A Publication of Physician Assistants for Global Health October by mikeholy


                                       A Publication of Physician Assistants for Global Health

     October 2010
                                 Dear Members,
                                 Fall is upon us and with the change of seasons comes continued positive changes for
                                 PAGH. Many of you have expressed frustrations with our website and we want you to
                                 know that PAGH is diligently working at making the website more user friendly as well
                                 as continuing to post current information regarding global health.

                                  We want to welcome Michael Jones, PA-C and Chad Eventide, PA-S to our web devel-
                                 opment team. Michael Jones, PA-C has been involved with PAGH for the last few
        CONTENTS                 years and will be taking on assisting us with Disaster Relief development for the web.
                                 Chad is currently a PA student at Duke University and will be assisting the team with
President’s Message.......1      current news and information of interest for PAs working in global health. We look
                                 forward to their participation and better serving you, our members with your interests.
Disease of the Month....1
                                 Please continue to visit our website for new developments!
                                  With the relocation of our current Network Coordinator, Fritz Fuller, to Cameroon
International Positions..4       we will be looking to fill this position. The Network Coordinator helps PAGH to
                                 strengthen their reach by connecting us with organizations that use PAs in volunteer
                                 and employment positions in medically undeserved areas. For more information please
                                 contact me at obockoff@gmail.com

                                 Olivia Bockoff, PA-C, MPAS
                                 Physician Assistants for Global Health

                                 Disease of the Month: Three Common Exam Findings
                                 By Jacob Hauptman, PA-C

                                 While working in international arenas, many times providers come across physical ex-
                                 am findings that while concerning to the patient are conditions that usually only re-
                                 quire monitoring. Knowledge of these conditions can be valuable to practioners in
                                 remote locations, who usually possess few diagnostic tools, allowing for a reasonable
                                 explanation for the patient and a viable diagnosis for the provider. Although there are
                                 many such conditions, three will be discussed here: seborrheic keratoses, pterygia, and
                                                                                                       Continued on Page 2

Continued from Page 1                                     the eye, non steroidal anti-inflammatory agents, or in
Pinguecula and Pterygium                                  more severe cases topical steroids can be used. In
The conjunctiva is a clear mucous membrane that func- the case of pterygia, as the tissue changes begin to
tions as an important barrier and protector of the eye. extend over the cornea, a noticeable change in vision
Formed of stratified columnar epithelial cells, this tis- can occur. The change presents as an astigmatism or a
sue is continuous with the skin at the eyelid margin (a blurring of vision due to the change of the curvature
mucocutaneous junction) and the cornea at the limbus. of the cornea. Initially this vision change can be man-
A scarring of this conjunctival tissue, usually occurring aged with ophthalmic aids such as glasses or contact
in tropical regions of the world, can lead to visible     lenses. When vision becomes threatened the only
growths on the eye. When hyaline and elastic tissue       definitive treatment is excision of the pterygium, but
form on either side of the cornea (more commonly          unfortunately there is a high rate of reoccurrence.
the nasal aspect), presenting as yellowish nodules,
these growths are referred to as pinguecula.              Lipoma
                                                          A collection of mature adipocytes present in the sub-
                                                          cutaneous tissue, the formation of lipomas is usually
                                                          due to a karyotypic abnormality of the adipocyte chro-
                                                          mosome. These overproliferating fat cells are encased
                                                          with a fibrous capsule and usually presents as a pain-
               Image available at: bluevsunglasses.com    less mass. Although they can indicate a genetic condi-
                  Image of a pinguecula.
                                                          tion such as familial multiple lipomatosis, lipomas are
 In the case of a pterygium, Bowman’s layer, a layer of frequently solitary, benign findings among the general
strong collagen fibers that helps the cornea maintain     populace. Clinically they present as a small (usually
its shape, is replaced by hyaline and elastic tissue.     less than 5 centimeters), soft, painless mass under the
This change presents as a triangular wedge of tissue      skin, usually in adults from 40 to 60 years of age.
over the corneal surface of the eye.                      Commonly lipomas are found on the trunk, neck or
                                                          proximal extremities and almost always spare the
                                                          head, hands, and feet. While growth greater than 5
                                                          centimeters can occur, larger size is not necessarily a

                Image available at: eyeswidebay.com.au
                    Image of a pterygium.

The true pathogenesis is unknown however the etiolo-
gy is commonly believed to be UV light or irritation                      Image available at: nlm.nih.gov
                                                                          Image of a lipoma on an arm.
from wind or particulates which precipitate a prolifera-
tion of tissue. The change can occur quickly over sev-     negative indicator. Rarely a lipoma can become pain-
eral months or present as more gradual growths over        ful, rapidly enlarge, or cause restriction of movement,
several years. Although pingueculae and pterygia are       all indications for a biopsy as this could indicate the
differentiated by their involvement with the cornea,       rare development into a malignant neoplasm such as
both can initially present with similar symptoms. Usual-   liposarcoma. Management of common lipomas is sim-
ly patients will complain of a localized redness and       ply monitoring. In patients who are experiencing symp-
irritation, believed to be a sign of active inflammation   toms or concerned about the cosmetic appearance of
of the tissue overgrowth. Management of this irrita-       a lipoma, surgical removal of the tumor can be per-
tion can be accomplished with topical lubricants for       formed.
                                                                                                            Continued on Page 3

Continued from Page 2                                                                        basal cell carcinoma or even melanoma. An attempt to
Seborrheic Keratosis                                                                         differentiate seborrheic keratoses from other lesions
A seborrheic keratosis is a benign epidermal tumor,                                          should be made. If the lesion does not have a stuck-on
usually presenting as a small (less than 20mm), well                                         or warty appearance, possesses blurred borders,
circumscribed patch, usually brown or tan in color.                                          asymmetry or is rapidly growing or painful, a biopsy
They can vary from single presentations to hundreds                                          should be considered. A variant of seborrheic kerato-
on one individual. Usually seborrheic keratoses pres-                                        sis that presents on the faces of dark skinned individu-
ent on the trunk, face, and upper extremities and are                                        als is dermatosis papulosa nigra. These lesions are
very slow growing. They can eventually develop a                                             usually small dark brown or black papules and are his-
papular, verrucous, waxy, or “stuck on” appearance.                                          tologically identical to seborrheic keratosis.
On close inspection, many will have a noticeable horn
cyst or dark keratin plug. The lesion represents an                                          No treatment is indicated for seborrheic keratosis,
                                                                                             however if desired the lesions can be removed in a
                                                                                             variety of ways. Liquid nitrogen can be employed for
                                                                                             smaller, thin lesions. Larger, thicker lesions are more
                                                                                             amenable to curettage after treatment with liquid ni-
                                                                                             trogen or shave excision after local anesthesia is ad-
   Image available at: emedicine.medscape.com    Image available at:emedicine.medscape.com
        Images of single and multiple seborrheic keratoses.
                                                                                             1) Jacobs, Deborah S; Pterygium October 2009 Up To Date Website Available:
 overproliferation of keratinocytes, many times with                                         http://www.uptodate.com/online/content/topic.do?topicKey=priophth/2824&selec
                                                                                             tedTitle=1~9&source=search_result Accessed September 2010
an increase in melanocytes. Although they are consid-
                                                                                             2) Goldstein, Beth et al; Overview of benign lesions of the skin; February 2010
ered benign, their appearance can sometimes be asso-                                         Up To Date Website Available: http://www.uptodate.com/online/content/topic.do?
                                                                                             topicKey=oth_derm/7792&selectedTitle=1~34&source=search_result Accessed
ciated with malignant neoplasms of the skin such as                                          September2010


                                                PAGH Editorial is up on the JAAPA Website
   Our editorial in response to the May 2010 JAAPA article “Health care volunteerism: What PAs need to
  know before making a trip,” has been published on the JAAPA website under Letters. We thank JAAPA for
   publishing our response and helping to spread the word about PAGH. You can access the letter on

                                                Attention PAs Who Have Worked In Kenya
  One of our student members, Liesel Ernst, is collecting data on PAs who have worked in Kenya for her Mas-
   ter's Degree. If you have experience working in Kenya and are willing to take a survey or participate in a
                       phone interview, please contact Liesel at lieselernst@yahoo.com

                                                Students Interested In Volunteering In Nepal
                                                Contact Michael Jones, PA-C at: mjones1700@comcast.net

                        VOLUNTEER OPPORTUNITIES

                                                  Hospitals of Hope
                 Year round opportunities in Bolivia and Liberia and the following trips to Haiti.
                                        December 5-11, 2010
 Working with Heart to Heart International doing outpatient clinics in the countryside north of Port-Au-
                          Prince. This trip is for medical professionals only.
                                           February 5-12, 2011
 Working at Mission of Hope's main clinic with some day trips. This trip may involve some surgery and can
                         accommodate both medical and non-medical volunteers.

                          Real Medicine Foundation/ Jeevan Jyoti Hospital
                                               Jhabua, Madhya Pradesh, India

Looking for a full time pediatrician for a year, but in the meantime since they’re facing a spike in diarrheal dis-
 eases, malaria, TB and other complications of severe acute malnutrition in their district they are also willing
     to bring on a volunteer or part-time pediatrician for several months until the full-time position filled.

                                                    Amazon Promise
                                                    2011 Expeditions

   Jan 15 - 22, 2011: One Week Non-Jungle trip /                  Jul 30 - Aug 13 2011: Two Week Jungle Trip: Villages of
 Iquitos: Clinics held in the city of Iquitos, in port areas of   the Yarapa, lower Ucayali, and lower Maranon Rivers. For
                  Belen and Masusa. OPEN                            medical volunteers wanting a longer stay, you may also
                                                                   take part in first week of medical student internship start-
 March 19 - 28 2011: 10 Days in Iquitos / Jungle (For the                              ing July 23rd. OPEN
 busy professional) - First five days in Iquitos holding clinics
 in the impoverished port areas of Belen and Masusa. We            Sept 10 - Sept 24 2011: Two Week Remote Jungle
  then travel to the jungle town of Nauta near the Pacaya                  Trip: Medical expedition to indigenous
   Samiria National Reserve, where we'll head out on the         communities. Participants must have prior extensive camp-
river each day to hold clinics in villages of the lower Ucaya-              ing experience. OPEN to 6 volunteers
   li River. We return to Iquitos on Monday, March 28 to
 give volunteers the remainder of the week to travel Peru           Oct 8 - Oct 29 2011: Three Weeks in Iquitos /
                 or to return home. OPEN                          Jungle: 1st week in Iquitos, 2nd and 3rd weeks in villages
                                                                   of the Pacaya Samiria National Reserve. Volunteers may
   Jul 23 - Aug 20 2011: Four Week Medical Student                    choose to participate in 1, 2 or all 3 weeks. OPEN
   Internship: Two weeks in the city of Iquitos, and two
   weeks in the jungle in the Villages of the Yarapa, lower        Nov 12 - Nov 19 2011: One Week Non-Jungle trip /
 Ucayali, and lower Maranon Rivers. Open to Medical, PA           Iquitos. Clinics held in the city of Iquitos, in port areas of
                and Nursing students. OPEN                                         Belen and Masusa. OPEN


                                            Benjamin Wellness Center
                                                    Gatamaiyu, Kenya
  Next trip: Jan 7-23, 2011, with a team of students from Philadelphia Biblical University to help the local
 church, AIC Gatamaiyu, with the construction of their education building. We will also be taking a medical
                                      team to conduct a medical camp.

                                           International Medical Relief

Sending one team to Pakistan - interested candidates can fill out an application. The location and dates will be
       disclosed only to the team itself because trip details will not be promoted for security purposes.

                                         Peacework Medical Projects

Recruiting the following volunteers for two week projects: Physician Assistants, Physicians, Nurse Practitio- ners,
                                 Registered Nurses, and Paramedics.
CAMBODIA: January 22- Feb 5, 2011                                   HONDURAS: MAY 21- JUNE 4, 2011:
(or close approximate). We are returning to the southern region     Our commitment to Honduras can be traced back to Hurricane
of Takeo, where Peacework Medical has been established in the       Mitch in 1998, and the first Peacework Medical project was in
center of 17 villages for primary care and health education. This   this beautiful country. We will return to the southern town of
project includes a cultural/recreational weekend to Siem            Nacaome for primary care and health education, where nearby
Reap/Angkor Wat, a UNESCO Heritage site.                            rural communities are given tickets to come “to town” to have
                                                                    access to our free services.

                               FIMRC Global Health Volunteer Program
 FIMRC is pleased to provide hands-on service opportunities at each of our medical sites through the Global
 Health Volunteer Program. Currently, opportunities exist at our sites in El Salvador, Nicaragua, Peru, Costa
Rica, India, and Ugan- da. FIMRC is a 501(c)3 nonprofit organization committed to building and operating medi-
  cal clinics and comprehensive community health care to impoverished communities worldwide. A detailed
                        overview of our program is available at www.fimrc.org/missions.

If you are aware of any trips or organizations that are looking for PA volunteers, please contact our president,
Olivia at obockoff@gmail.com. In the future it is our intention that you will be able to log onto a website and
look up trip information. (Please Note: it is not our desire to promote specific organizations only to connect
PAs with opportunities and encourage professional philanthropy. In the upcom- ing months we will offer
standardized information about any organization that uses PAs in underserved areas.
This information is not an endorsement of these organizations.

NYC Medics, Physicians for Peace, and Mercy Ships are organizations that are looking for volunteers.

Flying Doctors of America provides medical assistance and hope to as many of the poor and needy as we
are able to reach. Medical & dental teams to wherever the current need is. http://www.fdoamerica.org

Lalmba works in two exciting locations: on the shores of Lake Victoria in Kenya and in a stunningly beautiful
rain-forest in Ethiopia. They teach and train Africans to care for their own medical needs to every extent pos-
sible and have been doing this for 43 years. Goals are clinical medicine, coupled with public health, and work-
ing with local physicians. http://www.lalmba.org/modules/wiwimod/indes.php?Page=events

International Medical Relief: “Your skills as a PA would be of incredible value to any of our trips.” 2010
Trip Schedule includes trips to Cuba (April), Ghana (April/May), Ethiopia (June), Kenya (June), Uganda (June
and July), Myanmar (October), and the Brazilian Amazon (November). This unique experience is a very re-
warding way to journey through the world and at the same time bring valued aid to those in need.

                   Get Involved! Positions Open on the PAGH Board
In general PAGH activities require just 2-5 hours a month, varying depending on the month
  Ÿ Participation on monthly conference call (second week of every month) 30-90 minute calls.
  Ÿ Give monthly reports (email them if you can not be on call)
  Ÿ Attendance and assistance at AAPA conference (May) or the PAGH Global Health conference (Oct)
  Ÿ Take personal responsibility and creativity for your position and recruiting volunteers to help accomplish
                                               Open Positions

Secretary                                            Web Coordinator
 Ÿ Conference call and meeting minutes                Ÿ Manage web page
 Ÿ Distribution of emails to board and members        Ÿ Announcements on web, Facebook, yahoo
 Ÿ Keep track of PAGH documents                       Ÿ Topic discussions on Facebook, yahoo
 Ÿ Distribution and managing publications: ex Disease Ÿ Hire a web developer (long term goal)
   of the month, nexus                                Ÿ Direct member questions to proper people

Public Relations Chair
 Ÿ Maintain our relationship and influence with AAPA, Membership
   PAEA and state PA organizations- including partici- Ÿ Keep track of membership count and “interested”
   pation on international committees of other large      members
   PA orgs                                              Ÿ Recruiting new members
 Ÿ Help PAGH assert its role in Global Health arena     Ÿ Volunteer coordination
 Ÿ Develop informational tools for promotion of PA-
   GH and the use of PAs in underserved areas          Fundraising Committee Chair
 Ÿ Also educational tools for NGOs that use PAs on      Ÿ Execute Fundraising plans
   the PA physician team and proper use of PAs          Ÿ Assist treasurer and CME chair
 Ÿ Public relations with media etc

                                       Help Nexus Improve!
Your input can make a difference for future issues of Nexus. We welcome suggestions/submissions for future
Book Reviews, Spotlights, or other features. And of course any and all comments are welcome. Please direct
                                   to Jacob at: hauptmanjacob@yahoo.com.


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