Jefferson Shares Expertise to Advance Global Health

By Gail Luciani

We inhabit a constantly changing world. From the exploding digital revolution in communications to the ebb and flow of transnational business, rapid and sometimes historic change is taking place on our planet. In this volatile environment, we may forget that many of the earth’s populations are dealing with these dizzying changes while still competing for clean water, arable land and basic health care.

The issues are complex — population growth, loss of biodiversity, the spread of infectious disease, drought — and solutions must be comprehensive and wide ranging. Global health has been on the radar of medical professionals for many years, and collaborative research has helped deliver significant achievements — including a vaccine for meningitis A, a rapid test for detecting tuberculosis and a malaria drug for children.

But advancing global health in the 21st century requires more than sharing research and technological innovations across national borders. Improving and achieving equity in health for all people is at its heart, and it has become an area of growing interest for both medical students and the colleges that educate them.

A Tradition of Global Learning

Harsh Sule, MD, left, oversees an ultrasound in Sierra Leone. Photo courtesy of Dr. Sule.
“At Jefferson, an increasing number of medical, population health and health professions students are seeking global health learning experiences,” says Janice Bogen, assistant vice president, international affairs. “Since 1997, 477 students have been partially funded for their study abroad experiences with Foerderer Award funds.” Bogen is a member of the Jefferson Global Health Initiative Committee, which formed in 2010. The committee includes representation from all schools, with members working to promote the integration of global health into curricula today and perhaps leading to a Jefferson Global Health Center in the future.

A center would build on Jefferson’s strong tradition of global learning. “Medical education is and should be an international experience,” says Joseph Gonnella, MD; distinguished professor of medicine; director, Center for Research in Medical Education and Health Care; and dean emeritus. “The sharing of medical knowledge is as old as the profession itself. From the earliest recorded history, medical education has been an international two-way bridge. We receive as much as we give in our global relationships.”

Historically, Jefferson has signed contracts for collaborative research relationships in Korea, Italy, Japan, China and Argentina. Formal agreements with the Kimmel Cancer Center provide access to researchers who collaborate with scientists from institutions in Italy, Australia and Austria. In Japan, collaborative research with the Noguchi Medical Research Institute is improving medical care for patients around the world.

In addition, Jefferson opened the Japan Center for Health Professions Education and Research in January 2012 to promote the exchange of training and research among Jefferson, the Japanese Association for the Development of Community Medicine and the Noguchi Medical Research Institute.

Jefferson began a medical education venture in Malaysia in 1991 that was designed to improve education in the region and provide selected Malaysian students the opportunity to study at the medical college.

In Israel, the Louis and Fannie Tolz Collaborative Research Project between the American Committee for the Weizmann Institute of Science in New York and Jefferson supports collaborative research in areas such as computational biology. Scientists from both institutions have met and shared ideas about prospective projects. In addition, American students studying medicine in Israel have an opportunity for elective rotations at Jefferson.

In 2012, approximately 100 members of Jefferson’s faculty reported participating in conferences, scientific programs, medical meetings or lectures in a foreign country. And their peers in these countries come to Jefferson as well. “Jefferson sponsors a biannual symposium designed to foster interaction among global leaders in biomedical research,” says Bogen. “The event includes the presentation of the prestigious Lennox K. Black International Prize for Excellence in Medicine, which is a major contribution to Jefferson’s overall global presence.”

Jefferson faculty take time to visit an historic site during their trip to Israel. Photo courtesy of Dr. Zvi Grunwald.
Center and Department-Level Initiatives

The Center for Research in Medical Education and Health Care researchers are collaborating on a series of projects with the Regional Health Care System of Emilia- Romagna, Italy. According to Daniel Louis, center manager, current projects include development of models to predict risk of hospitalization for patients with chronic disease, analyses of the distribution and outcomes of surgical services for patients with cancer and analyses of intraregional variation in medical, surgical and pharmaceutical treatment.

Many departments have active research collaborations with their peers across the globe; for example, the Department of Dermatology and Cutaneous Biology works with scientists in a host of countries including Finland, Germany and Hungary. “These collaborations relate to our ongoing work on molecular genetics of heritable skin diseases, with translational implications for diagnostics, genetic counseling, prenatal testing and development of novel molecular therapies,” says Jouni Uitto, MD, PhD, professor and department chair.

The Department of Radiation Oncology has an active international fellowship program that provides training to medical students, radiation oncology residents, medical physics residents and fellows. “Our international program is extremely important. It brings new ideas, concepts and energy into the department and allows us to develop collaborative relationships with talented physicians, physicists and scientists throughout the world,” says Adam Dicker, MD, PhD, professor and chair of radiation oncology and professor of pharmacology and experimental therapeutics.

John Melvin, MD, chair of the Department of Rehabilitation Medicine, oversees an international program that both hosts foreign visitors and encourages faculty to travel to international locations to provide advice, teaching and services. “Our department disseminates information about medical rehabilitation to individual health professionals here on Jefferson’s campus and at international sites,” he says. “Through this two-way process, our faculty also has gained a broader understanding of how various health systems care for people with disabilities.” Melvin has met with governmental policy makers in several countries including China, where there is now a comprehensive plan for the development of rehabilitation centers throughout the country.

Learning While Healing
Jefferson emergency department physicians have twice traveled to Sierra Leone to help improve the quality of health care and its delivery within the developing West African country. The team provided clinical care and helped train local healthcare workers to perform point-of-care ultrasound. Jefferson’s growing work in Sierra Leone provided the impetus for establishing the first post-residency Global Health Fellowship program for emergency physicians in Philadelphia, which began in July 2011.

“Sustainable development requires improvements in local governing structures, improvements in financing and improvements in education,” says Harsh Sule, MD, assistant professor of emergency medicine and director, international emergency medicine. “That’s why we decided to make our department’s focus not international emergency medicine, but rather the broader field of global health including the social determinants of health.” The program is a joint effort between the Jefferson Department of Emergency Medicine and the Jefferson School of Population Health.

Learning opportunities in other countries are crucial to the study of medicine in the United States because students need to be aware of the breadth of disease. “We need to think about sending our students to other countries so that they will learn about some of the diseases we don’t often see here,” says Gonnella.

JMC students work with children as part of a JeffHEA LTH educational program in Rwanda. Photo courtesy of Dr. James Plumb.
Students have that chance when they volunteer with JeffHEALTH, a model of student global education in Rwanda. The 7-year-old program encourages students who volunteer between their first and second year of medical school to learn approaches to care, education and research as well as methods of integrating primary care and public health. Students can also offer a range of services that meet community needs and work on specific programs developed with Rwanda partners such as HIV/AIDS education, malnutrition, clean water, income generation, family planning and prenatal care. “As an organization, JeffHEALT H seeks to build a Universitywide community of health professionals interested in working to advance health in African communities,” says faculty advisor James Plumb, MD ’74, professor in the Department of Family and Community Medicine and director, Center for Urban Health. The program has been so successful that many medical students return for an elective in their fourth year. In addition, nursing, physical therapy, occupational therapy and population health student involvement underscores the importance of multidisciplinary education across borders.

Geo-political borders may end in Philadelphia, but refugees from around the world arrive daily needing health care. The Center for Refugee Health operates out of Jefferson’s Department of Family and Community Medicine and is headed by Marc Altshuler, MD ’01. Each year, the center sees approximately 300 patients from more than 30 countries, including Iraq, Iran, Burma, Vietnam, Haiti, Nepal, Eritrea, Bhutan and the Congo. Rheumatic heart disease, not often seen in developed countries, is a common condition among refugees. A 19-year-old patient from Nepal arrived at the clinic weighing just 74 pounds, so weak her family had to help hold her up. “When I met her family, her father said to me ‘My family’s health is in your hands.’ She was seen in our center, then in cardiology, within 10 days,” Altshuler said. “Her heart valve was replaced at Jefferson and today she is doing well and living like a normal 21-year-old.”

Impact Across Regions
True to a global interpretation of health care, Jefferson initiatives often cross borders in their execution and impact. Barry Goldberg, MD, who co-chairs the global health committee, pioneered the “Teach the Teachers” program at the Jefferson Ultrasound Research and Education Institute in 1990. The institute trains physicians worldwide in regional ultrasound education centers who then return to their respective countries to teach what they have learned to others. There are currently 37 training centers, and physicians from Central and Eastern Europe, sub-Saharan Africa, the Caribbean and Latin and South America have been trained through affiliate centers worldwide.

True to its tradition of global learning, Jefferson has made contributions that range from the translation of its Scale of Empathy into 42 languages to a recent study that found that a re-sterilization and implantation strategy for explanted implantable cardioverter-defibrillators could have important humanitarian and economic effects for citizens of low- and middle-income nations. A renewed global health presence will build on Jefferson’s strengths of academics, clinical training and research excellence, contributing to the spread of equity in health for all people and the advancement of scientific knowledge resulting from global collaboration.
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