Journal of the American Geriatrics SocietyEarly View OLD LIVES TALE The professor Matthew Dacso MD, MSc, FACP, Corresponding Author Matthew Dacso MD, MSc, FACP [email protected] orcid.org/0000-0003-3386-9784 Department of Global Health & Emerging Diseases, UTMB School of Public & Population Health, University of Texas Medical Branch, Galveston, Texas, USA Correspondence Matthew Dacso, Department of Global Health & Emerging Diseases, UTMB School of Public & Population Health, Internal Medicine, University of Texas Medical Branch, 301 University Blvd., University Hospital Clinics 4.340, Galveston, TX 77555-0434, USA. Email: [email protected]Search for more papers by this author Matthew Dacso MD, MSc, FACP, Corresponding Author Matthew Dacso MD, MSc, FACP [email protected] orcid.org/0000-0003-3386-9784 Department of Global Health & Emerging Diseases, UTMB School of Public & Population Health, University of Texas Medical Branch, Galveston, Texas, USA Correspondence Matthew Dacso, Department of Global Health & Emerging Diseases, UTMB School of Public & Population Health, Internal Medicine, University of Texas Medical Branch, 301 University Blvd., University Hospital Clinics 4.340, Galveston, TX 77555-0434, USA. Email: [email protected]Search for more papers by this author First published: 01 March 2024 https://doi.org/10.1111/jgs.18846Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

In recent years, the concept of One Health (OH) has arisen as an approach that helps to catalyze the creation of transdisciplinary teams needed for surveillance and investigation of emerging disease dynamics. Besides a wealth of descriptions of what the OH approach encompasses, a dearth of information is available regarding the training of individuals in OH competencies. In 2019, the Nigerian Center for Disease Control developed an OH strategic plan to meet the country’s human, animal, and environmental health challenges. In response to the demand for clinicians, scientists, climatologists, conservationists, and environmentalists, who have expertise in environment, human, plant, and animal health to work collaboratively in addressing OH challenges in Nigeria. An interprofessional group of faculty from the University of Texas Medical Branch, the University of Jos, and the National Veterinary Research Institute convened to develop a novel OH course ‘entitled ‘One Health for Translational Team Science. The objective of the course was to explore the evolution of an emerging epidemic, capitalizing on various learning environments, including animal, environmental, human, and public health perspectives. The 6-week course comprised of three parts: 2-weeks virtual part of case-based group discussions focusing on animal and environmental aspects, 2 weeks of individual field experiences, and a final virtual part focusing on human health. Pedagogical tools used were: case-based group discussions, breakout group presentations, role-play activities, field project write-up, peer evaluation, group writing assignments, and weekly reflections with the goal of working in teams to develop and practice the fundamental leadership and management skills in addressing emerging public health challenges. Post-course evaluations showed that all participants felt more confident identifying and practicing the necessary attitudes and skills to participate effectively in the evaluation of an outbreak. Furthermore, the roles, responsibilities, and “One Health ways of thinking” for the various disciplines and professions involved in improving global health were articulated and identified.

Early in the COVID-19 pandemic, substantial disruptions in personal protective equipment (PPE) supply chains forced healthcare systems to become resourceful to ensure PPE availability for healthcare workers. Most worrisome was the global shortage of N95 respirators. In response, a collaboration between the Department of Infection Control and Healthcare Epidemiology and the Department of Biosafety at the University of Texas Medical Branch developed a PPE recycling program guaranteeing an adequate supply of respirators for frontline staff. The team successfully developed and implemented a novel workflow that included validated decontamination procedures, education, and training programs as well as transportation, labeling, and storage logistics. In total, 15,995 respirators of various types and sizes were received for recycling. Of these, 12,752 (80%) were recycled. Following the program's implementation, we surveyed 134 frontline healthcare workers who overwhelmingly graded our institution's culture of safety positively. Overall impressions of the N95 respirator recycling program were mixed, although interpretation of those results was limited by a lower survey response rate. In an era of increasing health security threats, innovative recycling programs like this one may serve as a model for other health systems to respond to future PPE supply chain disruptions.

Texas is a geographically large state with large human and livestock populations, many farms, a long coastal region, and extreme fluctuations in weather. During the last 15 years, the state of Texas has frequently suffered disasters or catastrophes causing extensive morbidity and economic loss. These disasters often have complicated consequences requiring multi-faceted responses. Recently, an interdisciplinary network of professionals from multiple academic institutions has emerged to collaborate in protecting Texas and the USA using a One Health approach. These experts are training the next generation of scientists in biopreparedness; increasing under-standing of pathogens that cause repetitive harm; developing new therapeutics and vaccines against them; and developing novel surveillance approaches so that emerging pathogens will be detected early and thwarted before they can cause disastrous human and economic losses. These academic One Health partnerships strengthen our ability to protect human and animal health against future catastrophes that may impact the diverse ecoregions of Texas and the world.

Late in 1983, in a remote Dou Donngo community on Sumbawa Island in Indonesia, a woman suffered an extensive burn to her back when she fell into a fire. The usual treatment for this injury was for a sando, a local healer and ritual specialist, to spit betel juice into the wound, a procedure called sampuru or ufi in the local language. One of us (PJ), doing ethnographic fieldwork in the community, was armed with a new publication, Where There Is No Doctor,1Werner D. Thurman C. Maxwell J. Where There Is No Doctor: A Village Health Care Handbook.Revised edition. Berkeley, CA, Hesperian Health Guides2017Google Scholar a medical how-to book then widely used by Peace Corps volunteers and others in remote settings. Asked to help in the treatment of the woman and finding guidance in Where There Is No Doctor that did not include sampuru, a discussion ensued revealing that the sampuru’s beneficial effects would not be mitigated by its application to a bandage rather than the wound. Thus, after the application of petroleum jelly and sulfanilamide under a sterile dressing, the sampuru was performed over the dressed wound. This combination of therapies was effective in promoting uneventful healing, importantly within the cultural contexts of both the Western ethnographer and the sando, and, most importantly, the patient.2Just P. Dou Donggo Social Organization: Ideology, Structure, and Action in an Indonesian Society [dissertation]. University of Pennsylvania, Philadelphia1986https://repository.upenn.edu/dissertations/AAI8703222Date accessed: March 9, 2019Google Scholar Though the juice of betel leaf and areca nut (widely chewed in South and Southeast Asia) has potential medicinal properties,3Haslan H. Suhaimi F.H. Thent Z.C. Das S. The underlying mechanism of action for various medicinal properties of Piper betle (betel).Clin Ter. 2015; 166: 208-214PubMed Google Scholar its effect on burn recovery, particularly when combined with human saliva, is doubtful. Yet it was important for the sando to contribute to the treatment of the patient as the sando was widely respected as a healer in the community, and his intervention was critical for the comfort of the patient. This salutary interaction is the story of Where There Is No Doctor and demonstrates its enduring relevance for medical practice. Donde No Hay Doctor was written in 1973 by David Werner as a guide for village health workers that he and others called “promotores de salud” (health promoters). Werner, not himself a physician, worked in Ajoya, Sinaloa, Mexico as a disability advocate and community activist. He envisioned 3 levels of health care. At the level of the community, he envisioned that health education would permeate the population, driven by promotores who had specialized education in health. The second level was the training of campesinos (farmers) from remote villages as promotores at the clinic in Ajoya. The third level was the operation of the Ajoya Clinic, still run by village health workers. There was no doctor involved, because of the impoverished and remote nature of the community. The Ajoya Clinic had a unique funding model. People could either pay an annual fee or could work in the clinic. Because of the poverty of the area, few could pay, but their payment formed the basis of the cash needed to operate the clinic. With community workers alongside the promotores, the clinic was sustained. Werner emphasized prevention rather than treatment. Avoidance of diarrhea in children and pervasive vaccination were among the keys to the strategy. Ten years after the establishment of the Ajoya project, Werner wrote Donde No Hay Doctor. The timing of the book was propitious as there was an expansion of programs like the Peace Corps that sent volunteers to remote areas where not only was there no doctor, there never was going to be one. So, armed with the book, these workers were able to provide not only medical care but also guidance on health behavior. Donde No Hay Doctor and its successors have been translated into 26 languages, and its relevance in places like the highlands of Sumbawa cannot be gainsaid. What is its relevance in the US medical practice system that has 38 magnetic resonance imaging machines for every million people (almost 4 times the number in Canada)?4Organisation for Economic Co-operation and Development Magnetic resonance imaging (MRI) units.https://doi.org/10.1787/1a72e7d1-enDate accessed: March 9, 2019Google Scholar Where There Is No Doctor quite simply is an owner’s manual for the human body, allowing the user to change the oil, adjust the clutch, and even rebuild the transmission if needed. Where there is no need, where there are plenty of doctors (and magnetic resonance imaging machines), Where There Is No Doctor provides a common language for communication between health care professionals and people who are sick or who are trying to avoid being sick. The book is based on 6 tenets:1.Health care is not only everyone’s right, but everyone’s responsibility.2.Informed self-care should be the main goal of any health program or activity.3.Ordinary people provided with clear, simple information can prevent and treat most health problems in their own home—earlier, cheaper, and often better than can doctors.4.Medical knowledge should not be the guarded secret of a select few but should be freely shared by everyone.5.People with little formal education can be trusted as much as those with considerable formal education, and they are just as smart.6.Basic health care should not be delivered but encouraged. In the United States, we are told that there is a shortage of those providing primary care.5Association of American Medical Colleges The complexities of physician supply and demand: projections from 2016 to 2030, 2018.https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdfDate accessed: March 9, 2019Google Scholar The solutions proposed involve training more physicians, physician assistants, and nurse practitioners. Yet, reorientation to the principles of Where There Is No Doctor would substantially change the type of work that primary care practitioners perform. Where There Is No Doctor teaches a different type of doctoring than does standard medical education. Rather than us giving to them, a strategy of collaborating around the best interest of the patient, and those trying to avoid being patients, means that each party brings its own expertise to the table. The physician is an expert in medicine, biology, pharmacology, and the art of medicine. The patient is the expert in him or herself. Further, the Where There Is No Doctor strategy recognizes that the binary relationship of patient and caregiver is not sufficient. As we understand the social determinants of health to have an outsized role in disease outcome, we are compelled to understand that the context of illness, its ecology, is as much a determinant of outcome as is the right dose of medicine, perhaps more so. For example, we as physicians can advocate for breastfeeding, but if the community is not structured to allow the mother to breastfeed during the workday, what is the use? Similarly, core societal issues such as drug use, violence, environmental degradation, and income disparity affect the patient-physician dyad in a way that cannot be altered by a prescription pad. Where There Is No Doctor is a prescription for a new type of medicine, as relevant to urban America in 2019 as it was to Sinaloa in 1973.

There continues to be an increase in the number of learners who participate in international health electives (IHEs). However, not all learners enter IHEs with the same level of knowledge, attitude, and previous experience, which puts undue burden on host supervisors and poses risks to student and patient safety. The Multiple Mini-Interview (MMI) is a technique that has become a popular method for undergraduate and postgraduate-level health science admissions programs. This paper describes the MMI process used by our program to screen first-year medical students applying for pre-clinical IHEs. Two country-specific cases were developed to assess non-cognitive skills. One hundred percent (100%) of the students (n = 48) and interviewers (n = 10) who participated in MMIs completed anonymous surveys on their experience. The majority of students rated the scenarios as realistic (>90%); 96% found the MMI format fair and balanced; 96% of students felt that they were able to clearly articulate their thoughts; 75% of students stated that they had a general understanding of how the MMIs worked; only 33% of students would have preferred a traditional one-to-one interview. Feedback from both interviewers and students was positive toward the MMI experience, and no students were identified as unfit for participation. Ultimately, 43 students participated in pre-clinical IHEs in 2016. In this paper, we will outline our MMI process, detail shortcomings, and discuss our next steps to screen medical students for IHEs.

Since emerging in Saint Martin in 2013, chikungunya virus (CHIKV), an alphavirus transmitted by the Aedes aegypti mosquito, has infected approximately two million individuals in the Americas, with over 500,000 reported cases in the Dominican Republic (DR). CHIKV-infected patients typically present with a febrile syndrome including polyarthritis/polyarthralgia, and a macropapular rash, similar to those infected with dengue and Zika viruses, and malaria. Nevertheless, many Dominican cases are unconfirmed due to the unavailability and high cost of laboratory testing and the absence of specific treatment for CHIKV infection. To obtain a more accurate representation of chikungunya fever (CHIKF) clinical signs and symptoms, and confirm the viral lineage responsible for the DR CHIKV outbreak, we tested 194 serum samples for CHIKV RNA and IgM antibodies from patients seen in a hospital in La Romana, DR using quantitative RT-PCR and IgM capture ELISA, and performed retrospective chart reviews. RNA and antibodies were detected in 49% and 24.7% of participants, respectively. Sequencing revealed that the CHIKV strain responsible for the La Romana outbreak belonged to the Asian/American lineage and grouped phylogenetically with recent Mexican and Trinidadian isolates. Our study shows that, while CHIKV-infected individuals were infrequently diagnosed with CHIKF, uninfected patients were never falsely diagnosed with CHIKF. Participants testing positive for CHIKV RNA were more likely to present with arthralgia, although it was reported in just 20.0% of CHIKF+ individuals. High percentages of respiratory (19.6%) signs and symptoms, especially among children, were noted, though it was not possible to determine whether individuals infected with CHIKV were co-infected with other pathogens. These results suggest that CHIKV may have been underdiagnosed during this outbreak, and that CHIKF should be included in differential diagnoses of diverse undifferentiated febrile syndromes in the Americas.

As medical student interest in global health soars, so too does the desire by students to do research in international settings. However, very few medical students receive formal training in research skills. Mentorship is a key component of any research endeavour by students. The University of Texas Medical Branch focuses preclinical rotations on value-adding, mentored scholarly projects, developed with host site collaborators. The structure of this program allows preclinical students to engage meaningfully with international partners, who serve as research mentors. Mentorship is critical to successful development, implementation, and dissemination of scholarly projects. This paper describes a qualitative evaluation of a pilot mentorship program, which included semi-structured, one-on-one interviews with mentors and students who participated in the 2015 global health preclinical experience. Overall, mentors and students were satisfied with the mentorship experience. Challenges to mentoring were insufficient time and lack of student accountability to deadlines. Students reported satisfaction with the mentor relationship. The common theme from student interviews was the importance of communication. The better the communication, the better the experience.

were trained and these, through training 15 trainers, have trained over 200 frontline facilitators to implement the educational program.

As people living with HIV/AIDS (PLWHA) live longer, and HIV incidence declines, health systems are transitioning from vertical-only care delivery to horizontal integration with social and other services. This is essential to responding to the chronic nature of the disease, and health systems must respond to full-breadth of socio-economic conditions facing PLWHA. We use excellent self-rated health as a referent, and assess the role of non-biomedical conditions in mediating HIV+ status and excellent overall health among a large community sample of Kenyan women. After controlling for age and wealth, we found significant mediation by social support, partner HIV status, meaningfulness of life, family functioning, food sufficiency, and monthly income. If the goal of health systems is to help all people attain the highest level of health, integrating vertical HIV services with socio-economic support and empowerment may be required. Further investigation of the relative contribution of social support, family functioning, food and financial sufficiency should be conducted longitudinally, ideally in collaboration with HIV clinical services.

BACKGROUND:There is growing concern that short-term experiences in global health experiences (STEGH), undertaken by healthcare providers, trainees, and volunteers from high income countries in lower and middle income countries, risk harming the community by creating a parallel system of care separate from established community development efforts. At the same time, the inclusion of non-traditional actors in health planning has been the basis of the development of many Healthy Community Partnerships (HCP) being rolled out in Canada and the United States. These partnerships aim to bring all stakeholders with a role to play in health to the table to align efforts, goals and programs towards broad community health goals.RESULTS:This methodology paper reports on the process used in La Romana, Dominican Republic, in applying a modified HCP framework. This project succeeded at bringing visiting STEGH organizations into a coalition with key community partners and supported attempts to embed the work of STEGH within longer-term, established development plans.CONCLUSIONS:In presenting the work and process and lessons learned, the hope is that other communities that encounter significant investment from STEGH groups, and will gain the same benefits that were seen in La Romana with regards to improved information exchange, increased cross-communication between silos, and the integration of STEGH into the work of community partners.

Contemporary interest in in short-term experiences in global health (STEGH) has led to important questions of ethics, responsibility, and potential harms to receiving communities. In addressing these issues, the role of local engagement through partnerships between external STEGH facilitating organization(s) and internal community organization(s) has been identified as crucial to mitigating potential pitfalls. This perspective piece offers a framework to categorize different models of local engagement in STEGH based on professional experiences and a review of the existing literature. This framework will encourage STEGH stakeholders to consider partnership models in the development and evaluation of new or existing programs. The proposed framework examines the community context in which STEGH may occur, and considers three broad categories: number of visiting external groups conducting STEGH (single/multiple), number of host entities that interact with the STEGH (none/single/multiple), and frequency of STEGH (continuous/intermittent). These factors culminate in a specific model that provides a description of opportunities and challenges presented by each model. Considering different models, single visiting partners, working without a local partner on an intermittent (or even one-time) basis provided the greatest flexibility to the STEGH participants, but represented the least integration locally and subsequently the greatest potential harm for the receiving community. Other models, such as multiple visiting teams continuously working with a single local partner, provided an opportunity for centralization of efforts and local input, but required investment in consensus-building and streamlining of processes across different groups. We conclude that involving host partners in the design, implementation, and evaluation of STEGH requires more effort on the part of visiting STEGH groups and facilitators, but has the greatest potential benefit for meaningful, locally-relevant improvements from STEGH for the receiving community. There are four key themes that underpin the application of the framework: Accounting for these themes in program planning for STEGH will lead to more equitable outcomes for both receiving communities and their sending partners.

Welcome to Annals of Global Health,Annals of Global Health is a peer-reviewed, fully open access, online journal dedicated to publishing high quality articles dedicated to all aspects of global health. The journal's mission is to advance global health, promote research, and foster the prevention and treatment of disease worldwide. Its goals are to improve the health and well-being of all people, advance health equity, and promote wise stewardship of the earth's environment. The latest journal impact factor is 3.64.Annals of Global Health is supported by the Program for Global Public Health and the Common Good at Boston College. It was founded in 1934 by the Icahn School of Medicine at Mount Sinai as the Mount Sinai Journal of Medicine. It is a partner journal of the Consortium of Universities for Global Health. Authors of articles accepted for publication in Annals of Global Health will be asked to pay an Article Publication Charge (APC) to cover publication costs. This charge can normally be sourced from your funder or institution. We are committed to supporting authors from all countries to publish their work in Annals of Global Health regardless of national income level, and to achieve this goal, we waive the Article Publication Charge for manuscripts where all authors are from low-income or lower-middle-income countries (as defined by the World Bank). From time to time, Annals of Global Health publishes Special Collections, a series of articles organized around a common theme in global health. Recent Special Collections have included “Strengthening Women’s Leadership in Global Health”, “Decolonizing Global Health Education”, and “Capacity Building for Global Health Leadership Training”. Global health workers interested in developing a Special Collection are strongly encouraged to contact the Managing Editor in advance to discuss the project.

This study assessed the impact of several interventions, including predeparture simulation training and procedure logs, on incidence needlestick injuries (NSIs) among U.S. medical students on global health (GH) elective in Botswana. Review of NSI incident reports before and after introduction of these interventions demonstrated a reduction in the number of splash and body fluid exposures (n = 5 [6%] vs n = 21 [23%]; P < .001), respectively. Simple predeparture training is highly effective in reducing NSIs among students participating in GH electives.

Objective Many mobile phone resources have been developed to increase access to health education in the developing world, yet few studies have compared these resources or quantified their performance in a resource-limited setting. This study aims to compare the performance of resident physicians in answering clinical scenarios using PubMed abstracts accessed via the PubMed for Handhelds (PubMed4Hh) website versus medical/drug reference applications (Medical Apps) accessed via software on the mobile phone. Methods A two-arm comparative study with crossover design was conducted. Subjects, who were resident physicians at the University of Botswana, completed eight scenarios, each with multi-part questions. The primary outcome was a grade for each question. The primary independent variable was the intervention arm and other independent variables included residency and question. Results Within each question type there were significant differences in 'percentage correct' between Medical Apps and PubMed4Hh for three of the six types of questions: drug-related, diagnosis/definitions, and treatment/management. Within each of these question types, Medical Apps had a higher percentage of fully correct responses than PubMed4Hh (63% vs 13%, 33% vs 12%, and 41% vs 13%, respectively). PubMed4Hh performed better for epidemiologic questions. Conclusions While mobile access to primary literature remains important and serves an information niche, mobile applications with condensed content may be more appropriate for point-of-care information needs. Further research is required to examine the specific information needs of clinicians in resource-limited settings and to evaluate the appropriateness of current resources in bridging location- and context-specific information gaps.

Global health training opportunities for medical students and residents have proliferated in recent years. These short-term elective rotations allow trainees to learn about global health issues by participating in various aspects of education and health care in resource-limited settings. Recently published consensus-based ethical guidelines have suggested considerations for the design of international electives that address the activities of host and sending sites, visiting students and residents, and sponsors.The authors analyze the value of global health training opportunities for medical students, residents, faculty, host and sending institutions, and other stakeholders from the perspective of the Botswana-University of Pennsylvania Partnership, a program that has provided global health experiences for health care trainees for more than 10 years. Drawing from the Working Group on Ethics Guidelines for Global Health Training framework, they illustrate the ethical and logistical challenges faced by the program's organizers and the solutions that they implemented alongside their host site partners. They conclude with a summary of recommendations to guide implementation of ethically sound international health electives in resource-limited settings.