   to accredit public health schools and pro-           Through this accreditation, SGU
Contact Caroline McCann at         grams. Accreditation from this council            reaffirms its commitment to the highest
+ 1 (631) 665-8500 ext. 396 or     enhances the stature of SGU around the            standard of public health excellence with any article   globe and strengthens SGU’s commitment            and to positively contributing to global
suggestions or comments.           to providing a public health program of           public health challenges today and in
                                   excellence to its students, an exceptional        the future.

2                                                                                                     ST. GEORGE’S UNIVERSITY
                       ST. GEORGE’S UNIVERSITY LAUNCHES
St. George’s University has long demon-
strated a commitment to scientific
research. In a fervent and continuous
effort to fulfill its mission to advance
health care and environmental develop-
ment worldwide, research has played a
key role in its academic curriculum. With
the establishment of the Windward
Islands Research & Education Foun-
dation (WINDREF) on the True Blue
campus in 1994, SGU secured itself a
place to carry out short and long-term,
multidisciplinary research and education
programs in fields which include
epidemiology, anthropology, virology,
conservation ecology, marine biology and
other topics relevant to tropical climates
and developing nations.
    St. George’s University’s most recent
research-driven endeavor is the Medical
Student Research Institute (MSRI), an
innovative web based project skillfully
constructed and promoted to further estab-
lish research as an integral component of
the School of Medicine academic pro-
gram. According to Dr. Stephen Weitz-
man, Dean, St. George’s University School
of Medicine, “The MSRI grew out of a
conviction that research is necessary for      assist students and faculty in their efforts   ance and mentorship of expert faculty.
progress in understanding of health and        to publish scholarly research.                 Similarly, a Research Member track is
disease and for improving patient care.”          Furthermore, the MSRI will offer med-       available to students who have completed
    As a centralized source for all basic      ical students who have demonstrated aca-       term 5 with a GPA of 3.5 or higher.
science and clinical research, the MSRI is     demic excellence the opportunity to begin         The MSRI Selection Committee
designed to serve many purposes. The           a four-year clinical journey that will lead    encourages all interested students to learn
MSRI will facilitate collaborations            to a Doctor of Medicine degree with            more about these opportunities and the
between qualifying medical students and        Distinction in Research. In order to enroll    latest SGU research projects on the
faculty members to conduct research with-      in the MSRI MD with Distinction in             MSRI website located under “My SGU” at
in their chosen specialties and share          Research, students must apply during  The Committee encourages
resources between SOM and its multiple         terms 2 through 5 and maintain a GPA of        faculty members who are actively per-
clinical facilities. The online capabilities   3.7 or greater. The select group of students   forming research to register with the
of the MSRI will offer a virtual environ-      will be limited to 50 students per year.       MSRI. The success of the MSRI depends
ment within which ideas can be shared,         They will be involved in basic, clinical,      upon their willingness to participate as
scholarly activity can be tracked and pro-     translational, or social science research      a virtual mentor to students from across
moted, and resources can be provided to        throughout medical school under the guid-      the globe.

    THE   CHRONICLE                                                                                                          3
                                    OAS Scholarship Recipients Michelle Ash and
                                              dietetic internship to qualify as a Regis-   drug interactions of local and regional
                                              tered Dietician in her home country of       herbs,” said Michelle. She hopes to get
                                              Trinidad, sharing her expertise in an        involved in the collection and analysis of
                                              effort to combat the rise of obesity, dia-   data to uncover current trends and associ-
                                              betes, and heart disease. “Helping those     ations relating to eating patterns within
Michelle Ash is the one of two recipients     who may not have the same opportunities      the Caribbean region.
of the coveted Organization of American       that I have had in my lifetime thus far is      Michelle is passionate about the need
States (OAS) Scholarship to attend            of utmost priority to me.”                   for improved preventative health care in
St. George’s University. Michelle joined         Michelle is an individual with a clear    the developing nations of the Caribbean,
St. George’s University this fall as an       vision for her future. After graduating      and is a fervent believer that a sound
incoming Master of Public Health stu-         from St. George’s University, she plans to   investment in preventative health care
dent, and is one of only five recipients of   return home to Trinidad as a dietitian and   now will result in long-term reduction of
the OAS Graduate Academic Scholarship
from the OAS Member States of Trinidad
and Tobago. “I am quite excited that my                                                    I know that my advanced
OAS scholarship has allowed me the
opportunity to further my knowledge and
                                                                                           degree options and
skills at such a highly recognized and                                                     additional certification
respected institution,” said Michelle.
    Michelle is joining the Department of                                                  options in the arena of
Public Health and Preventive Medicine                                                      public health are also
at a very exciting time with SGU’s MPH
program having recently received CEPH                                                      almost limitless. I feel so
    With regard to this recognition,                                                       privileged to be a part of
Michelle states, “I believe that this                                                      the SGU family at this
accreditation means that my MPH degree
will have so much more value now. First-                                                   exciting point in time.
ly, students can be rest assured that the                                                                         — Michelle Ash
quality of the MPH program at SGU is
among the best, since it is now ranked
highly alongside all other accredited         specialized public health educator. She      total annual health care expenditures of
schools of public health in North Ameri-      hopes to apply her MPH degree to             these countries. She continued, “Public
ca. And on a personal note — besides          chronic disease prevention and lifestyle     Health nutrition plays a vital role in
being eligible for the CPH Board exami-       management by providing medical nutri-       decreasing the number of new chronic
nation — I know that my advanced              tion therapy to those individuals already    disease cases diagnosed every year, as
degree options and additional certifica-      diagnosed with chronic diseases, specifi-    well as reducing the excessive demand
tion options in the arena of public health    cally kidney disorders, cancer, and          for medications and surgeries which
are also almost limitless. I feel so privi-   HIV/AIDS.                                    result from complications arising from
leged to be a part of the SGU family at          When asked about specific research        poorly managed chronic diseases.”
this exciting point in time.”                 opportunities, she expressed a keen inter-      The future is bright for Michelle Ash,
    To date, Michelle has dedicated her-      est in alternative medicine such as herbal   and so too for the communities her
self to a career in Dietetics & Nutrition.    remedies indigenous to the Caribbean         expertise and dedication will transform.
After graduating with a BSc in Human          region. “A great deal of research still      She looks forward to making contri-
Nutrition & Dietetics from the University     needs to be done on the safety, chemical     butions through grassroots program
of West Indies, she completed a one-year      makeup, functions, side effects, and food-   development as well as national health

   4                                                                                                       ST. GEORGE’S UNIVERSITY
Victoria Bethel Pursue Masters of Public Health
   sector reform through policy planning           time frame for completion. When asked         throughout its Consortium of OAS
   and implementation.                             about her on-campus experience, Victoria      Universities, a list of reputable education
      The OAS was established in 1948 with         stated that her expectations have been        institutions with which St. George’s
   the signing of the Charter of the OAS.          surpassed and she has found “the campus       University is proudly associated.
   It was created to achieve among its 35          setting tranquil and conducive to study-         “Wherever I can make the most impact
   independent member states of the Ameri-         ing, the facilities comfortable and the       is where I will be,” Victoria stated and
   cas, as stated in Article 1 of its Charter,     professors very accommodating.”               this is testimony to the promising career
   “an order of peace and justice, to promote         Looking towards the future, Victoria       she has ahead of her. We look forward to
   their solidarity, to strengthen their collab-   plans to apply her MPH degree to              her continued success and extend best
   oration, and to defend their sovereignty,       “address lifestyle changes at the school      wishes to her and all the participants in
   their territorial integrity, and their inde-    level and target adults to make a real        the MPH program.
   pendence.” The Organization of Ameri-           change” within the health care system.
   can States constitutes the principal politi-
   cal, juridical, and social governmental
   forum in the Hemisphere.
                                                                                                 I am anxious to get out
   Second SGU Student Receives                                                                   and make a significant
   Coveted OAS Scholarship                                                                       impact on public health
   Victoria Bethel joins fellow classmate
   Michelle Ash as the second recipient of
                                                                                                 and all that it entails.
   the coveted Organization of American                                                          I also hope to influence
   States (OAS) Scholarship to attend
   St. George’s University (SGU). Victoria                                                       others into entering
   is currently enrolled at SGU as a Master
   of Public Health (MPH) student.
                                                                                                 the field.      — Victoria Bethel
      After completing her medical training
   in the Dominican Republic, she returned
   to her native Bahamas where she worked
   as a General Practitioner. During her
   period of study at medical school and her       She intends to pursue her passion and,
   added experience as a practicing clini-         as she further stated, “I am anxious to
   cian, she repeatedly encountered chronic        get out and make a significant impact
   medical conditions which she felt may           on public health and all that it entails.
   have been preventable had the patients          I also hope to influence others into enter-
   been more knowledgeable about their             ing the field.”
   healthcare and had intervention been                Victoria considers it an honor to have
   made sooner. This fueled her interest and       received the OAS scholarship which is
   desire to make a positive impact in the         having a profound impact upon her
   public health arena.                            career. The OAS supports human
      Having decided upon her field of             resource development throughout its
   study, Victoria said that selecting the         member states and beyond. Grenada
   MPH program at SGU was an easy                  became a member state in 1975. The OAS
   choice because it matched her objectives        encourages and supports active scholar-
   in terms of the classes offered and the         ship opportunities and participation

       THE   CHRONICLE                                                                                                          5
                                      FA L L 2 0 1 0 W H I T E C O AT C E R E M O N I E S

                      Medical Students Officially Welcomed at
                         Fall 2010 White Coat Ceremony
On Monday, August 16, 2010,                                                                           became a Knight Bachelor in
more than 400 students took the                                                                       1979 and was awarded a life
oath of Professional Commitment                                                                       Peerage as Lord Walton of
to mark their entry into the                                                                          Detchant in 1989.
medical program at St. George’s                                                                           Lord Walton of Detchant held
University School of Medicine.                                                                        the positions of President of the
This year’s biannual White Coat                                                                       British Medical Association
Ceremony was held at St. George’s                                                                     from 1980–82, of the Royal
University Taylor Hall, where an                                                                      Society of Medicine from
excited and emotional crowd                                                                           1984–86, of the General Medical
includ ing family, faculty, and                                                                       Council from 1982–89, and of
special invited guests filled the hall                                                                the World Federation of Neurolo-
to maximum capacity to witness                                                                        gy from 1989–97. Adding to the
the ceremony.                                                                                         list of accomplishments, Lord
    During opening remarks, St.                                                                       Walton has also chaired the
George’s University Chancellor                                                                        House of Lords Select Commit-
Dr. Charles Modica reminded stu-                                                                      tee on Medical Ethics and was a
dents that their journey has just                                                                     member of its Select Committee
begun, and is supported by dedi-                                                                      on Science and technology for
cated and accomplished faculty                                                                        ten years. In 2006 he was pre-
members. Speaking to the enthu-                                                                       sented with the Hewitt Award by
siastic crowd, Chancellor Modica                                                                      the RSM Foundation Inc.
said, “You’re here because we                                                                             Relying on this expansive
believe you can do it — and you                                                                       experience and qualification in
believe you can do it.”                         important people, and each one of you        the field of medicine and research, Lord
    The Chancellor reassured students that      has the opportunity to achieve your goals    Walton pointed out that in order to pro-
St. George’s University is not an institution   when you arrive in Grenada.”                 vide proper diagnosis and treatment “it is
where you have to compete, but one in              Lord John Walton of Detchant, the         important to recognize that you need
which students learn and succeed together.      keynote speaker for the ceremony, sought     core knowledge — knowledge of human
Chancellor Modica pointed out that at           to pass on lessons to the students, saying   structure and function, of anatomy,
St. George’s, “Everybody has the potential      that classroom, laboratory and clinical      physiology, bio-chemistry, and genetics
to succeed together — no one has to be          experience “is crucial to the practice of    because it is very important for many,
left behind.” He further stated that the fall   medicine in the 21st century, all of which   many reasons.”
2010 class has the luxury of following a        are part of a learning process which you        In addition to knowledge which is
legacy of success, from the 1977 charter        are all beginning today.”                    fundamental, Lord Walton highlighted
class to the successful graduation of              Lord Walton Kt TD MA MD DSc               the need for core medical skills, citing
nearly 9,000 physicians. “With this history     FRCP FMedSci, qualified in 1945 with         the importance of taking a complete
of success, the outcome is inevitable as        first class honors from the Newcastle        medical history and carrying out com-
long as there is application."                  Medical School of the University of          prehensive physical examinations. “His-
    Chancellor Modica explained one of          Durham. He was a former consultant           tory and physical examinations,” said
the best things at St. George’s University      Neurologist to the Newcastle hospitals,      Lord Walton, “are at the core of patient
is that “there are a lot of important           Professor of Neurology in the University     care.” Lord Walton also addressed issues
and individual stories, you get to meet         and Dean of Medicine from 1971-81. He        such as the importance of doctor-patient

   6                                                                                                         ST. GEORGE’S UNIVERSITY
                                      FA L L 2 0 1 0 W H I T E C O AT C E R E M O N I E S

                                                                Keith B. Taylor
                                                            Global Scholar’s Program
                                              On Thursday August 12, 179 first-year
                                              medical students from the Keith B. Taylor
                                              Global Scholar’s Program (KBTGSP)
                                              received their white coats in the presence
                                              of family, friends, and faculty at the
                                              Northumbria University campus in New-
                                              castle, United Kingdom.
                                                 Dr. Asif Ghauri welcomed the August
                                              2014 Class and had the honor of Master of
                                              Ceremonies. He was followed by remarks           KBTGSP Master               KBTGSP
                                                                                                of Ceremonies          Keynote Speaker
                                              from David Chesser, BSc, ACA Deputy              Dr. Asif Ghauri        Jane Macnaughton
   Keynote Speaker Lord Walton of Detchant    Vice-Chancellor and Finance Director at
                                              Northumbria University, and Dr. Robert            Most importantly, she asked the future
                                              Jordan, PhD, Associate Dean of Enrol-         doctors that in receiving their white coats,
                                              ment Planning at St. George’s University.     they never forget the reason and passion
                                              Keynote Address speaker, Jane Mac-            that led them to medicine in the first place.
                                              naughton, MA (Hon), MBChB, MRCGP,             “You have a lot to learn — the knowledge
                                              DRCOG, PhD, congratulated students on         and skills necessary to be a proficient doc-
                                              their success of reaching medical school,     tor, but in the midst of all that busy learn-
                                              but warned, “Just when you feel you have      ing, don’t neglect to develop the humane
                                              reached a summit—another one rears up         attitudes and behaviours that will make you
                                              to challenge you. Medicine is like climb-     a truly good doctor — caring, compassion-
                                              ing a mountain and never reaching the         ate, and understanding…So you put on that
                                              summit, but each rise you get to has a fab-   white coat, don’t take off yourself.”
    Master of Ceremonies, Brandon Francis
                                              ulous vista and as you go you learn more          Following the Keynote Address,
communication and establishing a trust-       and more that will help you on your climb.    students were robed in their white coats
ed relationship with patients. He further     You need to be lifelong learners as doc-      and recited their Oath of Professional
stressed the importance of research,          tors, and it starts now.”                     Commitment led by Dr. Asif Ghauri.
saying, “Today’s research brings tomor-
row’s medicine.
   The esteemed doctor shared his expe-
riences with the incoming medical class,
reminding them that the practice of med-
icine deals with living, thinking beings
and this should never be forgotten, and
always taken into consideration, when
treating patients.
   Following the keynote address the stu-
dents were robed in their white coats,
took the oath of professional commit-
ment, and were officially welcomed as
“Medical Students” to the St. George’s
University School of Medicine.

   THE   CHRONICLE                                                                                                           7
                                    FA L L 2 0 1 0 W H I T E C O AT C E R E M O N I E S

              School of Veterinary Medicine White Coat Ceremony
The School of Veterinary Medicine, which                                                    belong to a profession that prides itself in
has been a part of St. George’s University                                                  serving society and you have joined a
for eleven years, held its 23rd White Coat                                                  dynamic and exciting international univer-
Ceremony on Tuesday, August 17, at the                                                      sity that will provide you with a unique
Bourne Lecture Hall. The 77 prospective                                                     environment to study modern global
veterinarians who were honored and wel-                                                     veterinary medicine.” He encouraged the
comed in this ceremony came from ten                                                        students: “In addition to challenging your-
countries: the United States, United King-                                                  self, challenge your classmates. This is
dom, Canada, Guyana, Jamaica, Botswana,         SGUSVM Master             SGUSVM            your family for the next four years. Mentor
Mexico, France, Ireland, and Sweden.             of Ceremonies         Keynote Speaker      each other, help them through the next four
                                                 Dr. Emma Hage         Bonnie V. Beaver
   The Chancellor, Dr. Charles R. Modica,                                                   years and they will help you.”
officially welcomed and congratulated         Ceremonies, Dr. Emma Hage, congratu-              Following the delivery of a splendid
the students. “At St. George’s University,    lated the students on their accomplish-       speech by Keynote Speaker, Bonnie V.
there is an environment of caring,” he        ment. “I wish you tremendous success on       Beaver, BS, DVM, MS, the students
said. “You are special to us. You are small   your veterinary journey,” she said.           donned their white coats and recited their
in number… but your spirit is great and if       The Dean of the School of Veterinary       Oath of Professional Commitment led by
you are anything like your predecessors,      Medicine, Dr. Raymond Sis, also address-      Associate Professor Dr. Kristin Chaney,
you will make us proud.” Mistress of          ed the incoming students. He said, “You       DVM, DACVIM.

St. George’s University’s Gerard St.Cyr              (Continued from page 1)
motivates its staff and faculty to expand     Health and Preventive Medicine, Dr.           break from his mathematics and chemistry
upon the great quality of the program,        Omowale Amuleru-Marshall, for “their          teaching position at the local Grenville
which he expects will attract an even         vision and efforts in putting the machin-     Secondary School. As fate would have it,
broader student body, faculty, and visiting   ery in place.” He credits Dr. Omur Elci,      he read a brochure for the DPHPM and
professors in the near future.                Chair, Department of Public Health and        went directly to the Registration Office to
    Research and service activity will        Preventative Medicine, for his organiza-      apply for the MPH Program.
certainly be an area that will gain more      tion and leadership which resulted in            Even as an undergraduate student at
attention and focus as MPH students get       CEPH accreditation for St. George’s           Andrew’s University in Michigan, US,
more involved with the Windward Islands       University with its first application.        Mr. St. Cyr’s genuine desire to contribute
Research & Education Foundation (WIN-            Mr. St. Cyr points out that Doctor of      to improving the welfare of mankind
DREF). Established in 1994 with funds         Medicine/Master of Public Health dual         was always at the forefront. While he
granted by the University, WINDREF, an        degree students benefit from CEPH             excelled and valued his career in teaching
independent nonprofit organization locat-     accreditation as well. The dual MD/MPH        both at the university and secondary
ed on the True Blue campus, is driven to      degree requires 48 credits of Public          school levels, the opportunity to enhance
advance health and environmental devel-       Health courses, in addition to completing     his education and redirect his career with
opment through multidisciplinary research     the four-year Doctor of Medicine              a MPH degree while remaining near
and education programs.                       degree program. Upon graduation, SGU          his family in Grenada was one he
    The rigorous preparation for CEPH         MD/MPH students will have the advan-          embraced fully.
accreditation was truly a collaborative       tage of shortening their preventive medi-        Gerard St. Cyr has successfully com-
effort by faculty, students, and local and    cine residency requirement by one year.       bined his two passions of teaching and
regional health professionals, with each      Mr. St. Cyr believes this benefit will        public health. He describes teaching his
team member having a specific role and        entice more students to apply for the dual    students at St. George’s University as a
responsibility in this comprehensive          degree program.                               “dream come true,” viewing the opportu-
process. Mr. St. Cyr praises the Univer-         A native of Grenada, Mr. St. Cyr’s first   nity to guide and influence a future
sity’s administration together with the       association with St. George’s University      generation of public health specialists as
former Chair, Department of Public            was coaching summer basketball camp on        a gift that continues to give.

   8                                                                                                         ST. GEORGE’S UNIVERSITY
                          KBTGSP EDITION OF THE SGU CHRONICLE

          Editors: Joshua Ramjist, Medical Student and Cheryl Macpherson, Professor and Chair of Bioethics

         his special edition of the SGU Chronicle          tives on health, healthcare, and the impact of
         highlights the creativity and dedication of       culture therein.
         the students in the Keith B. Taylor Global           In an ever shrinking world, the concept of Global
Scholars Program (KBTGSP). The Global Scholars             Medicine no longer resides solely within the distant
Program allows students in the School of Medicine          reaches of the globe but has taken up residency in the
to complete the first year of their studies in New-        clinics and hospitals of North America and Europe.
castle, England, and then to join their counterparts in    Diseases that were once confined to discrete regions,
Grenada for the second year. Afterwards, students          have now become commonplace thus making it imper-
continue on the conventional St. George’s University       ative that physicians are broadly trained in both what
medical curriculum through their clinical clerkship        is expected and unexpected in the clinical realm. What
rotations. The compositions within this issue mirror       is more, physicians are now expected to deliver a high
the vision of the Global Scholars Program, that of         standard of care across ethnicities and languages,
“Global Medicine.” The authors, while hailing from         which are exotic and foreign to their own. It is under
different and diverse backgrounds, share a common          these conditions that the beauty of the Global Scholars
bond having studied and matured within Newcastle           Program emerges. A student is given the opportunity
as part of the Global Scholars Program.                    to train in multiple countries and to embrace different
   In an effort to support and promote that concept,       cultures and soak up their diversity. Ultimately, these
several KBTGSP students sought to publish their            benefits not only impact on the student but enhance
related thoughts and experiences for the entire            the quality of care they are able to deliver to their
SGU community. Working through SGU’s Bioethics             future patients. Such awareness, experience, and toler-
Department and the Office of Communications,               ance of differences support global bioethics and
they solicited, edited, and compiled the essays for        human rights. It is from those motivations that the con-
this special issue. Included are poems and perspec-        cept and contents of this special issue arose.

THE   CHRONICLE                                                                                              9
                                 KBTGSP EDITION OF THE SGU CHRONICLE

                                   THE POSITIVE IMPACTS OF
                                THE GSP’S HIDDEN CURRICULUM
                                                            by Alex Drossos

About the Author: Alex is currently in                                                        Health Service and experienced the UK
his third year of medical school in the                                                       system from the patient perspective. We
KBTGSP at St. George’s University,                 The GSP has been                           were also exposed to the British teaching
completing his clerkship in New York                                                          style as we were taught by many local
City. He is also a part-time student at          — and continues to be —                      professors. In Grenada, we had direct
the University of Toronto in the Health                                                       hospital experience during the Clinical
Professions Education (Higher Edu-                an experience unlike                        Skills course. Many of us got involved in
cation) M.Ed. program.                                                                        the community, one example being when
                                                    any other medical                         our GSP class organized a soccer match
As a student in the second GSP class I                                                        where we competed with local Grenadian
can attest to the fact that we all wanted            school program.                          high school students to raise funds for
the GSP to truly have a Global Medicine                                                       their team. The diversity of New York
curriculum. We were also determined to                                                        offers endless exposure to multicultural-
take the faculty and administration to task                                                   ism, both inside and outside of the hospi-
on this issue, including the likes of Dr.       lead to a hidden curriculum with the          tal setting.
Calum Macpherson, Dr. Curry, and Fiona          positive impact of promoting a Global             Through the GSP and the experiences
Thomson. In terms of Global Medicine            Medicine perspective.                         it has brought us thus far, we have all
we had a special lecture series, and               The Online Dictionary of the Social        grown in terms of knowledge, maturity
attended the annual Medsin-UK Global            Sciences (         and especially in terms of being global
Health Conference. Now there are selec-         defines the hidden curriculum as:             citizens. As global citizens we better
tives specifically designed for the North-                                                    appreciate and accept our differences. We
                                                   “The norms, values and social
umbria campus.                                                                                can thus both adapt to and empathize with
                                                   expectations indirectly conveyed to
    At other times the results fell short of                                                  a much greater variety of circumstances
                                                   students by the styles of teaching,
our expectations. We had no shortage of                                                       patients present. The GSP has been —
                                                   unarticulated assumptions in teach-
great ideas for activities that would fur-                                                    and continues to be — an experience
                                                   ing materials and the organizational
ther enhance the Global Medicine cur-                                                         unlike any other medical school program.
                                                   characteristics of educational insti-
riculum of the GSP, but not all could be                                                      Though there is always room for
                                                   tutions. Social scientists find that
implemented for a variety of reasons. Our                                                     improvement and growth in any program,
                                                   the influence of the hidden curricu-
first year at Northumbria University                                                          through its hidden curriculum the GSP
                                                   lum on educational outcomes is
came and went quite quickly. It was defi-                                                     has already offered us much more in
                                                   equal to or greater than the overt or
nitely a great year and we felt that we                                                       terms of Global Medicine than most of us
                                                   intended curriculum.”
made good strides with the evolution of                                                       realize and acknowledge.
the GSP, but at the same time felt a void           The hidden curriculum can also
in the area of Global Medicine.                 include activities outside of class time,
    Now in my third year of medical             including recreational and social events,
school and the GSP — after completing a         cultural experiences and even travel, the
year in Newcastle, a year in Grenada and        latter of which all GSP students quickly
now a few months in New York City —             learned to master! Learning to navigate
I have realized that although the formal        many different airports results in a fairly
curriculum itself isn’t 100 percent global      quick study of societies and cultures.
in its content, the nature of the entire pro-       While in the United Kingdom most of
gram, indeed the entire experience, has         us registered as patients with the National

   10                                                                                                         ST. GEORGE’S UNIVERSITY
                                 KBTGSP EDITION OF THE SGU CHRONICLE

                                                               by Neel Shah

About the Author: Neel Shah is                                                                 tion), the average settlement is nearly
currently a 22-year-old medical stu-                                                           40 percent higher in the UK.3 While this
dent studying as part of the KBTGSP                  As the United States                      surely can account for a portion of the
in Newcastle upon Tyne, UK. He cur-                                                            increased costs, the margin is not nearly
rently resides in his place of birth,            continues with its overhaul                   large enough. Prescription drugs account
Toronto, Canada. He can be reached                                                             for about 12.4 percent of US health care
at                                   to reform the largest                     expenditures (10 percent for Medicaid);
                                                                                               in total the US spends more on prescrip-
Three trillion dollars, yes trillion with         private and public health                    tion drugs than any other OECD nation.4
twelve zeros; that is what health care is                                                      However, if one were to hypothetically
expected to cost in the United States
                                                 care program in the world,                    remove this entire amount from US
within ten years if no changes were to             it is apparent that in a                    health care expenditures, the US still
happen.1 As of 2007, health care related                                                       spends twice that of the UK per capita.2
costs accounted for 16.0 percent of the             topic as polarizing as                         What then is responsible for the differ-
US Gross Domestic Product (GDP), com-                                                          ing health care costs in both these coun-
pared to the United Kingdom’s 8.4 per-             health care reform, no                      tries? Administrative costs and hospital
cent of GDP, and the Organisation for                                                          in-patient costs are significantly higher in
Economic Co-operation and Develop-                 change will come easy.                      the United States — higher in fact than
ment (OECD) average of 8.9 percent.2                                                           any other country in the world.4 The
The UK functions through a highly cen-                                                         excessive costs, however, can most easily
tralized National Health Service (NHS);                                                        be accounted for in the drastic increase in
it pays $2,446 US purchasing power par-          to bear this out; the UK consumes more        health insurance premiums. From 1988 to
ity (PPP) per capita out of public funds,        alcohol (11.0 vs. 8.6 Liters per capita),     2005, health insurance premiums have
achieving nearly universal coverage.2            more tobacco (21.0 percent vs. 15.4 per-      increased yearly by as much as 18 percent
Conversely, the US pays $3,307 (US PPP)          cent smoke regularly), and has only a         for a family of four and on average 9 per-
per capita out of public funds alone, and        slightly healthier population in terms of     cent a year, while worker’s earnings and
covers less than 40 percent of the popula-       Body Mass Index (62.0 percent vs. 67.3        inflation have never increased by more
tion.2 You read that correctly. The US           percent are overweight or obese).2 These      than 6 percent in any given year.1 As
pays more money out of public funds than         risk factors attribute to a large cause of    health insurance rates continue to climb,
the UK per capita, and achieves astonish-        mortality in both these countries, but the    real earnings vs. inflation have remained
ingly less than half the coverage managed        difference is negligible.                     relatively stagnant. Hospitals have also
by the NHS. The question then is what               Perhaps the answer then lies in the        been increasing their costs to offset the
does more than twice the money ($7,290           increase malpractice litigation and phar-     payments they receive from insurance car-
vs. $2,992 US PPP) buy you in terms of           maceutical costs in the United States.        riers and to account for nonpayment,
health care results?2                            Physicians often claim the fear of mal-       caught in the crossfire are over 36 million
    Surprisingly the US trails behind the        practice litigation drives them to practice   uninsured Americans and millions of tax-
UK in life expectancy (79.5 years vs. 78.1       “defensive medicine,” leading them to         payers who have seen public health care
years) and infant mortality (5.0 vs. 6.7         order diagnostic tests which yield no ben-    costs increase.5 When taking into account
deaths per 1,000 live births).2 Surely           efit to the patient, but increase costs.      the lower life expectancy and higher
though, this difference can be attributed        However, while the US has 50 percent          infant mortality rates, the US does outper-
to increased risk factors from the US            higher rate of malpractice litigation         form almost every other nation in other
lifestyle right? Statistics however, do little   (0.18 vs. 0.12 claims per 1,000 popula-                          (Continued on page 12)

    THE   CHRONICLE                                                                                                           11
                               KBTGSP EDITION OF THE SGU CHRONICLE

(Continued from page 11)                      • Insurers are prohibited from discrimi-
                                                                                             1   Manchikanti, L. (2008). Health Care Reform in the
relevant statistics. The US suffers from a      nating against individuals with                  United States: Radical Surgery Needed Now More
lower mortality than the UK from Cancer         pre-existing conditions                          Than Ever. Pain Physician, 11, 13-42.
(157.9 vs. 173.3), Acute Myocardial                                                          2   Organisation for Economic Co-Operation and Devel-
                                              • Chain restaurants are required to                opment. (2009). OECD Health Data 2009 Statistics
Infarction (37.9 vs. 45.3), Cerebrovascu-
                                                display caloric content on menus                 and Indicators for 30 countries. Organisation for
lar Disease (33.4 vs. 52.0) and Diseases of                                                      Economic Co-Operation and Development.
Respiratory Systems (59.8 vs. 75.3) [all      • Penalties for companies and individu-  ,3343,en_2649_3
values represent deaths per 100,000].2 The      als who refuse to provide/purchase               “Accessed Jan 28th, 2010”
United States also has a significantly          health insurance                             3   Anderson, G. F., Hussey, P. S., Frogner, B. K., &
higher number of MRIs and other high-                                                            Waters, H. R. (2005). Health Spending in The Unit-
                                              • Increased taxes on pharmaceutical                ed States and The Rest Of The Industrialized World.
tech equipment per capita than most                                                              Health Affairs, 24 (4), 903-914.
                                                companies, as well as increased Med-
nations and adapts faster than the slower                                                    4
                                                icaid discount on brand name drugs6              Pearson, M. (2009). Written Statement to Senate
centralized NHS.1 The message that                                                               Special Committee on Aging. Organisation for
                                                                                                 Economic Co-operation and Development.
reform was needed seems to be clear.              The bill has spurred many opponents  
With the passage of Patient Protection and    to wonder at the possibility the Congres-          “Accessed Jan 28th 2010”
Affordable Care Act into law, change has      sional Budget Office is incorrect, and this    5   DeNavas-Wait, C., Proctor, B. D., & Smith, J. C.
                                                                                                 (2009). Income, Poverty, and Health Insurance
arrived, but in what form?                    may actually increase the deficit.8                Coverage in the United States: 2008. U.S. Census.
    The bill aims to reel in insurance        As the United States continues with its        6   Congressional Bills 111th Congress. H.R. 3590
premiums, and provide some level of           overhaul to reform the largest private and         Public Print (2009)
insurance coverage for 30 million unin-       public health care program in the world, 
sured Americans.6 The Congressional           it is apparent that in a topic as polarizing       “Accessed Apr 29th 2010”
Budget Office predicts the new bill will      as health care reform, no change will          7   Congressional Budget Office. Cost Estimate
also serve to reduce the deficit compared     come easy. It remains to be seen just how          for Pending Health Care Legislation. (2010)
to if no changes had been enacted,            effective this reform act and future legis-        Manager%27sAmendmenttoReconciliationPropos-
by $138 billion within the first decade,      lation will be at curbing increasing fraud         al.pdf?p=9 “Accessed Apr 29th 2010”
and by $1.2 trillion within the second        (15 percent of total Medicare spending)1           James, Frank. Health Overhaul Another Promise
                                                                                                 U.S. Can’t Afford. (2010). NPR.
decade.7 Most changes will be effective       and lowering infant mortality and health 
by 2014, with the bill coming into            care outcomes. The debate exemplifies              overhaul_another_promis.html
                                                                                                 “Accessed Apr 29th 2010”
full effect by 2018. Highlights of the        the change awaiting the health care field,
bill include:                                 and the responsibility of all those
                                              involved to become educated, aware, and
• Insurers are prohibited from charging
                                              well apprised of the issues. The United
  co-payments on certain kinds of
                                              States’ attempt to revitalize health care
  preventive care
                                              has ensured progressive changes, but it is
• Insurers are prohibited from dropping       only a step in the continuing goal of all
  policyholders when they get sick            nations — to provide efficient, effective
                                              and excellent care to all.
• Enhanced Medicare eligibility as well
  as improved fraud detection within

   12                                                                                                              ST. GEORGE’S UNIVERSITY
                                 KBTGSP EDITION OF THE SGU CHRONICLE

                                                “NO HABLO INGLÉS”
                                                     by Joshua K. Ramjist, MS-III

About the Author: Joshua is a member                                                                Later that evening I reflected on the
of the KBTGSP August 2007 class. He              Our value to our patients                      lack of my history taking during the day.
is currently rotating at Maimonides                                                             In medical school we would take turns
Medical Center in Brooklyn, NY, and is             is not measured in the                       practicing open- and closed-ended ques-
an inductee to the Gold Humanism                                                                tions, all to build our repertoire and con-
Honor Society. He is originally from
                                                quantity of time or number                      fidence asking pertinent, disease specific
Pickering, Ontario, Canada.                        of words we’re able to                       questions. However, my textbooks that
                                                                                                offered so much promise diagnosing dis-
It was the first day of my Internal
                                                 exchange, but the quality                      eases, never explained how to proceed
Medicine rotation as a third year medical          of our interaction and                       when you can’t ask a question, or can’t
student. After two years of reading books                                                       understand the response.
and attending lectures, I was excited to see      sincerity with which we                           As the week wore on, I began to ques-
what actually existed in the real world. Just    aim to meet their needs.                       tion the quality of care I was delivering. I
like all my textbooks had promised, there                                                       felt that my inability to converse with my
was a 52-year-old male with chest pain                                                          patients created a chasm between us. After
radiating down his left arm and an 85-              Still full of enthusiasm, I told myself     my first week on the medical ward, I had
year-old female with a fever and consoli-       that the next patient would be better —         cared for 10 different patients and only
dation over the right lower lung base. After    68-year-old female complaining of right-        one with whom I shared a common lan-
the morning sign-out, I walked up to the        side back and flank pain. I thought of          guage. The communication with my nine
medical floor to meet my intern who wel-        relevant questions, wrote down her lab          non-English patients was facilitated with
comed me to the team and assigned two           values and walked in to her room. My            assistance from a nurse or clerk who hap-
patients who would be in my care.               68-year-old patient stared up at me from        pened to be in the vicinity. While that gave
   As I approached my patient’s room, I         under her fort of blankets. I introduced        us a method to work around our linguistic
reviewed her chart — 93-year-old female         myself as the medical student taking care       differences, it became apparent to me that
sent from nursing home with suspected           of her in the hospital; she interjected “no     it was only the tip of a larger cultural
urinary tract infection. I quickly reviewed     speak English, Spanish por favor?               divide. Just as a physical examination pro-
the important aspects of the history and            “Having grown up in Canada, my              vides a small window into a patient’s
physical examination, and feeling confi-        knowledge of Spanish was limited to what-       health, language is merely an outward
dent, knocked on the door and strode into       ever Sesame Street taught me as a child,        manifestation of a larger culture that I
her room. There I found Mary sleeping,          and the few words that I knew were similar      could not fully grasp.
her mouth drooping open but appearing           across the languages. I called for a hospital       I looked for other professions that
comfortable. As I moved to her bedside to       translator, who to my dismay wasn’t avail-      shared similar problems. It seemed
wake her, I was greeted with various loud       able for another hour; we were scheduled        opportunities for misinterpretation were
groans and incoherent mumbling. I pro-          to start our bedside rounds in less than 30     everywhere. I experienced this firsthand
ceeded to introduce myself and asked her        minutes. Flustered, I approached my intern      when getting a haircut in my largely
how she was feeling. Again I received the       to report my inability to obtain any patient    Spanish-speaking neighbourhood. I told
same incomprehensible response. I asked         information outside of vital signs and          the barber I wanted a “trim, just a little off
a few other questions, without ever hear-       physical exam findings for either of my         the sides and not too much off the
ing a recognizable syllable. It seemed as       patients. Shockingly, he was content with       top.” As he wielded the tools of his trade
though the chart forgot to mention her          my sparse details, patted me on the shoul-      upon my unsuspecting tuft of hair, my
extensive history of dementia as this was       der and said “make sure you’re ready to         trim quickly progressed to whatever he
considered her baseline functioning.            present to the attending.”                                         (Continued on page 14)

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                                KBTGSP EDITION OF THE SGU CHRONICLE

                                                          CARE ACROSS TWO CULTURES
“NO HABLO INGLÉS”                                                            by Michael Presta, MSIII

(Continued from page 13)                       About the Author: Michael Presta is           Thai woman opted to withhold any
decided would look best. Unfortunately         from Montreal, Quebec, Canada, and            epidural anesthetic and began pushing
our opinions of “best” differed. Later,        currently completing third year of            once she was fully dilated and effaced.
staring at my lack of hair in the mirror       SOM at New York Methodist Hospital            Moreover, she was without her husband’s
I realized this was precisely what I was       in Brooklyn, NY.                              presence, as per Thai custom. I joined the
doing with my patients. I received a bit of                                                  nurses and doctors in the ceremonious
information that I did not fully under-        A thin Thai man with warm eyes waited         humming during contractions to encour-
stand, formed an opinion and proceeded         for me outside the minuscule airport in       age the expectant mother. It was even
to deliver care that I deemed “best” for       rural Krabi, Thailand. He held out a ban-     more intriguing when a young resident
my patients. Even at my novice level of        ner with my name written on it in cursive.    doctor began applying light pressure on
training I realized that it’s rare in medi-    With simple eye-contact he began head-        the woman’s belly to facilitate the
cine that what satisfies one patient might     ing over in my direction. I did not have to   birthing process. He reassured us that this
not be appropriate for all. While I only       show him any identification; our under-       rather outdated technique was really only
received a bad haircut, my patients might      standing was based solely on facial           done as a last resort, to facilitate delivery
have been left with their personal needs       expressions and body language. This gen-      before proceeding to emergency cesarean
unmet because I allowed our language           tleman could speak no more than a few         section. The delivery was nonetheless an
differences to be an impediment to gain-       sentences of broken English, which was        absolute success.
ing a full understanding of their needs.       nonetheless wildly superior to my knowl-         All in all, the experiences of my med-
    The following weeks on the medical         edge of Thai. Impressively, he still man-     ical selective in Thailand deepened my
ward, with my goofy haircut, I took a new      aged to convey that he had a deep respect     passion for the medical profession and
approach to seeing patients. I made a list     for doctors since their expertise had         cultivated a desire to learn variations
of the most common languages spoken by         “spared the life” of his eldest son.          in practice among different cultures
patients at our hospital, and carried a few    According to his beliefs, an “evil spirit”    throughout the world. A year later in my
key phrases in each of those languages —       had made the boy very ill and eventually      education, during my clinical rotation in
enough so they knew I was there to help,       necessitated the amputation of his right      obstetrics, I was pleasantly reminded of
that I didn’t speak their language fluently,   leg. I was thrown aback at first by this      Thailand when a young resident similarly
but I was going to find someone who            description of what I suspected, accord-      proceeded to apply what I would then
could translate. I also let my body lan-       ing to Western medicine, to have been a       learn was termed fundal pressure to a
guage and demeanor convey more                 severe case of Streptococcal cellulitis.      woman’s belly during a delivery. He, like
expression — the power of a warm smile         I was filled with awe at this version of      the young Thai doctor, added a disclaimer
and a reassuring hand on an anxious            one of the many different cultural expla-     that this technique should not usually be
patient’s shoulder — can relieve a great       nations attributed to illness by people       performed due to the risk of certain
deal of apprehension for the patient and       around the world. Interestingly, extremely    complications such as dystocia and Erb’s
myself. Even under the time pressure of a      severe cases of such illness must some-       palsy. In conclusion, this international
busy schedule, I have learned that a lan-      times be treated by removal of the limb       selective gave me the exposure to realize
guage barrier is a poor excuse to not con-     here in America as well.                      that despite the more superficial cultural
nect with your patients. Our value to our         My appreciation for the cultural diver-    differences, the fundamentals of medical
patients is not measured in the quantity of    sity of medicine continued to mature          care are remarkably similar across these
time or number of words we’re able to          when in a crowded but prestigious             two cultures.
exchange, but the quality of our interac-      Bangkok hospital, I had the opportunity
tion and sincerity with which we aim to        to observe natural labor and delivery for
meet their needs.                              the first time. The petite primagravida

   14                                                                                                         ST. GEORGE’S UNIVERSITY
                                 KBTGSP EDITION OF THE SGU CHRONICLE

                      CODE BLUE                                      MY DREAM
                    by Aaron Fernandes MS-III                          by Dr. Francis Kalu

           About the Author: Aaron Fernandes                 About the Author: Dr. Francis Kalu
           MS-III, KBTGSP August 2007, is cur-               hails from Afikpo, Nigeria. He is a
           rently rotating at Woodhull Medical               former Clinical Tutor at the KBTGSP
           Center in Brooklyn, NY. He is origi-              from 2007-2008. This poem was
           nally from Scarborough, Ontario,                  written for the August 2007 KBTGSP
           Canada.                                           class as they approached their first
                                                             term final examinations.
                    In his stretcher, lying so still
                   An empty gaze, devoid of will
                                                                    It’s yours for the asking,
                   Met our eyes, and told us well
         Of a hollow body, where his soul once dwelt            Wake up every morning smiling,

                                                         Success is yours everyday, walking and working,
           The musical rhythms of incessant beeps
                                                            Through the ups and downs still holding,
           The commanding voice, that rose to speak
                    Save his life, the jargon said             SGU army in yourselves believing,
            They tried in vain, as he lay there dead
                                                                   At dusk after conquering,
                                                              an exhausted giant peacefully resting
                  Their potions ready, a dash of epi
                                                          My Dream, MD, in my bosom, softly kissing
                  His did beat, but ’twas not steady
              As it quivered, and then flat-lined
                  They tried in vain, one last time

                    As they left, he greeted dusk
                   Leaving for us, an empty husk
                  His lifeless eyes, that told us well
         Of a hollow body, where his soul once dwelt

THE   CHRONICLE                                                                                        15
                                KBTGSP EDITION OF THE SGU CHRONICLE

                          PROPHYLAXIS AFTER SURGERY
                                                           by Neeraj Singh

About the Author: Neeraj Singh is a               At NYUHJD there is a recommended           optimize outcomes and lower risks to
student in fourth term of St. George’s         delay of two hours between the removal        patients. Since DVT and its consequences
University School of Medicine (SOM),           of the epidural catheter providing pain       are highly likely to occur in post-opera-
and was a student in the Keith B.              medication and the first administration of    tively immobilized patients, new LMWH
Taylor Global Scholars Program at              an antithrombotic agent. This is because      drugs have been developed to provide
Northumbria University in Newcastle,           although antithrombotics reduce the risk      longer-lasting thromboprophylaxis. How-
England. As a Student Representative           of DVT, they also increase the risk of        ever, the advent of these drugs introduces
who is interested in research, Neeraj          bleeding at the site of the epidural          the problem of putting patients who
Singh helped organize the first                catheter once it is removed.1 Often, DVT      receive epidural delivery of pain medica-
Global Scholars Research Symposium             can occur when erythrocytes are in stasis     tion at risk of uncontrolled bleeding once
at Northumbria in October 2009                 and when the body is in a hypercoagula-       their epidural catheters are removed. By
to showcase SOM medical student                ble state, both of which occur while a        allowing multimodal DVT prophylaxis,
research products to the local students        patient is recovering from a major opera-     including early mobilization, anticoagu-
and faculty.                                   tion.2 To prevent DVT, unfractioned           lation, and a delay between epidural
                                               heparin (UFH) can be administered to          removal and initiation of DVT prophylax-
During the break between my first and          patients to bind to antithrombin III, which   is, physicians can help limit post-opera-
second years of the Keith B. Taylor            then inactivates thrombin and hinders         tive complications. We can learn from
Global Scholars Program at SGUSOM, I           the coagulation cascade. Recently, deriv-     this by remembering that as new drugs
had the opportunity to observe the post-       atives of UFH known as low molecular          are developed, we must consider their
operative management of patients who           weight heparins (LMWH) have been              new side effects and contraindications
underwent orthopedic surgery at the New        developed. These drugs, including             and adjust treatment regimens according-
York University Hospital for Joint Dis-        enoxaparin (Lovenox) and fondaparinux         ly to provide the best possible outcomes
eases (NYUHJD). Among the most com-            sodium (Arixtra), also bind to antithrom-     for our patients.
mon procedures at this hospital are hip        bin III. However, since they are smaller in       I would like to thank Christopher
and knee replacement surgeries, for            size than UFH and do not prolong the          Gharibo, MD, and Frantzces Alabre, FNP,
which patients require epidural and            patient’s activated partial thromboplastin    for allowing me to observe patients
peripheral nerve catheters for post-opera-     time,3 they have greater bioavailability      undergoing post-operative pain manage-
tive pain management before being dis-         and half-life than UFH.2 Since LMWH           ment at New York University Hospital for
charged. While these patients recover,         drugs are active for a longer period of       Joint Diseases and for assisting with edit-
they receive pain medication such as           time than UFH, it becomes difficult to        ing this article.
bupivicaine, a local anesthetic, or fen-       control bleeding of the internal vertebral
tanyl, a general analgesic, often through      venous plexus in the epidural space when
epidural catheters. Meanwhile, these           an epidural catheter is removed from the
                                                                                             1 Choi, P. T., M. Bhandari, J. Scott and J. Douketis
patients must also undergo a regimen of        patient.2 For this reason, medical guide-       (2003). “Epidural analgesia for pain relief following
early mobilization and pharmacological         lines call for a wait time of two hours         hip or knee replacement.” Cochrane Database Syst
                                                                                               Rev(3): CD003071.
anticoagulation to prevent the develop-        between removing an epidural catheter         2 Ennis, R.S (2009). “Deep venous thrombosis
ment of deep venous thrombosis (DVT).          and initiating thromboprophylaxis.2             prophylaxis in orthopedic surgery.” Medscape
Because epidural delivery of pain med-            As physicians, we will be responsible        eMedicine Specialties.
ication and DVT prophylaxis can inter-         for providing the best possible care for        overview. Accessed 9 February 2010.
fere with each other, it is not advisable to   our patients. However, with an increasing     3 Segal, J. B., M. B. Streiff, L. V. Hofmann, K.

administer them simultaneously follow-         array of treatment options comes an             Thornton and E. B. Bass (2007). “Management of
                                                                                               venous thromboembolism: a systematic review for a
ing surgery.                                   increasing need to balance therapies to         practice guideline.” Ann Intern Med 146(3): 211-22

   16                                                                                                              ST. GEORGE’S UNIVERSITY
                               KBTGSP EDITION OF THE SGU CHRONICLE

                                  WHEN PATIENTS AND DOCTORS
                                   DON’T TRUST EACH OTHER
                                                          by Harman Virk

About the Author: Harman Virk is a                                                           experience their physical or emotional
third-year SOM student currently                                                             state. Second, even if they do cooperate,
doing her rotations at St. John
                                                 Lack of trust between                       patients may believe they know their
Hospital and Medical Center in                  patients and physicians                      body best, and may resent the physician
Detroit, Michigan. She is a proud                                                            if he or she does not ultimately follow
Canadian and interested in primary              is not a new issue, and                      their wishes.5
and preventative care especially in           mirrors an overall decline                         Despite the perceived imbalance of
socioeconomically-challenged areas.                                                          power, patients are less equal today than
                                                in the last 30–40 years                      ever before; they not only have more of a
How do you help someone who doesn’t            of Americans’ willingness                     partnership with their doctor, but also
want to help themselves? This was a                                                          have access to more medical information
question my supervising physician asked       to trust others.…However,                      than their predecessors.3 However, some
me one morning after a patient visit at our
internal medicine clinic in Detroit. The
                                               as physicians and future                      patients may not desire the increased
                                                                                             responsibility this power brings, and they
patient was a middle-aged African Amer-         physicians, we must do                       may feel the physician now does not have
ican woman who presented complaints of          all we can to contribute                     enough accountability for their health.
headaches and leg claudication. One rea-                                                     The physician, too, may dislike that
son for this was immediately obvious              to strengthening this                      patients no longer follow physician direc-
upon walking into her room, which                                                            tives as readily as they used to. With
smelled heavily of cigarette smoke. In
                                                 relationship; it is our                     increased access to information, other
addition, she did not monitor her diet or         duty to our patients.                      factors also come into play, such as high-
exercise, took her medication only when                                                      ly publicized medical malpractice cases,
symptomatic, and refused to acknowl-                                                         unethical medical studies, inadequately
edge that her habits — particularly her       of Americans’ willingness to trust             tested drugs, and patients’ belief that
smoking — had anything to do with her         others.1 While this declining trust may        physicians practice solely for monetary
complaints. She listened politely while       have a negative impact on other social         purposes.1, 4, 5 All these factors result in a
the physician discussed lifestyle modifi-     relationships, the physician-patient rela-     less fruitful encounter for both physician
cations yet again. However, it was evident    tionship is one that is especially depend-     and patient, and may damage the relation-
she did not trust the physician’s medical     ent on trust and honesty on both sides in      ship irreversibly over time.
advice regarding her smoking and hyper-       order to be successful.2 One reason for            One other controversial factor that has
tension. The physician, in turn, distrusted   this is because there is usually a power       been studied with regard to its effect on
the patient’s ability to monitor her health   differential involved from the beginning       physician-patient relationships is the race
any further. In effect, nothing was accom-    — the patient is vulnerable and seeking        of the patient vs. the physician. Distrust of
plished by the visit due to this distrust.    help from a physician, who wants to help       physicians among minorities, particularly
But was this due a simple failure of com-     but is nevertheless removed from the           among African American patients, has
munication or something more? And how         patient’s emotional and mental situation.      been recognized as maybe being more
did physician-patient distrust affect that    This perceived lack of equality manifests      prevalent than among whites’ distrust of
relationship, not just in this case, but in   itself in very important ways. First, due to   physicians, due to historical inequalities
general?                                      the power differential, the patient may be     and inequities in service and research
   Lack of trust between patients and         reluctant to cooperate fully with the          experiments such as the Tuskegee Syphilis
physicians is not a new issue, and mirrors    physician, perceiving it as ceding control     study.1 Overall, African American and
an overall decline in the last 30–40 years    of their body to someone who cannot                                (Continued on page 18)

   THE   CHRONICLE                                                                                                           17
                                  KBTGSP EDITION OF THE SGU CHRONICLE

(Continued from page 17)                          study indicates that only a third of women     an easy process in day-to-day practice, as
Hispanic patients do have greater distrust        with breast cancer disclosed using alter-      evidenced by the patient mentioned in
of physicians compared to Caucasians in           native treatment to their medical doctors      the opening vignette. However, as physi-
univariate analysis1. However, studies            while almost all women discussed their         cians and future physicians, we must
show that these racial differences vary           medical treatment with their alternative       do all we can to contribute to strengthen-
quite substantially based on individual           practitioners.4 Lack of trust also reduces     ing this relationship; it is our duty to
characteristics in different cities, with         patient compliance with physician-             our patients.
race being a less predictable factor of           prescribed treatment regimens and vice
distrust than gender, location, and socio-        versa. According to a study conducted by
economic status.1 The patient referenced          Kerse et al., patients were one-third more
in the opening example was African                likely to be compliant with their medica-
American and the physician was not.               tions if they understood and agreed with
However, the patient was also a female            their primary care physician’s plan.6
from a socioeconomically challenged                  It is clear that physician-patient dis-
area in the city of Detroit. It is difficult to   trust can have many possible origins. The
say which factor is the most important            relationship, once damaged, is difficult to
measure of distrust in an individual              rebuild as the bedrock of trust is lost.
patient, and thus a physician may not             Therefore, rather than trying to pinpoint a
know which factor to focus on while try-          few missteps to avoid in one’s own clini-      1   Armstrong K, Ravenell K, McMurphy S, Putt M,
ing to build a trusting relationship with         cal practice, it is better to build a system       Dugan E, Zheng B, Mishra AK. Racial/Ethnic
patients who are reluctant. Physicians            to use with all patients that heads off or         Differences in Physician Distrust in the United
                                                                                                     States. American Journal of Public Health. 2007;
may therefore make the mistake of stereo-         works through any possible source of               97-7: 1283-1289.
typing certain demographics and                   conflict without breaking trust. Such a        2   Strasser R. The doctor-patient relationship in general
approaching patients with a cautiousness          system is built on four Cs: communica-             practice. Med J Aust. 1992;156: 334–338.
that is not conducive to communication.           tion, continuity of care, compassion, and      3   Coulter A. Partnerships with patients: the pros and
This approach may in fact make the                concordance.7 Concordance is defined as            cons of shared clinical decision-making. J Health
                                                                                                     Serv Res Policy.1997 Apr;2(2):112-21.
patient resentful or defensive, which fur-        agreement, the harmony of opinions             4   Nowlis R. “Keeping doctors in the dark: why women
ther damages the relationship.                    between the patient and physician regard-          don’t discuss using alternative treatments for breast
   How does a lack of trust in a                  ing that individual’s care. It may be              cancer”. UCSF in the News. January 27, 2000.
                                                                                                     Available at:
physician-patient relationship alter the          impossible to achieve 100 percent agree-           doctors-in-the-dark-why-women-dont-discuss-using-
dynamics of an office visit and follow-up         ment due to the patient’s varying opin-            alternative-treatm/. Accessed April 9, 2010.
patient care? It may make patients less           ions; however, physicians must take the            Parker-Pope T. “Doctor and Patient, Now at Odds”.
                                                                                                     The New York Times. July 29, 2008. Available at:
likely to visit a physician for medical           time to communicate with the patient     
problems, especially those at the primary         regarding the evidence they use to treat           ml?_r=2&ref=health&oref=slogin. Accessed April 8,
care level. In addition, when they do visit,      the patient in that manner. They must also
                                                                                                 6   Kerse N, Buetow S, Mainous AG, Young G,
they may not share all relevant informa-          show compassion for the patient’s emo-             Coster G, Arroll B. Physician-Patient Relationship
tion such as herbal or synthetic supple-          tional situation and offer help for signifi-       and Medication Compliance: A Primary Care
                                                                                                     Investigation. Annals of Family Medicine. 2004;
ments, any drugs based in alternative             cant stressors that would make them less           2:455-461.
medicine (homeopathy, ayurveda), or               likely to be compliant. Lastly, continuity     7   Mainous AG, Baker R, Love MM, Gray DP, Gill JM.
any other procedures they may be receiv-          of care bolsters all three other factors, as       Continuity of care and trust in one’s physician:
                                                                                                     evidence from primary care in the United States and
ing. Data from an ongoing five-year Uni-          patients and physicians may understand             the United Kingdom. Fam Med. 2001 Jan;
versity of California, San Francisco,             each other better over time. It is often not       33(1):22-7.

   18                                                                                                                   ST. GEORGE’S UNIVERSITY
                                 KBTGSP EDITION OF THE SGU CHRONICLE

                                            INTERNATIONAL HEALTH
                                                             by Jamie Zakkak

About the Author: Jamie Zakkak,                                                                  for health prevention programs. Without
SOM, Class of 2012, is a fifth term                                                              strong public health measures in place,
medical student of St. George’s                    Let us not be passive…                        efforts to improve health at the individual
University who began clinical rota-                                                              level are often limited and can be futile.
tions in Brooklyn, New York, in                    Let us instead be agents                          We, as medical students in training,
August 2010. Prior to starting med-                                                              with the desire and compassion to help
ical school, she completed graduate
                                                  of change, both in society                     those most in need, must keep these ideas
coursework in public health and
worked at the Virginia Department of
                                                       and in the clinic.                        in mind as we complete our degrees and
                                                                                                 residencies, and then enter the health
Health as a research analyst.                                                                    workforce. Let us not be passive, merely
                                                                                                 bandaging problems that arise due to poor
“Health care is vital to all of us some of       es to all while students from the Middle        societal infrastructure and economies.
the time, but public health is vital to all of   East and Africa described the difficulties      Let us instead be agents of change, both
us all of the time.”                             in obtaining health care in their countries,    in society and in the clinic. We can
                     — Dr. C. Everett Koop       due to deficiencies in trained profession-      address unjust policies by joining relevant
                                                 als, poor infrastructure, and inadequate        interest groups to lobby on our behalf. We
During my second semester of medical             funding. Everyone deserves the chance in        can vote to elect political figures that
school in the SGU Keith B. Taylor Global         life to reach their full potential, and it is   share our values in regard to health, and
Scholar's Program, I traveled to Istanbul,       imperative that health services be accessi-     we can improve public health by raising
Turkey, to participate in the 12th World         ble to all to ensure this goal.                 awareness of non-medical determinants
Congress International Student Meeting               Health outcomes at the individual and       of health. In the clinic, we can approach
on Public Health (ISMOPH, April 26–27,           population level are heavily influenced         each patient in a comprehensive manner,
2009). One hundred students were select-         by non-medical health determinants, such        looking beyond the chief complaint, to
ed worldwide to share their perspectives         as political, economic, and social condi-       promote healthy practices and overall
on public health and medicine and to cre-        tions. Representatives from Southeast           wellness.
ate a declaration to guide health-related        Asia described lack of employment lead-             On the flight back to Newcastle
efforts in the coming years. Despite the         ing to starvation and depression, while         from the conference, I remember feeling
great number of countries in attendance,         students from Greece discussed the lack         inspired, but also hopeless given the mul-
similar themes in regard to pursing opti-        of accountability required of hospitals         titude and complexities of our global
mal wellness on a global scale emerged.          in dealing with patients. These examples        health problems. Now, over one year later,
These key conclusions include health as a        highlight how factors other than medicine       I realize that we should never feel hope-
human right, addressing non-medical              negatively impact health outcomes, and          less. Although we may be infinitesimally
determinants of health, and improving            contribute to the growing health dispari-       small relative to the greatness of the
public health sectors.                           ties that exist.                                world, the efforts of each and every one of
   Health is not a luxury to be enjoyed by           Public health needs must become a           us, doing as best as we can, is what mat-
the rich and powerful, but a basic com-          priority to improve global health in a sus-     ters the most. Our efforts can and will
modity that should be afforded to every-         tainable way. The importance of having          combine to result in meaningful and sig-
one irrespective of social standing and          basic necessities, like clean water, food,      nificant change. And, as we seek to
financial security. Participants from the        and proper sanitation, were stressed by         improve health at all levels of society, we
United Kingdom discussed the National            the majority of students; and those from        will truly begin to optimize the health of
Health Service, their publicly funded            Turkey and the United States also empha-        our patients, and thus, ultimately, the
health care system which provides servic-        sized the lack of governmental support          health of our world.

    THE   CHRONICLE                                                                                                            19
                                                                                    All members of the SGU community —
                                                                                    students, faculty, administration, staff and
                                                                                    alumni — are invited to participate in the third
                                                                                    annual photo contest.

                                FOCUS                                                   All winning photographs will be featured
                                                                                    in Mace magazine. Best in Show will receive
                                                                                    a $100 gift certificate to SGU’s new online
                               An SGU Perspective                                   bookstore. First place winners in each of
                                                                                    the six categories will receive a $20 gift
                                                                                    certificate. Check out all the possible prizes —
                                                                                    including hoodies, t-shirts, hats and more — at
                                                                                        Take the opportunity to show off your creativ-
                                                                                    ity and talent by submitting a photo in one of the
                                                                                    following categories:
                                                                                    • People: They say your eyes are the windows to
                                                                                      the soul. Capture emotions, personalities, or
                                                                                      human nature through the human form or
                                                                                    • Edges of the Earth: Think beyond
                                                                                      limits, to where the edges of the earth meet
                                                                                      the corners of the sky or — in Grenada — the
                                                                                      sea. You’re creativity has no bounds,
                                                                                      whether you choose to focus on landscapes or
2009 Best in Show and First Place / People: “The Red Dragon: Carnival Masquerade”   • Night: During the night you have the oppor-
Jayson Danlag                                                                         tunity to see the world differently and capture
                                                                                      some of the most visually stunning images.
                                                                                      The glow of the moon, the golden hour of
                                                                                      sunrise, the shadow of a sunset all provide
                                                                                      unique opportunities for a photographer.
                                                                                    • Tradition: Capture the history of the island,
                                                                                      native customs or rituals, or the heritage of
                                                                                      any ethnicity or culture.
                                                                                    • Natural Light: The color, direction, quantity,
                                                                                      and quality of the light can alter the shapes,
                                                                                      colors, tones, and forms of a scene or subject.
                                                                                      The same image can drastically transform
                                                                                      throughout the day, under variable weather
                                                                                    • Reflections: Use water, windows, mirrors,
                                                                                      and so forth to alter images entirely. Reflec-
                                                                                      tions can lead to amazing effects and beauti-
                                                                                      ful photographs.

2009 First Place / Ants-Eye View: “To dEYE for” Brenda Kirkby                         Submissions are due by December 31, 2010.
                                                                                    Winners will be announced January 21, 2011.

   20                                                                                                       ST. GEORGE’S UNIVERSITY
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                          2011 Mace magazine. In its sixth           University might have contributed to in a
                          year of production, the Mace has           small or large part. Your creative submis-
                          evolved into a highly anticipated          sions will serve as a powerful reminder of
                           expression of the abundant                our potential, both as individuals and
                           creativity of the SGU commun-             members of our community.
                            ity-at-large.                               Please submit entries to Samantha Ince-
                                 In light of this year’s theme,      John in the Office of University Commu-
                             “Journey,” we ask you to reflect        nications by November 15 via email to
                             upon the paths that you chose to or mailed directly to
                              follow in your life. Whether           the Office of University Communications
                              singular in scope and focus, or        (see contact information below). Please be
                               a journey with many inter-            aware that any submissions received after
                               twined roads, your destination        December 1 will not be guaranteed place-
                                is the result of years of dedica-    ment in the 2011 Mace.
                                tion, passion, and fair share
                                 of sacrifice.                       Office of University Communications
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                   friends of the University, you have the           c/o The North American Correspondent:
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THE   CHRONICLE                                                                                   21
                            G R A D UAT E P R O F I L E
                            Tshephang Moeng
                            School of Veterinary Medicine, Class of 2012

                            Tshephang Moeng is a fifth term veteri-            “There are also many African and
                            nary medical student at St. George’s           Caribbean student associations to help
                            University. He is originally from Kanye,       assist in the adjustment to a new island.
                            Botswana—less than an hour away from           But there are so many similarities
                            and southwest of the capital, Gaborone.        between Botswana and Grenada, that
                            After pursuing his Bachelor of Science at      the adjustment was easy.” Tshephang
                            the University of Botswana, he applied to      Moeng describes his first reaction to the
                            the preveterinary program at St. George’s      island. “Grenada looks like a paradise.
                            University and was placed into the third       When I first got there I went to the Grand
                            year, completing term 3-1 and 3-2.             Anse campus and it was awesome —
                                In addition to his dreams of becoming      the weather, buildings, view, vegetation,
       I want to take my    a veterinarian, Tshephang has decided to       warm welcome from the people. There
                            pursue a dual degree Master of Public          really are students from around the world
education on food safety,   Health. His ultimate goal involves return-     and we all interact with one another.”
                            ing to Botswana where he hopes to use              Academically, Tshephang speaks of
    zoonosis, HIV/AIDS      his dual degree “to improve standards of       one African professor in particular who
 and knowledge of other     public health and address the different
                            public health issues that can affect the
                                                                           has inspired him. Dr. Saul Mofya from
                                                                           the Republic of Zambia offered Tshep-
    public health issues    country. I want to take my education on        hang advice on areas to focus on and
                            food safety, zoonosis, HIV/AIDS and            study and helped Tshephang discover
      back to Botswana.     knowledge of other public health issues        what he was interested in and what fur-
                            back to Botswana.”                             ther topics of study he could take back to
                                Tshephang explained what he thought        utilize in Botswana.
                            about St. George’s University and                  In addition to pursuing his Doctor of
                            Grenada, “It is a great place for social and   Veterinary Medicine and Master of Pub-
                            academic life. The atmosphere is warm          lic Health degrees, Tshephang is incredi-
                            and welcoming. There are people from           bly energetic and involved with many
                            the University there to pick you up at         extracurricular activities, including intra-
                            the airport when you arrive and people to      mural soccer, Public Health Society, and
                            show you around. Everyone I met was so         the African Student Association. He
                            nice and fun that it is difficult to feel      enjoys mingling with the locals and peo-
                            homesick when you are here. Academic           ple from different places around the
                            life can be hectic, but we have study          world to learn about their cultures. Cur-
                            groups and lectures and people to help         rently, he is considering completing one
                            you along with the education require-          of his requirements for the public health
                            ments. International students in Grenada       degree by taking a practicum in Kenya
                            have a special orientation and are given a     through the University. Tshephang
                            tour of the campus. We have different          Moeng expects to graduate from the
                            social groups and organizations to help        School of Veterinary Medicine in 2012
                            immerse us in the culture — including          and earn his Master of Public Health in
                            driving, social customs, et cetera.”           Spring 2011.

22                                                                                          ST. GEORGE’S UNIVERSITY
                              G R A D UAT E P R O F I L E
                              Elly Masitha
                              School of Veterinary Medicine, Class of 2011

                              Elly Masitha—originally from Bobonong,        Carnival! He recalls, “I met people
                              Botswana—pursued his Bachelor of              from different parts of the world — the
                              Science degree at the University of           Caribbean, Africa, United States, and
                              Botswana. However, because the                Canada. I made friends with students
                              University did not offer veterinary pro-      from different parts of Africa who I may
                              grams, and in order to fulfill his dreams     have otherwise never met.”
                              of becoming a veterinarian, he decided to        In regard to academics, Elly comment-
                              leave his homeland to finish his educa-       ed, “The professors did a very good job.
                              tion. Elly always had an interest in          They tried their best and offered so much
                              veterinary medicine, having spent time        of their time and were always available
                              taking care of animals on small farms         for extra help.” Now that he’s about to
    The school offered me     throughout his life. His ambition led him     receive his DVM degree, Elly can provide
                              to St. George’s University Preveterinary      some direction for prospective students
   the dual degree option     Program. Upon successful completion of        who are applying to graduate schools.
                              the one-year program, Elly enrolled in St.    He advises, “On the island you come to
 (DVM/MPH) and for me         George’s School of Veterinary Medicine.       work hard and you should work hard, but
                                 Elly had many reasons for selecting St.    also enjoy the island and don’t put
     it was all I needed to   George’s University as the best option for    yourself under too much pressure. Work
                              him, not the least of which is the location   hard and have fun!”
       know to go there.…     of the campus. The True Blue campus is           He recommends the University with-
It would be an advantage      indeed an academic paradise. Secondly,        out hesitation. “St. George’s University is
                              the international aspect of the University    the best school to can prepare you for
    to my country and my      was appealing because he would meet           whatever career you want to choose.” He
                              students from other countries around the      currently resides in Edinburgh, United
    people. Once I decide     world. Lastly, Elly explained, “The school    Kingdom, where he is completing his
                              offered me the dual degree option             final year of clinical training. Elly’s
    to go home I can take     (DVM/MPH) and for me it was all I             dreams include being involved in
                              needed to know to go there. When I go         research, although he is uncertain if he is
     back that experience.    back home to Botswana, my Master of           going to pursue further education. While
                              Public Health and Doctor of Veterinary        he expects to earn his DVM in June 2011,
                              Medicine degrees will be an advantage         he recently earned his Master of Public
                              to my country and my people. Once             Health degree from St. George’s
                              I decide to go home I can take back           University in May 2010. While Elly may
                              that experience.”                             return to his native Botswana upon
                                 Upon arriving to Grenada, Elly             receiving his DVM, he would like to
                              recalled, “The people of the island were      return and visit Grenada as well.
                              so welcoming and friendly that it
                              made me feel like I was home.” It was
                              his first time seeing the beach and he
                              also happened to come during one of the
                              biggest celebrations in Grenada —

THE   CHRONICLE                                                                                           23
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