Center for Global Health 2019 Travel Grant Finalists Announced

Allison Bossong, College of Health Professions 
Project: Text Message Based Health Education in Uganda
 
The use of mobile phone technology has introduced new possibilities to the healthcare of communities in low-and middle-income countries. Studies have shown that basic text messaging systems of standard mobile phones are proving to be of value to reducing barriers to care – such as long distances and lack of access – while making better use of existing but often limited human resources. 
 
Allison Bossong, a student in the Physician Assistant program, will travel to Masindi, Uganda with One World Health as part of her women’s health clinical rotation.  She will be part of a team working to advance a text message-based health program to educate the local community on preventative health measures. She will work in partnership with Masindi’s community-based health educators in continuing the development and implementation of two key health issues: prevention of malaria for prenatal mothers and diabetes management. 
 
Bossong will work with her team to recruit patients to the Masindi Kitara Medical Center to participate in the project and will host pre-interventional education meetings on lifestyle changes and preventative strategies. She will also work with the web-based portal system to disseminate customized text messages to patients, to educate them on better prevention and management of current health conditions. 
 
The ultimate goal of the project is to lower patient glucose levels, prevent malaria in pregnant women, and better encourage overall health for the local community. Bossong hopes to gain a better understanding of telemedicine and be able to apply her education and experiences in Uganda into her practice as a physician assistant. 
 
“I will gain exposure and learn how to treat many diseases that are not seen in the United States,” said Bossong. “This experience will only further my education because it is important to learn how to treat different and unique illnesses.” 
 
Samantha Brophy, College of Health Professions
Project: Providing Parent and Provider Education About Early Development in Costa Rica 
 
Developmental delay – when a child does not reach their developmental milestones at expected times - is becoming an increasingly common problem in children worldwide. This is a major issue in low-and middle-income countries, where many younger children are exposed to multiple, contributing risk factors such as poverty, malnutrition, poor health and unstimulating environments.   It has been proven that early detection of delays, which often manifest in sensory, motor, cognitive, language and social-emotional domains, can produce better outcomes in children.  But, developing countries often lack proper surveillance and mechanisms to identify at-risk children and to provide intervention services.  
 
Occupational therapy student Samantha Brophy became interested in this issue when she taught English as a Second Language several years ago in Central America, and saw first-hand the cultural barriers and the need for parent and teacher education around developmental delays. 
 
This summer, she plans to travel to San Jose, Costa where she hopes to address the gap in education by providing parents and providers resources and tools to support early development and identification of developmental delays.  Her project focuses on recognizing delays of at-risk infants and children ages zero to three years - a critical time for development of motor, cognitive, and language skills. This is a very timely and important topic for this region of the world where viruses, such as Zika, have had a great impact on early development.
 
Brophy is creating educational materials for the local healthcare staff which includes culturally relevant checklists, screening tools, videos, and presentations translated into Spanish.  These materials will focus on how to recognize motor, cognitive, and speech delays in young children.  To better inform caregivers, she is creating a short, educational packet which provides information on early motor milestones, risk factors, and infographics about development, such as the benefits of tummy time for an infant. 
 
The innovation of using these educational tools will help parents and providers with limited health literacy achieve a deeper understanding of managing developmental delays in early childhood development.  This project will allow her to build her skills in health literacy and demonstrate the impact of occupational therapy in a low resource setting.  
 
“When I was considering different schools, MUSC stood out to me because of the international opportunities that they incorporated into the curriculum,” said Brophy. “Personally, what I want to get out of this experience is to increase my communication skills when working with people from different cultures in a healthcare setting.”
 
Nicholas Cundiff, College of Medicine, Pediatrics 
Project:  Pediatric Palliative Care with Child Family Health International in New Delhi, India
 

In resource limited settings, palliative care is a key component of care for children with cancer and other life-limiting conditions. According to the World Health Organization, 98 percent of children globally who need palliative care live in low- or middle-income countries, where there are very few palliative care services available. Nicholas Cundiff will travel to New Delhi, India in October for a one-month rotation with Child Family Health International where he will build his knowledge of palliative care, and gain exposure to how holistic care is provided at the community level for patients with life-threatening or life-limiting illness.  He will divide his time in India between working in the wards of a pediatric hospital and focusing on pediatric palliative care. In addition, he will have the opportunity to experience ancillary services provided in other community settings such as an LGBTQ community center, an HIV counseling and treatment center, juvenile rehabilitation center, street children’s center, and a drug rehab non-governmental organization.
 
Throughout this rotation, he will learn from physicians, nurses and social workers providers and better understand how culture impacts communication and decision-making among patients, families and physicians.  As a pediatric resident, Cundiff found himself drawn to palliative care because of its emphasis on quality of life and family centered care. Given that Indian traditional medicine has a strong focus on wellness and quality of life, Cundiff anticipates that palliative and hospice care practices will be exceedingly different from his experience in the US. 
 
This rotation will give him a greater understanding of the skills necessary in the practice of palliative medicine – from improving discussions regarding decision making in difficult situations, communication clarity and thoroughness, addressing advanced directives and goals of care, and alternative management of pain. He is looking forward to learning about what this field means to practitioners in this unique culture that often has different priorities when discussing medical options.
 
“This combination of ideas is why I would like to travel to India and to learn to view medicine with this quality over quantity lens that seems to be much more natural in that region of the world,” said Cundiff.  This is one reason why I am so drawn to this specific rotation. I want to be impacted, I want to be changed, I want to expand my world view and understand different ways of life.”
 
Jessica Giblin, College of Health Professions
Project: Addressing Wheelchair Access and Sustainability in Uganda
 
In Uganda, very few of the people who have a mobility impairment have access to a wheelchair – a device which can provide an important step towards employment, social inclusion and participation.  According to a survey report commissioned by Uganda’s Ministry of Health, the country may need as many as 1.5 million wheelchairs to meet the demand in each of its 80 districts.  A longstanding problem has been the lack of adequate local production of wheelchairs that are appropriate, well-designed and properly fitted.  
 
Jessica Giblin, an undergraduate student in the Healthcare Studies program, is part of a student team traveling to Uganda where they hope to examine and improve wheelchair access and sustainability to individuals in Uganda with a mobility disability.  She will be working with One World Health at Masindi Kitara Medical Center to implement a wheelchair seating and mobility clinic. 
 
Giblin’s main objective is to participate in a research project which will improve her ability to systematically approach a global health issue by engaging and coordinating stakeholders, conducting a needs assessment, recruiting participants and analyzing outcomes. She will work with the local staff to identify a specific number of individuals needing access to wheelchairs and help coordinate scheduling the appropriate patients for the wheelchair clinic.  This initial step for gathering data and results holds the potential to inform future wheelchair sustainability plans.  
 
Her prior experience in Uganda and familiarity with the culture and existing program needs will be instrumental as she develops educational resources to address wheelchair safety and to aid the local staff with sufficient methods to improve the clinic process. She hopes to make a lasting impact in Masindi, and after graduation, Giblin plans to pursue a graduate degree in the MUSC College of Nursing.  
 
“My participation in this research project will provide immeasurable and experiential learning opportunities that will lay important ground work as I move into graduate education,” said Giblin.
 
Hannah Kaleebi, College of Medicine, Emergency Medicine
Project: Designing and Implementing an Electrocardiogram Training Curriculum for Mid-level and Ancillary Staff in Uganda
 
According to the World Health Organization, cardiovascular disease is responsible for about 10 percent of all deaths in Uganda. An electrocardiogram (ECG) – a test that records the electrical activity of the heart - can be invaluable to diagnosing heart disease but is often unavailable in low-resource settings. 
 
This year, the Masindi Kitara Medical Center received a donation of an ECG machine but the medical staff have very limited knowledge on how to use the tool and how to interpret its findings.  Hannah Kaleebi, a first-year emergency medicine resident, will travel to Uganda for a three-week rotation to educate healthcare workers on the clinical application of the ECG. She will work as part of a team designing and implementing a curriculum for the local staff which addresses core competencies in ECG use and interpretation.  
 
The goal of the project is to better train local health care workers on the tool’s use in order to improve utilization of resources, ensure accurate diagnosis with ECG interpretation, and enhance best practices for clinical application in a resource-limited setting. This experience will allow her to further understand and address the challenges of improving healthcare delivery in a resource-constrained setting.  Kaleebi hopes this continuing medical education has a lasting impact on the health care workers, and ultimately patients, in the community. 
 
“This opportunity would allow me to develop skills as an educator, a researcher and an emergency medicine provider and give me hands on experience providing care in a resource-limited setting,” said Kaleebi.  
 
Holly Knapp, College of Health Professions 
Project: Evaluating the Impact of Wheelchair Seating and Mobility Clinic on Functional Mobility in Ugandan Youth 

 
Holly Knapp, a physical therapy student, is traveling to Masindi, Uganda as part of an MUSC team to examine and improve wheelchair sustainability to individuals with mobility disability in the Ugandan community.  She will lead the efforts for evaluating and collecting outcomes from the pediatric wheelchair clinic, which will provide valuable data that will guide and support future wheelchair seating and mobility clinics. 
 
Based on a current needs assessment, children will be identified as potential candidates for wheelchair assistance and then evaluated once the visiting team arrives.  If appropriate, children and families will receive a wheelchair and be trained in basic wheelchair position and mobility skills. Using a pre- and post-test design, Knapp will collect data from key pediatric outcomes measures - Pediatric Evaluation of Disability Inventory and the Wheelchair Mobility Skills Test – to capture mobility, mobility assistance level, functional skills, wheelchair proficiency and safety. This data will be invaluable to informing future Ugandan wheelchair seating and mobility clinics and to support clinic replication, which ultimately will improve the mobility and participation of children with disabilities in low resource settings.
 
Through this project, Knapp hopes to gain knowledge on resource availability and level of care in low-resource settings and develop the skills that will allow her to be a more effective pediatric physical therapist in the U.S. Upon graduation, she hopes to participate in a pediatric residency to fulfill her life-long passion of working with children.  
 
“This grant will allow me to take my experience and interest in research and apply it to a project that is going to contribute to my professional development in a way that a classroom setting simply cannot,” said Knapp. 
 
Fedelis Mutiso, College of Graduate Studies
Project: Impacts of HIV Oral Self-Testing Kits for Partner Testing in Tanzania
 
Growing up in Kenya, Fedelis Mutiso had a first-hand view of the devastating effects of HIV on the local community in a time where treatment was rare and expensive, and stigma was high.  While attending college in Kenya, he volunteered with a student organization working with the youth from neighboring communities sensitizing them about HIV, the dangers it posed, and the importance of getting tested. These experiences, combined with his love of mathematics and science, instilled a desire in him to pursue a career in the field of global health, specifically in combating the HIV epidemic. 
 
Mutiso will travel to Bagamoyo, Tanzania this summer for an internship where he will work with Ifakara Health Institute on a community-randomized study to assess whether offering the option of rapid blood-based testing, as well as the option of oral self-testing, will impact HIV testing rates in male heads of household. This trip will offer him unique exposure to a clinical and population-based research in a low-income setting.  He will work with the local study team at both sites, where he will assist with many aspects of the study, including observing data collection, participating in implementation discussions, and quantitative data analysis.  He is eager to observe how project leaders and coordinators deal with issues that arise when conducting a research study, and to better understand the ethics of HIV studies in the human subjects research framework.  This experience will allow Mutiso to observe various aspects of data collection to ascertain HIV testing behavior patterns among household members, while developing an understanding of the role social norms, cultural influences, political and health systems play in HIV testing in the local community. 
 
“Eager to be a bigger part of the solution to the HIV pandemic, I was motivated to pursue a career that would allow me to impact people’s lives from a public health perspective,” said Mutiso. “This research internship will provide me with technical skills that will serve me will in my future research and career.”
 
Jaquelyn Ross, College of Health Professions
Project: Enhancing the Development of Infants and Toddlers in Uganda Through Parent and Healthcare Education
 
One of the most significant issues in Uganda is the high vulnerability of pregnant women and young infants and children to malaria. Malaria during pregnancy can lead to premature delivery, low birthweight, and developmental delays; and malaria exposure can lead to cerebral malaria, which is particularly devastating, effecting an estimated 785,000 children in Sub-Saharan Africa every year and resulting in significant neurological deficits. There is a critical need for healthcare providers to educate at-risk mothers regarding the effect of malaria on early childhood development and help provide ways to identify early developmental delays in the first year of life. 
 
Jaquelyn Ross, an occupational therapy student traveling to Masindi, Uganda with the nonprofit OneWorld Health, plans to address this need by developing patient-friendly educational materials related to the prevention of malaria. She will create a culturally-relevant series of infographics consisting mostly of pictures and short phrases translated in the local languages which highlight common preventative measures and includes a developmental checklist which focuses on recognizing red flags of developmental delays from birth to one year. The innovation of using this educational tool will help mothers with limited health literacy achieve a deeper understanding of how to prevent contraction of malaria and help recognize signs of developmental delay in motor, language, and cognition in early infancy.

 
While in Uganda, Ross will work directly the local hospital staff to better understand their current prenatal and postnatal education services for pregnant women and mothers with at-risk infants and determine best practices to incorporate information regarding risks and signs of developmental delays in their routine education services.  This project will provide her the unique opportunity to combine the practice of occupational therapy with health promotion, while enhancing her skills to become a more culturally competent health care provider. 
 
"Being able to gain perspective on the values and beliefs of diverse cultures will allow me to better connect and empathize while building patient relationships, which is an invaluable skillset to acquire as a future therapist,” said Ross.  “This will ultimately allow me to provide the best possible care (in the US) to individuals of all backgrounds and to learn how to overcome barriers to connect with and educate patients both individually and on the community level.”  
 
John Smith, College of Medicine, Psychiatry and Behavioral Sciences
Project:  Clinical Observership in Tanzania
 
MUSC clinical psychology resident John Smith, is traveling to Dar es Salaam, Tanzania for a month-long clinical rotation at Muhimbili University of Health and Allied Sciences, where he will observe how cultural, social and economic factors influence the treatment of psychiatric disorders in a resource-constrained setting.  Smith will rotate between inpatient, outpatient, and addictions settings, where he we will observe common pathology and treatment regiments, become familiar with medications and procedures common to resource limited psychiatric medical care, and gain a better understanding of the role that culture plays in relation to medical and mental health care.  
 
Smith’s interest in this opportunity sparked after attending an MUSC grand rounds presentation by Dr. Samuel Linkindikoki, a psychiatrist at MUHAS with a research focus on risk factors for HIV and gender-based violence, where the guest speaker talked candidly about the challenges health care workers face when providing psychiatric care in Tanzania.  Wanting to learn more about how common cultural practices and spirituality play a role in providing care in Tanzania, Smith followed up with a request to observe at MUHAS.  
 
This experience will allow Smith to answer critical questions that will help shape his career in psychiatry and his understanding of the barriers of mental health care in low-resource settings.  He hopes to better understand if mental health stigma translates globally, which antipsychotics and antidepressants are commonly used and why, if therapy plays a role in treatment, how culture affects patients’ recovery and how accessible mental health care is to the local community. 
 
“By experiencing first-hand how psychiatry is practiced in East Africa, I will be able to provide more culturally competent and unbiased psychiatric care to my patients here in America," said Smith. "It will enhance my career by teaching me how to approach a different culture when providing care and extrapolate those steps to other unfamiliar cultures that I will face.”
 
Taylor Stoll, College of Health Professions
Project: Outcomes Related to Wheelchair Seating and Postural Positioning in Rural Uganda
 
Mobility aids are highly sought after in low-income countries. As a result, many countries rely on charitable donations of wheelchairs, which are often unsuitable for navigating the physical environment. 
 
Taylor Stoll, a physical therapy student, is traveling to Masindi, Uganda, to provide wheelchair mobility opportunities to adults and children with disabilities. She will work with a team of students to pilot a wheelchair seating and mobility clinic for adults and children at the Masindi Kitara Medical Center run by the nonprofit One World Health. They plan to purchase special wheelchairs, known as Rough Rider wheelchairs, from Whirlwind Wheelchair International, a company that has successfully engineered and designed wheelchairs for low-resource countries. 
 
Stoll will be assessing patients' posture and mobility prior to and following the wheelchair delivery. She will determine if these wheelchairs provide the proper postural support, improve functional mobility and safety, and prevent secondary impairments such as pressure areas to the patients. In order to do this, she plans to use the Posture and Postural Ability Scale to detect postural deficits and asymmetries, and also plan for and assess the patient’s ability to maintain postural correction. 
 
Stoll is aware of the many hardships the local community faces on a daily basis. This trip will allow her to build on her previous experience to the country, observe the necessary skills to provide mobility care to rural populations, and lay the foundation for future mobility opportunities for low-income countries. Stoll hopes this experience will support greater wheelchair accessibility and sustainability in the Masindi region of Uganda. Stoll’s efforts will not only provide much needed aid for individuals with mobility impairments but will also guide future wheelchair sustainability in underserved areas. 
 
 “I hope to use this new education along with my experience in Uganda to further develop my clinical reasoning and patient handling skills prior to spending 32 weeks on clinical rotations,” said Stoll. “I believe that spending time in Uganda learning how to evaluate need, properly position patients, and safely instruct them will ultimately make me a more confident, creative, and decisive clinician.” 
 
Kristen Trickett, College of Medicine, Pediatrics 
Project:  Acute Malnutrition Management in Tanzania

 
Pediatric resident Kristen Trickett is traveling to Arusha, Tanzania for a one-month elective at Arusha Lutheran Medical Centre (an urban medical center) and Selian Lutheran Hospital (a community hospital), where she will work in the pediatric wards, caring for and learning about the healthcare of children in Tanzania.   She will collaborate with local health care providers to help evaluate the implementation of malnutrition treatment protocol.  Through this experience, she will have the opportunity to enhance her skills in diagnosing malnutrition, learn to identify different types of malnutrition such as marasmus, kwashiorkor, and various vitamin deficiencies, and evaluate various refeeding programs.
 
Trickett is part of the global health residency track in the MUSC Department of Pediatrics, where she has developed a specific interest in learning how to provide quality care to children in resource-poor settings. During residency, she was caring for a premature infant who had been re-admitted with a diagnosis of failure to thrive. The infant was malnourished in the context of a readily available food supply and government assistance through the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program. This sparked her interest in learning more of how this same infant might have presented if he had been born in a different setting, perhaps in a country with chronic food insecurity. 
 
Throughout her training, Trickett has cared for patients from low-income areas and has witnessed on a small scale the disparities that exist within her own community. She is interested in the issues facing the children of immigrant families, with a special emphasis on their increased risk for mental health disorders. 
 
This experience will allow her to observe and learn how these issues are being addressed on a larger scale in a low-income country and to better understand the role that culture plays in providing clinical care.  After finishing her program, Trickett will head to Vanderbilt University where she has been offered a faculty appointment in the Department of Pediatric Outreach Medicine.
 

“In choosing a residency program, the ability to expand my experience through a program that supports an international rotation was of great importance to me,” said Trickett. “Without the luxury of the various technologies, advances in medicine, and public health initiatives that have been available throughout my medical training, I will be forced to rely much more heavily on my clinical skills. This can only strengthen my proficiency in practicing both the art and science of medicine.”
 
Logan Wolford, College of Medicine, Emergency Medicine 
Project: Protocol Development at Masindi Kitara Medical Center, Masindi, Uganda
 
Emergency medicine resident Logan Wolford will travel to Uganda as part of a medical team that will spend one week at Masindi Kitara Medical Center, operated by OneWorld Health.  Working closely with his faculty mentor, Wolford will play a key role in preparing and leading the team on this short-term trip.  He will work with 12 team members to develop education and treatment protocols on a variety of the most pressing and commonly seen clinical issues, such as respiratory distress, fever and trauma, that are present in the local community.  While in-country, the team will focus on training the local hospital staff on these best-practice protocols to help further the quality of patient care in this resource-limited setting. 
 
Wolford is looking forward to putting his leadership skills to the test by overseeing an interdisciplinary team in educational protocol development.  He will be responsible for providing pre-departure training to the visiting team, incorporating cultural competency and an overview of educational methods and protocol development strategies in low-resource settings.  This opportunity will allow him to learn the nuances of program development in health care, education and global health team leadership. He hopes this trip is a building block for a longer commitment to continuing education for this Ugandan community. 
 
“In pursuit of my interests and passions for serving those around the world, I have continuously made conscience decisions throughout my medical education to put my desires to pursue global health first,” said Wolford.
 
Ryan Zipper, College of Medicine, Urology 
Project:  Urologic Humanitarian Relief to Hôpital Sacré Coeur in Haiti
 
Haiti is the poorest country in the western hemisphere with approximately 80 percent of the population living in poverty. Access to urologic care in Haiti is sparse, with less than thirty urologists in the entire county - most of whom practice in the capital of Port-Au-Prince.  Surgical specialty care outside of the capital is mainly provided by US volunteer teams who have long-term partnerships with local hospitals.  
 
This is the case at Hôpital Sacré Coeur, the largest private hospital and public health provider in the Milot region, where urology resident Ryan Zipper will travel to with a team of volunteer specialists to work alongside Haitian physicians to provide urologic care to the local community. MUSC urologist Dr. Robert Grubb, who has spent many years partnering with this organization, will be leading the trip and exposing his resident to the realities of providing care in a hospital which does not have access to full-time surgical specialty care.
 
Due to lack of routine medical care and lack of money for prescription medications, many patients present with advanced disease that is rarely seen in the United States.  Issues like bladder outlet obstruction from an enlarged prostate that can be managed with medication in the United States are treated in Haiti with either catheterization, which increases risk of urinary tract infections, or surgery when urologists are available.  
 
 Zipper will have the opportunity to observe different models of global healthcare delivery, develop a greater sense of cultural competency by practicing in a country where the patients have a different set of beliefs and values than in the US, and improve his understanding of urologic practice in a low-resource setting. He will gain a better understanding of global health issues such as HIV/AIDS, cholera, tuberculosis, malaria and typhoid, learn how to manage care for patients with these diseases and observe how hospital systems allocate available resources to prioritize care. Zipper will have access to very limited imaging equipment at Hôpital Sacré Coeur, allowing him to improve his diagnostic abilities and management of urologic diseases through physical exam and diagnostics like basic lab tests and film X-ray and ultrasound.  
 
“I am very fortunate to receive urologic training in residency in the United States with seemingly limitless resources in providing care for my patients,” said Zipper.  “On the other hand, I believe my skills and understanding of urology will be furthered in practicing in a low resource setting."