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					                                        S                         TANDPOINTS
                                                                        Volume 7, Winter 2008



                                A Publication Highlighting the Global Health Experiences
                                    and Research of Dartmouth Students and Faculty
                                 Compiled by the Dartmouth Coalition for Global Health

Dear Readers,
     In the past decade, global health as a cause has increasingly risen to the forefront of public policy concerns. The Bill and Melinda
Gates Foundation has given roughly $8 billion to fund organizations and initiatives that focus on sustainably improving global health,
of which nearly $2 billion goes directly to HIV, TB and reproductive health. In 2003, President Bush launched the President’s Emer-
gency Plan for AIDS Relief (PEPFAR), which promised $15 billion (later $19 billion) over five years to provide AIDS relief around
the world. Many countries worldwide now give generous portions of their annual budget to this cause. However, we would be fooling
ourselves if we thought this was enough. What more can we do to help the millions of people who are dying from easily preventable or
treatable diseases? How can we help those who live in extreme poverty or do not have access to clean water?
     The Dartmouth Coalition for Global Health (DCGH) asks these questions as it seeks to increase awareness of global health issues
on Dartmouth’s campus. This year, DCGH organized a Halloween Trick-or-Treatment campaign to increase campus awareness of HIV/
AIDS treatment, an educational dinner for the “Lose the Shoes” barefoot soccer tournament and an HIV/AIDS candlelight vigil. The
group also co-sponsored a dinner with an HIV+, Ugandian AIDS activist and the World AIDS Day Conference.
     This publication is due entirely to the hard work and dedication of our staff, particularly our Editor-In-Chief, Laura Hester, and
the Dickey Center for International Understanding. As always, we would like to thank the director of the Dickey Center, Ambassador
Yalowitz, for his support, as well as all of the authors. Standpoints would not be possible without them. We are grateful that they have
generously shared their experiences with us. It is my hope that you, the reader, will be inspired by their incredible stories and reminded
of your potential to help in so many different situations.

                                                                       Sincerely,
                                                                       Kristen Limbach ‘08
                                                                       Director of DCGH




                                                                                                         Photos by Marguerite Dashevsky ‘10



                                                                                                                   Winter 2008 STANDPOINTS    1
  T   able of     C   ontents

   Standpoints is a publication
              of the
     Dartmouth Coalition for
          Global Health
     and is sponsored by the
        Dickey Center for
   International Understanding

   Dickey Center Director
        Ken Yalowitz

    DCGH Co-Directors
    Kristen Limbach ‘08
     Mitalee Patel ‘08

       Executive Editor
       Laura Hester ‘09

      Managing Editor



                                  8F
                                                                                 Photo by Ben Robbins ‘08
      Vanessa Hurley ‘09
                                                                    Pg. 10- Learning to Listen
      Publicity Manager                   eature Articles-
                                                                            By Margi Dashevsky ‘10
       Wendy Diao ‘09                   Two Views of Tanzania
                                                                            Tanzania
             Staff
     Jasmine Daniel ‘10
      Alley Edlebi ‘09
    Jennifer Gaudette ‘10
                                  Pg 5- Introduction to the
                                       DARDAR Program
                                         By Margi Dashevsky ‘10
                                                                    16 S          tudent Articles


    Christine Goldrick ‘11               Tanzania                   Pg. 14- Mario’s Gift
      Richard Tsen ‘08                                                      By Rachel LaRocca ’09,
                                  Pg. 6- Plight of Isa
                                                                            Honduras
  For information or questions,          By Ben Robbins ‘08
          please e-mail:                 Tanzania
      dcgh@dartmouth.edu                                            Pg. 16- Finding Their Feet
                                  Pg 8- Dar es Salaam in Pictures           By Kristen Limbach ‘08
  Front Cover Photo by:                  By Ben Robbins ‘08                 USA
  Ben Robbins ‘08                        Tanzania

2 STANDPOINTS Winter 2008
                                                                           Table   C   ontents


                                                                           30 C
Pg. 18- A Question of                  Pg. 23- Reflections on


                                                                              I
       Leadership                            Khaborovsk: The
                                                                                       lasses &
        By Emmanuel Mensah ‘09               Russian Far East
        Ghana                                  By James Butterly, MD               nternships
                                               Russia                          In Global Health



                                                                           32 A
Pg. 20- Walking on Eggshells
         By Claire Wagner ‘10          Pg. 26- One Baby at a Time
         Mali                                 Interview of Cris Hammond             uthors&


23 F
                                               & Dr. James Strickler, MD           Organizations
                                               Kosovo
                aculty Articles




                                                                            Printed by Whitman
                                                                              CommuniCations


   Photo by Marguerite Dashevsky ‘10

                                                                                Winter 2008 STANDPOINTS   3
  F   eature   A    rticles




T                     wo



                                       T
                              Views from
                                           anzania




4 STANDPOINTS Winter 2008
                                                                                                  F       eature   A   rticles



                            The DARDAR (Dartmouth in Dar es Salaam) Study is a collabora-
                         tion between the Section of Infectious Disease and International Health at
                         Dartmouth Medical School and the Muhimbili University College of Health
                         Sciences (MUCHS) in Dar es Salaam, Tanzania. The study was developed
                         in 2000 as a clinical trial focusing on tuberculosis. In the beginning of the
                         study, more than 2,000 patients received a booster shot for the BCG
                         vaccine, which, if effective, would increase adult resistance to tuberculosis.
                         A main objective of the study is to establish expertise about HIV and tuber-
                         culosis among Tanzanian scientists at MUCHS.



              The DARDAR Internship Experiences of
            Ben Robbins ‘08 and Marguerite Dashevsky ‘10

                            The DARDAR Pediatrics Program (DPP) is a part of the DARDAR
                         study. DPP aims to provide family-based care and treatment to around 250
                         pediatric patients. The Program has been enrolling and treating patients
                         since 2006, and just this summer, it moved into a newly inaugarated clinical
                         facility.
                            Additionally, DPP collaborates with the community organization Bibi
                         kwa Bibi (Grandmother to Grandmother) that helps run a school and sup-
                         port grandmothers who are caring for their orphaned grandchildren. These
                         children are most commonly orphans due to the HIV/AIDS epidemic in
                         Tanzania.
                            Marguerite Dashevsky ‘10 and Ben Robbins ‘08 were the DARDAR
                         undergraduate interns in 2007. Ben lived and worked primarily at Bibi kwa
                         Bibi, while Marguerite worked on two main projects based out of DPP.
                         While both worked in the same city under similar conditions, their experi-
                         ences vary greatly. Their respective voices demonstrate the importance of
                         experiencing and addressing public health abroad.




Left page:
Background and lower left-hand photo: Marguerite Dashevsky ‘10
Upper right-hand photo: Ben Robbins ‘08
                                                                                                    Winter 2008   STANDPOINTS 5
  F              A

      P
      eature         rticles




                      light of
   Story and Photos by Ben Robbins ‘08
                                             I      sa
        Of all the terrible circumstances and trials that Bibi
    Jann’s students have lived through, the experiences of a
    first grader named Isa best exemplify the hardships that
    the Mbagala children face daily. His experiences can also
    used as an example to show the positive influence that                                                    Isa in the classroom
    Bibi Jann’s school has made upon the community.
        Isa was an easy student to get close to because he’s the      Fatuma, the director of Bibi Jann’s school, accepted
    kind of kid who is always nice to his classmates and likes     Bibi Isa as a member of Bibi to Bibi. Now, she lives with
    to sit quietly with his friends and teachers more than he      five other poor single grandmothers in a house rented by
    likes playing soccer or lede (pronounced leh-day, and is       Bibi Jann’s.
    a swahili version of dodgeball). Isa wasn’t dealt a great          I met Isa during my first week at Bibi Jann’s, and he
    hand in life. Both of his parents contracted AIDS before       missed almost my entire second and third week due to
    he was born. Either during birth or while breastfeeding        illness. At the end of the third week, an American from
    him as an infant, Isa’s mom passed her infection to him.       Harvard’s School of Public Health, Sarah Putney, came
    During his toddler years, Isa’s mom and dad both died          to see an orphan that she financially supports. During her
    from AIDS related infections. With nowhere else to go,         visit, Dickson and I told her about Isa’s HIV status and
    Isa’s impoverished grandmother became his guardian.            extended absence from school. She came with a Harvard
         Isa’s grandmother, Bibi Isa as we call her, cares for     driver, so we all thought it would be best if we went to
    three children. Dickson (another grandmother in the            check on Isa. When we arrived at his house, an obviously
    program) estimates she makes the equivalent of 70-90 US        congested Bibi Isa told us that Isa had been sick for about
    cents per day selling small donuts to neighbors.               three weeks. That morning he had become so sick that
                                                                   she thought he might die. Six hours earlier, she dropped
                                Bibi, Isa and children             him off at a small, local clinic but was herself too sick
                                                                   to wait with him. We drove to the clinic and found Isa
                                                                   on a stretcher in a semi-outdoor area still waiting to see
                                                                   a doctor. Sarah thought Isa could get faster care at a
                                                                   nearby Harvard/PEPFAR funded clinic so she asked her
                                                                   driver to take us all there. At the Harvard clinic Isa was
                                                                   diagnosed with an advanced case of malaria. The malaria
                                                                   was so severe that the doctor prescribed injections of anti-
                                                                   malarial medication every eight hours for 48 hours.



6 STANDPOINTS Winter 2008
                                                                                                          F    eature       A     rticles
                                                                                                      Ben, Isa, and Brian Christie ‘07
    Isa missed the following two days of school. At the Bibi
to Bibi meeting the following Saturday, Bibi Isa told Dickson
and I some troubling news. She told us that Isa hated the
needles involved in his monthly HIV-related blood test, and
that after his first few anti-malarial injections he refused to
return to the Harvard clinic. In the middle of his second day
of injections, Isa told Bibi Isa that he was “sick of all the
needles” and left home. He didn’t return for three days. I’m
still not sure where he went in that time.
     After six weeks, Isa seemed to return to his normal self
until another incident occurred the following Thursday. On
that day, Isa was chasing a soccer ball when he smacked his
forehead on the bumper of a car parked inside Bibi Jann’s.
When I checked to see if he was alright, yellow fluid was
draining from one of his ears. From my small amount of EMT
training I knew that yellow fluid in the ears after a head injury
could indicate a fractured skull. A few minutes later, Brian
noticed fluid draining from his other ear so we called a taxi
and drove to the HIV/AIDS pediatric clinic where Brian and I
work and where Isa is a patient.
     Isa didn’t have a broken skull but the doctors told us
that he had missed several appointments. Since he hadn’t
been coming regularly, his HIV infection had advanced
significantly. I’m not quite sure of the ethics of privacy issues
concerning the details of Isa’s doctors visits so I don’t feel
comfortable saying much more about the visit except that we
weren’t happy about what the doctors told us. The Bibi Jann’s
staff now gives him a cocktail of about five drugs, three times     Isa and Bibi Jann at the Clinic
per day to treat his various ailments.
    Isa’s problems have illustrated to me the importance of           How you can help
Bibi Jann’s school in many lives. Although Isa’s life is far          Brian, Paul, and I have started an organization at Dartmouth with the
                                                                      doctors that run DPP to help support Bibi Jann’s school and Bibi to
from perfect, without the school and Bibi to Bibi program, he
                                                                      Bibi. We’ve called the organization SALAMA Tanzania. SALAMA
wouldn’t have had much hope to make it to, let alone past age         means “peace” in Swahili and is an acronym for Students for the
six without the resources and support provided to him and his         Advancement of Learning and Medical Aid. Check out our website
family.                                                               at dartmouth.edu/~dickey/tanzania- we’ve got no paid staff so any
                                                                      donations you make to our organization are tax-deductible and will
                                                                      go directly to Bibi Jann’s school, Bibi to Bibi, or DPP depending on
                                                                      which organization and/or project you specify.




                                                                                                               STANDPOINTS Winter 2008 7
 F   eature    A   rticle




                                                    These are pictures of the grand-
                                                    mothers from Bibi-2-Bibi. They
                                                    are making crafts to sell and will
                                                      use the proceeds to help meet




        D S
                                                   their basic needs, as well as those
                                                     of their AIDS orphaned grand-
                                                                 children




                        ar es                    alaam
                                                                                Photos By Ben Robbins ‘08
                                                                                   Layout by Richard Tsen ‘08


                                                  in Pictures


                      A child in Dar es Salaam

                                                                                         Ready for Mbagala style soccer
                                                                                         with a homemade ball and goat
                                                                                                   spectator



8 STANDPOINTS Winter 2008
                                                                                  F
                                                                                  eature    A   rticle

                          The local witch-doctor’s son.
                           The witch doctor explained
                         that despite the fact that he kept
                         feeding his son rice, bread, and
                         doughnuts, he still showed signs
                           of severe malnutrition. The
                          distended stomach is due to a
                          condition called kwashiorkor
                           which is a disease caused by
                                protein deficiency.




                                                   Despite government efforts
                                                  aiming to offer education to
                                                  all Tanzanian children, most
                                                  do not have access to quality
                                                       primary schooling.




 Clean drinking water and
 sanitation are amongst the
  most powerful drivers of
healthy human devlopment.




                                                                                  Winter 2008 STANDPOINTS   4
                              L
   F   eature   A   rticles


                                     earning to Listen
                              Story and Photos by Marguerite Dashevsky ’10
                                    Previous issues of Standpoints contain numerous articles
                               written about the Dartmouth Global Health Initiative’s work in
                               Tanzania, but in this issue undergraduates are the ones writing for
                               the first time about their experiences working with the DARDAR
                               projects in Dar es Salaam. I write to fellow undergraduates in an
                               effort to share some memorable moments from my experience
                               during my off-term this past summer, and to reflect on the sig-
                               nificance and implications of my presence as a privileged white
                               foreigner in Africa. Although what I write is specific to my
                               experience in Dar, most of these issues are closely applicable to
                               the many volunteer and internship opportunities that Dartmouth
                               students pursue abroad every term.
                                   While preparing for my trip to Tanzania I thought a lot about
                               what sort of clothing I should bring; although I liked the idea of
                               packing light and planning to buy some basic Tanzanian clothing
                               upon my arrival, I was unsure if a mzungu (white person) dress-
                               ing like a Tanzanian would be strange or potentially offensive.
                               My first day in Dar I realized that the clothes I fianlly packed
                               were generally either too warm or too casual to wear at the clinic,
                               but as it turned out I didn’t have much choice anyway because
                               it took an entire week for my suitcases to finally turn up! Soon
                               after my arrival I was fully outfitted in a matching set of beautiful
                               batiks made by and given to me by the bibis. This unhesitating
                               generosity of my Tanzanian hosts, despite having just met me,
                               continues to amaze me to this day.
                                   Despite feeling self-conscious at first and wearing clothing
                               I wasn’t accustomed to, I grew comfortable and even proud of
                               my Tanzanian clothing because I hoped that it demonstrated
                               my respect and value of local culture. I soon gathered from the
                               responses I received from friends at the clinic and even strangers
                               on the street that they appreciated my efforts to wear Tanzanian
                               clothing. I was amused to realize one morning that on days I
                               wore my normal, Western clothes, no one would comment on my
                               appearance, but on days I wore Tanzanian clothes to the clinic I
                               was always greeted with many emphatic “umependeza’s” (you
                               look nice)!
10 STANDPOINTS Winter 2008
    The staff members at the clinic were supportive friends
                                                                                                  F   eature     A    rticles
                                                                    destructive disease, I simultaneously questioned what cul-
who gave me feedback on many things besides just the way            tural judgments and assumptions caused me to see the issue
I dressed. I learned so much from them both at the clinic           this way. Over time I began to appreciate the complexities
and in daily life. Dr. Fileuka, the young single mother I lived     and enormous challenges the
with, was just as willing to patiently give me pointers about       clinic staff faces in trying to
aspects of day to day life as she was to talk frankly about         support and counsel these
more sensitive topics surrounding HIV/AIDS. I found both            families.
types of conversations extremely insightful and I soon real-             I also came to real-          “I was surprised
ized that, especially for subjects like the latter, it was really   ize that in order to be truly        and deeply un-
important for me to conscientiously listen with an open             engaged in a dialogue about          settled to real-
mind.                                                               Tanzanian issues such as
                                                                    HIV disclosure it was es-           ize that the vast
    One particularly difficult topic for me to understand was
the doctors’ and counselors’ stances on the issue of pediat-        sential for me to consciously        majority of the
ric HIV disclosure. I was surprised and deeply unsettled to         step away from my own pre- clinic’s patients
                                                                             conceptions, so that I
realize that the vast majority of the clinic’s
                                                                             could really listen to
                                                                                                       do not know that
patients do not know that they are infected
with HIV. Sometimes the children are able to                                 what someone was            they are infect-
put two and two together on their own or find                                saying to me. Other-         ed with HIV.”
out some other way that they are HIV positive,                               wise, I realized that
but many are not fully aware why they have to                                it was dangerously
take medicine and go to the doctor so often.                                 easy to hear only
In the routine counseling sessions, the clinic                               what I wanted to hear. On several instances in Tan-
staff strongly encourages parents to explain to                              zania, I observed interactions between other people
their children the implications of being HIV                                 that resulted in significant misunderstanding. In
positive. Ultimately, it is the parents’ decision                            retrospect, I realize that my own misunderstandings
when their child learns about their HIV infection.                           usually occurred when I would anticipate someone’s
    This is a huge issue for the clinic, even in purely medical     response to a question, and my assumption of what they
terms, because they have observed first-hand that children          were going to say would distract me from what they were
who know their HIV status are better at taking care of them-        actually saying.
selves and adhering to medication. From my perspective,                Many foreigners that I met also seemed to act in the same
I immediately considered this reluctance to disclose HIV            way. They would subconsciously impose themselves and
status as a symptom of deeper issues of denial and avoidance        their values upon others either by being talkative and silenc-
                                            of a sensitive topic.   ing people around them or by not fully listening to what
                                            Although I saw an       others were saying. These individuals struck me as pushy,
                                            immediate need for      selfish, insensitive, and generally out of synch with the world
                                            openness in order       around them. They lacked respect for Tanzanian values and
                                            for families and        were completely unaware that their own perspective (which
                                            communities to be-      originates from their position of power) was oppressive and
   A Tanzanian sunrise                      gin to confront this    imposing.
      over the ocean.


                                                                                                        Winter 2008 STANDPOINTS       11
   F   eature    A    rticles


                                                                    “Being in a foreign place,
                                                                    where my cultural values
                                                                  were not the norm, taught me
                                                                      to free myself from my
                                                                       American/Dartmouth/
                                                                   privileged perspective that
                                                                     kept me from seeing the
                                                                    subtle differences around
                                                                               me.”

                                          Tanzanian girls

   This sometimes subtle, but nonetheless destructive, power
   dynamic can and does occur even in the smallest of interac-
   tions without being noticed.
       While in Tanzania I often found myself out of my comfort
   zone and had to learn to go with the flow, think on my feet,
   and laugh at my mistakes. Being in a foreign place where
   my cultural values were not the norm taught me to separate
   myself from my American/Dartmouth-educated/privileged
   perspective that at times kept me from seeing the subtle
   differences around me. I made an effort to seek out
   these cultural differences and valued them. In this way,
   I learned from the people I met through a collaborative
   process of sharing that didn’t have to place one “supe-
   rior” perspective above the other.
       The Dickey Center Internship Program provides an
   excellent opportunity for undergrads to get directly in-
   volved in the amazing work of the DARDAR projects in
   Tanzania. Living in Dar for eight to ten weeks has incred-
   ible potential if you are able to remain self-aware of your                    Above: Margi and two
   position of privilege. By entering into situations with an                     workers from the clinic.
   open mind you can avoid confining yourself to seeing and                      Left: Two Tanzanian boys
   hearing only what you expect – which can enable you to                           pose for the camera
   reach a deeply meaningful cross-cultural understaing.

12 STANDPOINTS Winter 2008
                                                                                            F    eature      A   rticles


       Margi’s work in Tanzania                               could be connected to these services. I spent my time
                                                              visiting various NGOs and other organizations that
    The primary project that I designed was to create         facilitated support groups, peer education, nutritional
a resource guide that could help the clinic connect its       counseling and homebased care. These organizations
patients to existing services in Dar.                         varied between those that were languishing due to a
    Like many, I have been particularly inspired by           lack of funding to others that were much more suc-
Paul Farmer’s approach to medicine, such as his com-          cessful.
mitment to providing high quality, holistic medical              In response to the immediate need for more psy-
care in severely impoverished regions. When I went to         chological and social support at the clinic we started
Dar, I was interested in exploring possibilities for find-    a youth group for the older children. In collaboration
ing ways to support the psychological and social needs        with an international organization called Roots and
of the clinic’s patients. This type of support is essential   Shoots, which is based out of the Jane Goodall Insti-
in order for any treatment to succeed. In order to create     tute, we began holding weekly meetings during which
a useful guide for patients at the clinic, I researched       we played games and tried to incorporate a health-
existing services available in Dar and ways that one          based educational component into our activities.




                                                                                      Photo by Ben Robbins ‘08


                                                                                                   Winter 2008 STANDPOINTS   13
    S  tudent       A    rticles

       The third clinic we arranged while in Honduras was at              its home on the streets of L.A. A few men spoke perfect Eng-
   the state prison. This was the one place I was most fright-            lish, many were not even Honduran. The majority were jailed
   ened to enter, yet it was the one place that had the most              for their tattoos (illegal in Honduras, although there is no fi-
   to teach me. We drove for nearly an hour up winding and                nancial means by which to remove them), while the rest were
   treacherous South American roads to reach the prison that              jailed for their identity. Their gang was a family, and whether
   overlooked the city. It was as if we were entering the scene           or not they had committed crimes, they were imprisoned. It
   of a movie – the walls were equally foreboding and disin-              was not, however, the political nature of the prison that struck
   tegrating, topped with rusted strands of barbed wire and               me and remained in my mind. It was the humanity.
   one guard post. Inside the prison, we were stripped of our                 José was the first patient to whom I handed medication
   passports and licenses,




                                 M                                                 G
                                                                                                                     that was prescribed
   all money and cell                                                                                                by the doctor on our
   phones (even though                                                                                               team. He hobbled to
   they would never work                                                                                             me on crutches and
   in Honduras), as well                                                                                             spoke to me in Spanish

                                                        ario’s                                      ift
   as our cameras. We                                                                                                even though he knew I
   were told nothing we                                                                                              could not understand a
   saw could leave the                                                                                               word. Our translator,
   prison. Most of the                                                                                               his fellow prison-mate,
   men inside were there                       by Rachel A. LaRocca ‘09                                              thanked me with the
   for their own protec-                                                                                             sincerity of a brother.
   tion. That is the cliché                                                                                          José had been shot by
   phrase politicians spew at us        In late July of 2006, I boarded a plane to leave the coun-
                                         try for the first time in my life, and I soon found myself         an inmate in another quadrant
   daily, but in Honduras, we
   quickly learned, it was for        amidst poverty beyond comprehension. For the next week, and a member of a rival gang,
   real. What we did not know          I worked and lived among the poorest residents of Teguci- a common occurrence among
                                        galpa, Honduras, a city of dust and hunger. Our job was             the prisoners. The guards of
   was that there was a thriving
   community within the walls.         to establish small, one-day clinics in the most unreachable the prison refused to ever set
                                                                                                            foot within the walls, therefore,
   Once a week, our guide, a for- regions of the city and spread a little hope with a few anti- José received suboptimal medi-
   mer nurse, led a Bible study         biotics. We were a team of nearly two dozen college and
                                        high school students, a nurse, a pharmacist, a handful of           cal care, even for a third world
   within the prison. This was
   the only “medical care” most       doctors, 350 pounds of commercial drugs we use everyday, country. He was most likely
                                        and – as we were soon to discover – the greatest joy in a           going to be debilitated for life
   of them had ever received.                                                                               due to the level of infection
       Inside the prison, we were                            world that knows little.
                                                                                                            in his leg. But the 30 Tylenol
   astonished by the artwork.                                                                               tablets we gave him brought
   In moments of utter despair                                                                              a smile to his face. It was
   and reverence, the men had created a virtual graveyard of              doubtful they would do much to ease his pain. The reason
   the stone walls. Every few feet, an astounding image of a              he smiled was because someone was acknowleding his pain.
   headstone rose from the wall, inscribed with the name of a             This smile showed that he was a real person, and he was
   brother. The quadrant we were assigned to was the home of              hurting.
   the 18th Street gang, transplanted and shifted from

14 STANDPOINTS Winter 2008
                                                                                                        S    tudent         A    rticles

     After José came Pablo. Pablo had pins in his shoulder         speak a word of
from a prior surgery. He was long overdue to have them             English, but had
removed, but the government would not allow him such a             spent the day
privilege. Instead, the pins dug and ate through his skin and      with the transla-        To Mario and his broth-
bone, dangerously creating opportunities for fatal infection.      tors, desperately         ers, what we gave was
Without surgery, the pins would remain in his shoulder. The        trying to help us
doctor who saw him dressed his wound, gave him an en-              in return for what       so much more. His offer
couraging word and sent him on to us. It was all we could          we brought him             was a simple thanks.
do. But still, he smiled and cried. It was more than enough.       and his brothers.
    The greatest things we had to offer the men were the           He jumped at the
littlest things. Every inmate received a bag with a tooth-         chance to give
brush, toothpaste, soap and sunscreen. And nearly every            back. Alex and Mario tentatively entered the building where
inmate came back for seconds. However, they were not               each man had a cell stocked with his personal effects.
greedy. They brought with them pictures of grinning infants            Mario had a few dingy tee-shirts and a pair of jeans. With
and giggling toddlers. Everything we gave them was going           a broad smile, he handed the jeans to Alex and then turned
home to their families who had even less than the grain and        his back as Alex slipped them on. When the two emerged,
rice given as food in the prison. They desperately wanted          Mario was elated. Alex was speechless. As the pants
one more toothbrush for a son or a small bag of children’s         drooped to his scrawny knees, he remained still. Mario was
vitamins to grant a daughter one month of better health.           quick to react. He whipped the belt from around his own
Selflessly, they were willing to trade their life-saving antibi-   waist and gently slid it through the loop of Alex’s pants, gaz-
otics for some Tylenol to send to their sick infants at home.      ing in Alex’s stunned face as he clicked the clasp closed.
Some even offered us paintings and pictures in exchange for            Mario’s gift was not small. He essentially relinquished
helping their families.                                            half of his possessions to a stranger, a young boy with more
    While the doctors saw inmates, the rest of the team            than the men in the prison could imagine. Yet to Mario and
played a rough and hardy game of basketball, the only en-          his brothers, what we gave was so much more. His offer was
tertainment within the small courtyard. Alex, a member of          a simple thanks. We brought medications and soaps donated
our team, suffered an extreme embarrassment. His pants, a          to us by billionaire drug companies and wealthy business-
worn and dirtied pair of scrubs, ripped down the middle, ex-       men seeking a tax-break. We brought doctors and students
posing his boxers and adding to the humility of our team’s         who were eager to help the ill. We brought the gift of health
                                             utter defeat. One     and even life. We thought we were bringing medical care to
                                             inmate, Mario,        people who had nothing. But, as we learned from Mario and
                                             gave a shy little     the other Hondurans we met throughout the week, Hondu-
       Selflessly, they were                 smile and beck-       rans are rich in generosity and humanity, and therefore, they
   willing to trade their life- oned to Alex.                      should not be defined by their poor health or their poverty.
                                             Mario did not         This lesson was the true gift.
saving antibiotics for some
Tylenol to send to their sick                                        *To this effect, all the names have been changed and the stories have
                                                                     been generalized. However, the nature of the experience remains the
     infants at home.                                                same. Unfortunately, there are no pictures of the inmates described in
                                                                     order to protect them.
                                                                      Royalty free images courtesy of http://office.microsoft.com/en-us/clipart/

                                                                                                               Winter 2008 STANDPOINTS             15
   S  tudent     A    rticles




    FTheir
     inding Feet
                         By


     I
                                                                     nursing students
                Kristen Limbach ‘08                                  helped us in the
                                                                     clinic once a week.
            heard about the Boston Health Care for the Home-             Usually when I tell people that I worked in a foot clinic
     less Program from a friend who had spent a term working         for the homeless, the response is a grimace, the words
     at their respite facility, the Barbara McInnis House. She       “that’s weird,” or both. It’s true that I spent a lot of time
     was so excited about the work she had done that it took         looking closely at feet, but the foot clinic is a lot more than
     no urging for her to go on at length about what an incred-      just caring for blisters and athlete’s foot. The homeless
     ible experience it had been. Consequently, once I learned       population depends heavily on keeping their feet in good
     that BHCHP would take me on as a summer intern, I could         condition, making foot care particularly crucial. Many
     barely wait to start. However, my internship with BHCHP         homeless get their shoes from shelters that don’t always
     was not the same as my friend’s—I was placed in the Bar-        have the right size, so crippling blisters are frequent. It is
     bara McInnis House only a couple afternoons a week—so I         not uncommon for people to walk ten or fifteen miles a
     did not really know what to expect.                             day in poorly fitting shoes. Shelter showers are a breeding
         The first half of every day I worked in the health care     ground for athlete’s foot and other foot fungi. When it rains,
     clinic at St. Francis House. My specific job was in the foot    it may not be possible for them to remove wet shoes and
     room of the clinic, where patients came to have their feet      socks for several days, which can result in immersion foot.
     examined, soaked, and bandaged. We also took their vitals       Those who have suffered frostbite generally have nerve
                                              and gave them free     damage in their legs and feet that causes them constant
                                              socks. Two other       pain, and some people are even missing toes. Infected open
     “The homeless popula- students-a senior at                      blisters are a constant threat as well because it’s difficult to
        tion depends heavily                  Harvard and a junior   keep feet clean. The foot room’s most important function,
     on keeping their feet in at Wellesley-worked                    though, is acting as a lure for primary care. Doctors can
     good condition, making with me every day.                       frighten those who have been disappointed by the health
       foot care particularly                 Other interns and      care system in the past.
                crucial.”




16 STANDPOINTS Winter 2008
                                                                                                           S   tudent        A     rticles



    An example is a man who came in during my last             met, but he had a severe problem with alcoholism and was
week; he had been bitten by a brown recluse spider and         constantly getting badly hurt from falling down or from
had a huge, festering wound on his forearm. The man had        being beaten up. Another man had a masters degree in
avoided the clinic because he had been turned away from        software engineering from MIT, but he had lost most of
a clinic once before. Offering a foot                                               his math skills when he had had a brain
soak, anti-fungal cream and                                                                 aneurism and could no longer
free socks sounds fairly                                                                          make a decent salary. One
harmless. People                                                                                     man I became good
who might not                                                                                           friends with was
                                        “...I think that having people
have ventured                                                                                             a former drag
                                       glad to see them and listen to
into the clinic                                                                                            queen running
otherwise were                         their problems was extremely                                        from an abusive
enticed by relief                       beneficial for individuals who                                     relationship. He
for their feet.                              lead such tough lives.”                                       was consistently
    One of the                                                                                           one of the most
interns’ primary                                                                                      cheerful, funny, and
duties was making sure                                                                             energetic people I have
people felt welcome in the                                                                    ever encountered. He disap-
foot room by remembering them,                                                          peared my last week there, and I
talking with them, and listening to whatever                               would like to think that he found a job, although
was going on in their lives. Once we had them at the clinic, I can’t help worrying.
we could take their vitals, inquire about their vaccination        My relationships with the patients at the clinic helped
history, check their TB test records, bandage small wounds, me realize that homelessness is not just the dirty man
test diabetics’ blood sugar, and encourage them to see the     jangling quarters in a coffee cup and mumbling to himself
clinic’s nurses and doctors. For me, this function of the foot on a street corner. Anyone living below the poverty line
room is the most important part of the clinic. It enabled us   is vulnerable to homelessness—people wearing collared
to develop strong relationships with the patients. Although    shirts and carrying briefcases came to get health care along
we couldn’t help them directly by finding them housing or      with those who fit the stereotypical homeless description.
jobs, I think that having people glad to see them and listen   Understanding this and the myriad of other societal and
to their problems was extremely beneficial for individuals     individual causes of homelessness is crucial to helping
who lead such difficult lives. There were several people       people improve their situations. My experiences working
with whom I formed especially great relationships. One         with this population will be especially valuable later as I
man was possibly the most kindhearted person I had ever        follow a career path in medicine.




                                       Royalty free images courtesy of http://office.microsoft.com/en-us/clipart/results.aspx?qu=feet&sc=20


                                                                                                               Winter 2008 STANDPOINTS        17
 S             A




                                         A
    tudent          rticles




                                                        Question of Leadership
                                                                  “The question of
                                                            transformation in Africa is a
                                                               question of leadership.”
                                                                  (Patrick Awuah)

                                                          Story By Emmanuel Mensah ‘09
                                                          Photos by Nathalie Gunasekera
              Many developing countries today face a leadership crisis. With-
          out a strong cadre of youth leaders—in business, academia, sci-
          ence, industry and every other imaginable field—there can be little
          transformation. The youth need to be integrated into any efforts
          at promoting peace and development. However, a United Nations
          report on international migration in 2006 said that about 50% of
          “highly-educated” Ghanaians have left the country. Migration of
          skilled labor is a source of major concern for developing countries
          as it impedes development.
             Faced with these challenges, the Ghana Youth Leadership Alli-
          ance (GYLA) was founded in 2006 by a group of Ghanaian stu-
          dents in top US colleges. GYLA is a non-governmental, nonprofit,
          nonreligious and nonpolitical organization, founded to promote
          networking, leadership and service among Ghana’s youth with the
          sole aim of assisting in Ghana’s development. The networking sec-
          tion (Ghana Unite) currently has a membership of more than 5000
          tertiary students and young professionals, and the leadership and
          service (G-soluxions) aspect has about 200 members.




18 STANDPOINTS Winter 2008
                                                                                           S   tudent      A    rticles

    I am the Co-Founder and Vice-President of GYLA.         traditional and enhanced curriculum, along with other
As a sophomore at Dartmouth College, I was given a          programs that aim to make education more accessible,
Tucker Fellowship to return home to Ghana and carry out     relevant, and enjoyable. It relies heavily on volunteers
a project on education and youth empowerment. I taught      and local support.
science, math and French at Creator, an elementary              Over the past 10 months, GYLA has also been trying
school in Tema. In addition to teaching, I also worked at   to form a partnership with the Rotary club to assist with
Narh-Bita hospital in Tema where I explored the chal-       the Guinea worm eradication and water projects taking
lenges facing the health sector in Ghana.                   place in Tamale. At Tamale’s Kwame Nkrumah Universi-
    However, I believe my most important achievement in     ty of Science and Technology (KNUST) , I am currently
Ghana was the leadership workshop series I initiated for    working with the GYLA members who are also mem-
middle school, high school and university students. As a    bers of the Rotaract club- a youth version of the Rotary
graduate of the Leadershape                                                          club- to develop a dam project in
Institute of the University                                                            the region. It is exciting to have
of Illinois and a facilitator                                                          young people from all differ-
of the Pearson Seminar on                                                              ent academic fields working
Youth Leadership (PSYL)                                                                together with the Tamale com-
in Canada, I used these                                                                munity to address development.
experiences to conduct the                                                             The Dartmouth Chapter of the
2 week-long program. The                                                               National Society of Collegiate
students explored topics                                                               Scholars (NSCS) is fundrais-
ranging from “challeng-                                                                ing for this project so that the
ing what is and looking at                                                             KNUST students can volunteer
what could be” to “bring-                                                              in Tamale.
ing vision to reality.”                                                                    On my trip, I also visited the
Currently, I am facilitating                                                           Tamale hospital, which serves
a mentor/mentee program                                                                the entire Northern region of
between the participants                                                               Ghana. GYLA’s executives
and young professionals in                                                            have been working on shipping
the leadership area of GYLA. I hope that the partnerships   medical equipment to the hospital, and I visited is to
I have formed will encourage youth in Ghana to excel        asses its medical equipment needs. This assessment was
and gain confidence to become leaders. With stronger        necessary in order to ask for donations and support from
leadership skills, the Ghanaian youth will be better        donors and partners.
equipped to execute their vision of a better society.           Mother Theresa once said, “We can do no great things,
    Being in Ghana also gave me the opportunity to form     just small things with great love.” Through my work with
alliances with various organizations such as the Manye      GYLA, I hope to incite the youth to address Ghana’s
Foundation, an NGO that assists migrant families in the     developmental problems in intellectual and practical
Kpone Barrier in Tema, Ghana. The Foundation’s main         ways, the ultimate result of which will be a partial, if not
operation is overseeing a primary school that merges        complete, reversal of the brain drain phenomenon.



                                                                                                Winter 2008 STANDPOINTS     19
 S  tudent     A   rticles
                                   “But Claire,” the young Malian women protested in French, “Why can’t we
                               shake our babies? We do it every time we give them a bath and they’re fine. Our
                               mothers did it. Our grandmothers did it. Everyone does it. It’s tradition!”

       Walking
                                   This past summer, I taught a culturally and geographically revised Health and
                               First Responder (Rescue) course for an NGO called Insitut pour l’Education Popu-
                               laire in Kati, Mali. The course was roughly based upon Dartmouth Ski Patrol’s Out-

               on              door Emergency Care course which I completed this past spring. The course was
                               taught during the summer session of a school called Ecole CIWARA (in Bambara, a
                               native language of Mali, this literally means “School of Champions”).

                E                   There were 60 students in two classes ranging in age from 8 to 40 years old.
                               The course was taught in French and translated into Bambara by a local teacher

                 g                                                                          until he contracted ma-
                                                                                            laria and could not come

               g
                                                                                            anymore. The language
                                                                                            barrier was a massive
                                                                                            problem. Describing
                 s                                                                          proper treatment for a
                                                                                            case of ectopic preg-

               h                                                                            nancy is hard enough in
                                                                                            English let alone through

                 e
                                                                                            a whisper-down-the-lane
                                                                                            style of translation. In
                                                                                            addition, many medical
               l                                                                            terms do not even exist in
                                                                                            Bambara. It wouldn’t be

                 l                                                                          a surprise if my descrip-
                                                                                            tion of an intracranial
               s                                                                           contusion may have been
                               lost in translation, but so it goes. Many students, including adolescents, were illiter-
                               ate, thus proving to be another obstacle. New review sheets and lesson plans were
                               devised solely based on images, symbols and physical actions so as not to hinder
                               the acquisition of knowledge from one student to the next. The skills in this course
        A Summer Teaching      were seemingly different from the students’ general academic studies because this
        Health and Rescue in   involved more physical skills. Instead of memorizing a French lesson, their hands
         Mali, West Africa     could memorize how to tie a solid knot, and their bodies could remember how to
                               build a stretcher.
                                   The class began with learning anatomy and anatomical positioning, went on to
        Story and Photos by    address Airway Breathing Circulation (ABCs) and CPR, then Rapid Body Check,
         Claire Wagner ‘10     Lift and Loads, building backboards/stretchers, the circulatory system and blood


20 STANDPOINTS Winter 2008
                                                                                               S   tudent     A    rticles
management, soft tissue injuries, internal bleeding, shock,
the Heimlich, pregnancy and pediatrics, nutrition, polio,
malaria, typhoid, AIDS, splinting, heat exhaustion/stroke,
and ended with head and spine injuries. As mentioned, all
of these forms of rescuing had to be revised due to the lack
of financial and general resources in the town and the 100
degree heat inside the classroom.
    For splinting, we used cardboard and torn up sheets; for
standing take-downs we used our hands instead of a back-
board; and for backboards/stretchers we used 2 pieces of
cut wood and a wool cloth. There was a game we would
play with two groups of students, Team Kidney and Team
Pancreas, both trying to gain points by completing medical
skills or answering health-related questions. “Team Kidney
is ahead one point! It’s your last chance, Team Pancreas,
to tie with the Kidneys!” we’d explain in French. “Question
number 7, for Team Pancreas, ‘I broke my wrist playing soc-
cer. Carefully assess the injury and splint my arm.’”           NEWS, printed an article about our health course in July
    Vincent, an 11 years old who was serving as the rep-        2007.
resentative and spokesperson of Team Pancreas, walked               During my training as a member of Dartmouth Ski
toward me, following the 14-step assessment and medical         Patrol, I was able to practice rescues on healthy students to
care procedure (including checking perfusion by pinching        know how to feel for something that is not healthy or natu-
my thumbnail, taking my pulse, checking for digit-sensa-        ral. An essential part of understanding the cultural context
tion and other steps) for this evaluation, grinned, and took    in Mali is knowing that many of these kids aren’t healthy.
his seat. “Team Pancreas, congratulations, you are tied with    What do you do when two of your students have polio or
Team Kidney!”                                                   one (probably more) of your students’ parents have died of
    The class ended with three cumulative events. Each stu-     AIDS? How do you react if two students died of malaria the
dent participated in Group Projects where 4-10 people chose     year before, and half of the kids in the class probably con-
a health-related topic, researched that topic and presented     tracted malaria last month. How would you treat a student
information in creative ways, such as theater, dance, song      who has a hematoma on her head?
and drawing. The second event was a five-station final               On a field trip, two of our students contracted malaria
evaluation that each individual was required to complete.       and fainted. I took them to a local “health care center” (an
The students were tested on their hands-on skills including     open room in an alley), where we found the doctor asleep
splinting, standing take-downs and vitals assessments. The      on the hospital bed. I woke him and explained the situation.
final event was a trip to two of the major hospitals in Mali    He offered us four unmarked white pills and sent us on our
during which we took three bright students to see the only      way. No receipt, no records, no prescription, nothing.
Dialysis Centre in all of Mali. I was able to have a meeting        At the public hospitals, neither doctors nor people work-
with the Director-General of the hospital, Gabriel Toure ,and   ing in the HIV laboratories were wearing body substance
many doctors at clinic Point G. A Bamako Newspaper, ECO         isolation latex gloves because each individual must pay for


                                                                                                    Winter 2008 STANDPOINTS     21
 S  tudent      A   rticles

   their own. Up until recently,                        ing on eggshells with these kids,
   they had no trash system                              wondering if we were hurting them
   in the hospitals; syringes                             emotionally by talking about polio
   were thrown out the win-                                or AIDS or hurting them physically
   dow into courtyards where                                when illustrating how to perform
   families waited for their                                a foot assessment, only to realize
   sisters, brothers, daughters                              that they already have a badly
   and sons to receive treatment.                             fractured ankle when they po-
       Their supposed cure for                                 litely whisper for you to stop.
   allergies is chicken soup.                                       Understanding the cultural
   Mothers traditionally shake                                  and geographical context of
   their newborn babies violently                        health care is just as important as
   when they wash them; potentially             the care itself. In order to influence health
   harming the brain’s develop-                               education in a foreign country, it
   ment. Some kids have festering                                     is essential to revise one’s
   and infected sores on their bodies.                                own techniques. One
   They have skin diseases, asthma,                                   must also utilize resources
   anemia and all sorts of untreated                                 and provide explana-
   problems. In their daily environ-                                tions that offer reasonable
   ment, there are people on the                                   compromises to what has
   roads with such severe polio                                   already been established. If
   that their legs are backwards                                 this is not done, information
   and they walk with shoes on                                  will not penetrate the society
   their hands. Even if someone                                in a positive way. Cervical
   did have a concussion, they prob-                          spine collars and oxygen tanks
   ably could not afford to get an MRI or any                will not be found in small village
   other treatment. Another peer                            classrooms, nor will the words
   had malaria when he was                                 for a high altitude pulmonary
   young and his grandmother                               edema be found in local or tribal
   gave him the injection to                                languages. These topics would
   cure it. He was paralyzed in                              not be practical subjects to teach.
   his left foot because the shot                             Adjusting our own understand-
   was not given properly. This                                ing of medicine to the level of
   case of accidental paralysis is                              applicability, literacy, language
   due to a supposedly rare com-                                 barriers, monetary resources
   plication of IM buttock injec-                                 and each individual’s health
   tions, but it seems not to be very                             condition is fundamental
   rare in Mali.                                             when teaching new ideas about
       In sum, we were often walk-              health for young minds.


22 STANDPOINTS Winter 2008
                                                                                     F    aculty     A    rticles




      R
                       K
                      EFLECTIoNS oN
                                                                             ThE   RuSSIAN
                                       hABARovSK:                                FAR EAST


                                                  By John r.Butterly, m.d.


    I thought I was going to                                                      Russia’s fresh water). East of
Siberia for a medical conference.                                                 Lake Baikal is considered the
There was a romantic, exciting
                                                         One                      Russian Far East, and that is
sound to that place, and every-               grand boulevard with trees          where Khabarovsk is found.
one knew where it was. A friend               with one grand cafe in sun          The city is about 1,500 miles
warned me not to say anything           with strong black coffee in very small    almost due north of Seoul, Ko-
political, and I responded, “Why                         cups.                    rea on the mighty Amur River.
not? What could they do to me?                                                    Founded in 1858, it is the sec-
I’ll already be in Siberia.”
                                               One not necessarily very           ond largest city in the Russian
“They could make you stay,” he                         beautiful                  Far East, after Vladivostok.
responded. Good point.                     man or woman who loves you.                The city of Khabarovsk
    It turns out that Siberia is                    One fine day.                 itself is quite nice. The people
considered the area east of the                                                   that we met, mostly faculty of
Ural Mountains up to Lake Baikal                                                  the Far East Medical College,
(the largest, deepest, and oldest
                                        Recipe For Happiness Khabarovsk Or        the medical students, and rep-
lake in the world, containing 20%                    Anyplace                     resentatives of the government
of the world’s liquid, surface fresh           -Lawrence Ferlinghetti             of the Khabarovsk Krai were
water, and importantly, 90% of                                                    intelligent, warm, motivated,

                                                                                          Winter 2008 STANDPOINTS    23
 F  aculty   A    rticles
     Walking down the main street, Amursky Boule-         the developed world in many respects.
  vard, one cannot tell that they are in a non-Ameri-         One very real, concrete example of these scars
  can or non-European city, except for the signs          left over the past seven decades is in the build-
  in Russian and a few other attributes. The young        ing that has taken place since the fall of the Soviet
  women tend to walk down the boulevard arm-in-           Union. If someone asked me what the most signifi-
  arm in pairs. The young men, on the other hand,         cant change has been in the Russian Federation’s
  seem to wander more in packs, and sometimes, they       infrastructure over the past 16 years, I might have
  are dressed in a “Soviet” style of black jeans, T-      mentioned something about a broader range of
  shirts, and black leather jackets. Most of the young    commerce with the rest of the developed world. It
  adults look relatively indistinguishable from their     seems, however, that the most extensive progress




  American counterparts.                                  has been made in architecture; large cathedrals have
      The similarities, however, are superficial and      replaced those that the Soviets destroyed after the
  belie a major gap in social, cultural, scientific,      Civil War of 1918 – 1922. The buildings are beauti-
  and economic growth when compared to Western            ful and massive, in the Russian style with onion-
  Europe and the U.S. I am not a political scientist or   shaped turrets sheathed in gold or blue-tinted metal.
  historian by any means, but it seems that the policy    My new Russian friends were very proud ofthem.
  of isolation followed by the former Soviet Union        When I asked them what the names of the cathe-
  has left the population tragically behind the rest of   drals were, they did not know (and seemed

23 STANDPOINTS   Winter 2008
perplexed that I had asked). At first I thought that
                                                                                        F     aculty
                                                        ties financially. For example, upon graduation the
                                                                                                            A     rticles

this represented an “empty” investment for them,        average Russian physician is paid $100 to $200
but I quickly realized that this was a critical part    per month! I suggested that, as things improved in
of their healing process – the Soviets tried to take    their country, if they paid attention to their respon-
away their history and culture, and they want it        sibilities of providing quality medical care to their
back.                                                   patients, they would see improvements in their so-
    The other site in the city of which our hosts       cial and financial status. When that was translated
were very proud was the Memorial of the Great           there was a uniform response from the students that
Patriotic War (World War II). It is very similar in     did not have to be translated for me. They clearly
look to our Vietnam War Memorial. Interestingly,        did not believe me. I asked the translator why
our Japanese counterparts, who were the third arm       this was. and she answered that Russian medical
of this tri-national meeting,                                                      students had been told this
would not get out of the car                                                       for years but that nothing
to view this. Perhaps the fact                                                     ever changed. It was very
that Khaborovsk was the site
                                        After visiting Khabarovsk,                 sad to see such established
of the war crime trials of the        I am left with an impression                 cynicism in these young
Japanese after World War               that the Russians are a very                adults.
II had something to do with                                                            We also visited a few
this.                                 good, intelligent, well-inten-               of the regional hospitals.
    The medical meetings             tioned people handicapped by They were very clean, rel-
were very interesting. The                                                         atively unadorned facilities
Japanese and American phy-
                                      years of social and economic                 with a clear institutional
sicians presented data-based                     disadvantage.                     feel to them. Their new
reviews of new therapies or                                                        technologies were about
novel applications of exist-                                                       20 years behind ours, be-
ing therapies and would have                                                       cause they did not have the
been appropriate for any national or international      money ro resources for new medical supplies.
meeting. The Russian presentations were more a              The trip was extremely informative. After visit-
catalogue of all of the well-established techniques     ing Khabarovsk, I am left with an impression that
and technologies they had mastered. We met in an        the Russians are a very good, intelligent, well-in-
auditorium with about 200 medical students and          tentioned people handicapped by years of social
allowed them to ask us whatever they wished. They       and economic disadvantage. I think it will take
seemed mostly interested in the financial status of     them many years to overcome the handicaps that
American physicians compared to those in Rus-           70 years of oppressive, isolationist Soviet rule has
sia. While they were very surprised to hear about       left them. I have never felt myself to be excessively
the level of debt of the average American medi-         chauvinistic when it comes to my nationality, but
cal student on graduation, it is still very clear that  this experience has left me extremely grateful that I
American physicians have vastly greater opportuni-      am a citizen of the USA!
                                                                   Royalty free images courtesy of http://intour.khv.ru



                                                                                                Winter 2008 STANDPOINTS     25
       o
F   aculty    A    rticles



                         ne                                                                     (Above) Dr. Mynevere Latifi Hoxha,
                                                                                               Chief of NICU, Prishtina University Hos-
                                                                                                                pital




                 Baby at a
        Time
     An Interview with Dr. James Strickler
     and Chris Hammond about their work
      for Kosovo-Dartmouth Alliance for
              Healthy Newborns


  Standpoints: Why are you working              Cris Hammond and Dr. James Strickler           Cris Hammond: In the pre-natal
  in Kosovo?                                  work with the Kosovo –Dartmouth Alliance         period, we work with family health
                                             for Healthy Newborns with AmeriCares. The         centers and clinics in different
  Dr. James Strickler: The major rea-          president and CEO of Americares is Curt         regions of Kosovo, helping them to
  son we’re involved is because Kosovo                    Welling ‘71, Tu ‘77.                 provide prenatal care and services
  has a very high infant mortality rate.      Photos and Images Courtesy of Dr. Strickler      for women during pregnancy.
  The highest percentage is in the peri-              Interview by Jennifer Gaudette           Many women in rural areas are not
  natal period.                                                                                aware of the need to have prenatal
      Our programs have two foci: the care                                                  care throughout their pregnancies.
  of women during pregnancy and improving the healthcare of         Those in more urban or suburban areas are often not getting
  infants at high risk at the obstetrical and pediatric hospitals   optimum prenatal care. The family medicine doctors and
  at the university clinical center in Pristina. The focus is on    nurses have been trained, and with Dartmouth’s assistance,
  the obstetric hospital. Treatments that the Kosovans didn’t       have been given additional resources. They’re working on
  have before have been introduced: assisted ventilation (C-        clinical systems so that they can set up essential services for
  PAP) and the introduction of medications that facilitate gas      normal pregnancies and educate women about what to expect
  exchange and improved ventilation. We use World Health            throughout pregnancy and know what to recognize, as well as
  Organization guidelines for pregnant women, including the         how to get advanced care.
  number of {physician} visits, what you should be doing, etc.
  and extend those to six regions in Kosovo. Cris and her team      SP: What about the antenatal aspect of reproductive health?
  are extending the program throughout Kosovo.


26 STANDPOINTS Winter 2008
                                                                       Others, 4%
                                                                                                                                F   aculty   A    rticles
                                                           Asphyxia, 5%
  Causes of Early                                 Infection, 9%
 Neonatal Death in                                                                                      Prematurity,    Some Kosovo
     Kosovo                                                                                                49%
                                                        Perinatal
                                                       Causes, 15%
                                                                                                                         Statistics...
                                                                Congenital                                             •     Perinatal mortality
                                                                Anomaly,
                                                                                                                                rate in 2000:
                                                                   18%
                                                                                                                               29.1 deaths
CH: We have started providing antenatal care. We have about twenty family                                                  per 1000 individuals per year
medicine centers now providing these services to women and there is the plan for
the extension of this to other principalities and regions of Kosovo. The Ministry of                                   •     Perinatal mortality
Health and the Professional Doctors’ and Nurses’ Associations there have embraced                                               rate in 2006
the program and would like to extend it throughout Kosovo.                                                                        23.15
   Getting women basic care that they have not had access to before has had great
                                                                                                                           per 1000 individuals per year
success and that helps improve the likelihood that these successes will be extended
to other regions.
                                                                                                                          • 49% of early
SP: What is your goal for the project?                                                                                  neonatal deaths in
                                                                                                                       Kosovo 2006 were due
JS: We want to help the Kosovans develop better systems of antenatal, perinatal,
and prenatal care. The long-term goal is to help the Kosovans develop an integrated,                                       to prematurity
long-term system.You have more than the doctors and nurses, you have a team of
people. It’s the team systems approach that is a major thrust of our program.                                          •     Hands-on trainings
                                                                                                                              in antenatal care
      Perinatal Mortality Rates in 2000-2006 in Kosovo
                                                                                                                             conducted by the
                                                                                                                             Kosovo-Dartmouth
                                  35
                                         29.1
                                                                                                                               Alliance to-date:
                                  30
                                                                                                                                     64
         Deaths per 1000 people




                                                            27.1       27.6
                                                 28.7                            25.7
                                  25
                                                                                         22.14
                                                                                                 23.15
                                  20                                                                                       • Number of
                                  15                                                                                   professionals trained:
                                  10
                                                                                                                            253 doctors
                                                                                                                            697 nurses
                                  5
                                  0
                                       2000     2001     2002      2003       2004      2005     2006
                                                                     Years


                                                                                                                                    Winter 2008 STANDPOINTS   27
    F   aculty    A    rticles
     SP: What is the systems approach?                              point of a successful outcome, which is a healthy baby and
                                                                    mother.
     CH: When we talk about the systems approach, we include
     every aspect of health care. We talk about the smallest unit   SP: What kind of success has the program had?
     of care, microsystems, and we try to emphasize keeping
     the patient as the center of our focus. You have to include    CH: A year ago, babies were dying on a daily basis be-
     doctors and nurses together and you have to include the        cause (the hospitals in Kosovo) did not have the resources
     patient as a central unit. We work very hard with them to      needed to take care of them. Six months ago you could
     come up with systems that will work for the Kosovo situ-       walk in and see babies surviving because of these mea-
     ation. Everybody plays a role in getting a woman to the        sures. Now you can walk in and see babies that are not


            “Everybody
           plays a role in
         getting a woman
         to the point of a
          successful out-
         come, which is a
         healthy baby and
              mother.”




                                                                                                AmeriCares program
                                                                                                manager for Eurasian
                                                                                               International Programs,
                                                                                             Jim O’Brien, sees the work
                                                                                                      first-hand




28 STANDPOINTS   Winter 2008
                                                                                               F   aculty    A    rticles


        “A year ago, babies were
        dying on a daily basis...
       Now, you can walk in and
        see babies that are not
         only surviving but also
       thriving because of these
               measures.”
                                                                                      Why We Do This?
only surviving but also thriving because we’ve introduced therapists
for things like nutrition. We’re saving at least one baby per 5 days that    (Above) In November 2006, the first premature
a year ago wouldn’t have made it. We’re not talking about high-tech             newborns, a set of twins, were treated with
saves of infants that then are going to require advanced care through-                      CPAP in Kosovo.
out life. Most of these children will have a normal life and that’s pretty    (Below) In September 2007, the two twins are
great.                                                                       now two healthy babies living happily at home
                                                                                            with their family
SP: What role is AmeriCares playing in the partnership with Dart-
mouth?

CH: Dartmouth has both a breadth and depth of expertise for training,
but the resource part is where AmeriCares comes in to play. Ameri-
Cares is an organization that has donated over $13 million worth of
resources to Kosovo since the war. They’re a critical partner because
they bring in the resources and the technical support for funding and
providing the resources we need. They make connections through
their network that will be able to sustain us in the future.

SP: What is the next step for the program?

JS: We’re in the process of establishing a private Kosovar organiza-
tion, the Foundation for Healthy Mothers and Babies. This will not
be an American foundation working in Kosovo, it will be a Kosovar
foundation. We have strong support for doing this from the director of
USAID in Kosovo; we have enthusiasm from the Kosovars; and we’re
developing strong support in the American-Albanian community.
They’ll be able to continue to fund sustained programs.


                                                                                                  Winter 2008 STANDPOINTS     29
   C               G           h
            L
       lasses in       lobal       ealth


              OOKING FOR A                           GEOG 013
     GLOBAL OR PUBLIC HEALTH CLASS?
                                                     Population, Culture & the Environment 12
     Although Dartmouth may not offer a Global
     Health major, the school has a plethora         GEOG 015
     of classes that address Global Health-re-       Geography of Food and Hunger 2A
     lated issues. For those who are passionate
     about health and for those just curious,
     here is a cross-departmental list of the        GOVT 005
     spring courses that could address health        International Politics 2
     and health policy in the United States and      International Politics 10A
     around the globe.
                                                     GOVT 044
                    Spring 2008                      Politics & Political Economy in Africa 2A

   ANTH 017                                          PBPL 084
   The Anthropology of Health & Illness 10           Moral Values & Public Policy 10A

   BIOL 011                                          REL035
   Emerging Infectious Diseases 9L                   Religion and Science 2A

   ENGS 005                                          SOCY 066
   Healthcare/Biotechnology in the 21st Century 2A   Sociology & International Development 12
                                                                                  Photo by Ben Robbins ‘08
   ENGS 006
   Technology & Biosecurity 2A

   ENVS 003
   Environment and Society 12

   ENVS 080
   Environmental History, Politcs and Cultural
   & Ecological Change 11


30 STANDPOINTS Winter 2008
                                                                              I  nternships in             G    lobal     h     ealth

                                                                                Cornerstone Foundation of Belize
                                                                                      Public Health Intern
                                                                                  -Three-month to six-month internship
    Sakhi’s Women’s Health Initiative for
                                                                                  -30 hours per week
    South Asian Women in New York City                                            -Unpaid, contribution of $385 per month
          -Minimum three-month internship                                         -Fluency in Spanish not required
          -Minimum 15 hours per week                                    Cornerstone programs are relatively unstructured, allowing
          -Unpaid                                                       you to plug into existing projects and/or to initiate new
          -Recommended fluency in Bengali,                              projects that grow out of community needs and your capa-
                    Hindi, Punjabi, and/or Urdu                         bilities, interests and goals.Duties vary according to skill
          -Interest in public health/women’s issues                     and interest. Some of the areas public health interns work
Sakhi for South Asian Women is currently accepting                      with include: HIV/AIDS advocacy, health education, nutri-
applications for summer internship positions                            tion, physical education, counseling, etc.
including a “Women’s Health Initiative” Internship.                     For more information, please visit:



                                                                                L
Through the Women’s Health Initiative (WHI), Sakhi
works to educate and inform survivors as well as                        http://www.peacecorner.org/program.org
healthcare providers on the effects of violence on wom-
en’s mental, physical, and sexual health by helping South
Asian women access healthcare and learn about health                             OOKING FOR A
issues through one-on-one support, workshops, support                   GLOBAL HEALTH INTERNSHIP?
Group, and public education materials.                           Look no further than www.idealist.org. The
For more information, please visit:                                 site mainly has unpaid internships but
http://www.sakhi.org/about/internships.php                        offers amazing opportunities! Here are a
                                                                   few Global Health volunteer and intern-
                                                                 ship opportunities in the United States and
                                                                       abroad that we found interesting.

                                           ELI Medical Internships in Ghana
          -One-month to six-month internship
          -30 hours per week
          -Unpaid, contribution of $1175 for first month and $300 for each following month
ELI works with hospitals and clinics throughout Ghana to provide medical internship programs designed for pre-medical stu-
dents. Interns will have the opportunity to learn about the day to day practice of medicine in Ghana by shadowing doctors and
nurses. This is a unique opportunity to learn about the challenges the Ghanaian healthcare system is facing first hand. Interns will
also learn quite a bit about the treatment of diseases such as malaria, HIV/AIDS, Guinea Worm, and tuberculosis. Participants
with this program will have no medical responsibilities, but depending on qualifications, may be asked to assist with tasks around
the hospital or clinic. Interns with this program are encouraged to get involved with health education and outreach programs as a
way to give back to the community.
For more information, please visit: www.eliabroad.org

                                                                                                              Winter 2008 STANDPOINTS   31
  A   uthors &      o   rganizations

   Ben Robbins ‘08
   DARDAR Health Study/Bibi kwa Bibi
   http://dms.dartmouth.edu/dardar/overview/

   Marguerite Dashevsky ‘10
   DARDAR Health Study/ DARDAR Pediatrics Program (DPP)
   http://dms.dartmouth.edu/dardar/overview/

   Rachel LaRocca ‘09
   Medical Missions of Tabernacle Church of Buffalo
   http://www.thetab.org/

   Kristen Limbach ‘08
   Boston Health Care for the Homeless
   www.bhchp.org

   Emmanuel Mensah ‘09
   Ghana Youth Leadership Alliance (GYLA)
   http://www.gsoluxions.com

   Claire Wagner ‘10
   Insitut pour l’Education Populaire
   http://www.injep.fr

   John Butterly, MD                                 All photo credits
   Trinational Medical Meetings                     are given on each
   at Far East University                         page. All clip art used
                                                   is from royalty free
   James Strickler, MD and Cris Hammond                    sites
   Dartmouth-Kosovo Alliance for Healthy
   Newborns/Partnered with AmeriCares
   http://dms.dartmouth.edu/dean/initiatives/kosova.shtml
   http://www.americares.org                                          Top: Photo by Marguerite Dashevsky ‘10
                                                                      Middle and Bottom: Photos by Ben Robbins ‘08

32 STANDPOINTS Winter 2008

				
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