* VOLUME 8 * ISSUE 3 * December 2014

Department of Medicine

Global Health
MEDICAL EDUCATION IN THE GLOBAL VILLAGE

A publication of the Global

Health Pathway, engaged in
medical education, clinical
care and research in global
health.
Battling Ebola in Sierra
Leone
continued on page 12
Faculty Spotlight
page 2
The Story of Anton
page 3
Intern Spotlight
page 5
Resident Spotlight
page 6
U of M Hosts
page 8
The Fight for Equal
page 9
Global Health Expands
page 11
ASTMH
page 16

Battling Ebola in Sierra Leone

by Malini DeSilva, MD, MPH

Editors Note: Dr. DeSilva is a 2012 Graduate of the Global Health Pathway

As a CDC Epidemic Intelligence Service (EIS) officer, I had the

opportunity to travel to Sierra Leone to take part in the CDCs Ebola
Response. Im fairly sure everyone involved in the Ebola response can
agree on some key interventions for containment of the outbreak:
comprehensive case and contact finding, effective medical management
of patients, community engagement, and strict adherence to infection
prevention practices.
continued on page 12

Global Health Footprint

Where in the World Are We Working?
The goal of the Global Health
Footprint, launched to the
continued
on page
12
public on
November
1, is to
provide viewers with a
snapshot of the breadth and
depth of the work our faculty
and residents are engaged in
locally and worldwide.
Each footprint outlines the
summary of the project, key
contact, collaborators, partner
organizations, and the projects
contact information.

Find the Global Health Footprint by

visiting the Global Health website at:
www.globalhealth.umn.edu
1

Faculty Spotlight
by Jonathan Kirsch, MD

Patricia Walker, MD, DTM&H, CTropMed,

FASTMH
Department of Medicine, Associate Professor
Medicine Global Health, Director
William Stauffer, MD, MPH, CTropMed
Department of Medicine, Associate Professor
Medicine Global Health Course, Director
Brett Hendel-Paterson, MD, CTropMed
Department of Medicine, Assistant Professor
Medicine Global Health Online Course, Director
Not pictured:
Kate Venable, MD, CTropMed
Department of Medicine, Assistant Professor
Medicine Global Health Online Course, CoDirector
David Boulware, MD, CTropMed
Department of Medicine, Associate Professor
Global Health Research

Directors Note
Patricia Walker, MD, DTM&H, CTropMed,
FASTMH

2014 has been a banner year for the

Global Health Pathway. We have 47
residents currently enrolled 20 in
Internal Medicine, 24 in MedicinePediatrics, and 3 in Medicine
Dermatology. Residents in the Pathway
participate in our annual spring inperson Global Health Course (one of
only 18 in the world), our online Global
Health Course, evening Tropical and
Travel Medicine Seminar Series, and
international electives for two months
at one of 13 sites. In addition, they have
the option of a local rotation at
HealthPartners Travel and Tropical
Medicine Center, as well as opportunity
for a Global Health Chief Resident year.
continued on page 14

Having attended medical school here at the University of

Minnesota, Im happy to be back after 11 years away from
this great state. Im especially excited to be part of the
Global Health Pathway, a major factor in my return to the
U of M. Back in medical school, I was the co-chair of the
Students International Health Committee, sat on the
board of the Center for Cross-Cultural Health, and
volunteered at La Clinica (West Side Community Clinic) in
St. Paul. During my training, I participated in clinical and
human rights work for one year in Chiapas, Mexico. After
internal medicine residency at HCMC, I moved to Ithaca,
New York where I worked in hospital medicine, primary
care, eventually landing the coolest job in the world. In
this latter position, I traveled throughout the state of NY
with a mobile medical unit (my rusty VW wagon) and a
coordinator, providing medical services to migrant
farmworkers in old farmhouses, trailers, dairy barns,
apple orchards, vineyards, and anywhere else I was
needed. I now join the Global Health Pathway core faculty
after working at the University of North Carolina for six
years, focusing on hospital medicine and volunteering in
global health and migrant farmworker health.
Global health is not simply about treating people abroad. It
also includes understanding why people migrate locally,
leaving behind family, and taking risks as they adapt to
new environments. Ive cared for Latino patients in MN,
NY, NC and Mexico, and I believe that care for
underserved, marginalized populations doesnt stop at
artificial borders. Ive been a member of the board of
Doctors for Global Health for six years and hope to apply
some of their social justice principles in my work here.
continued on page 5

Jonathan Kirsch, MD
removing an ingrown
toenail in the kitchen of a
trailer on a dairy farm.

continued on page 5

Our family likes to travel whenever

we can, grow and prepare food,
bike, ski, hike, and listen to and play
music. I am a year round bike
commuter, and our family is excited
to be back in Minnesota so we can
enjoy the great outdoors, especially
when there is a lot of snow.

The Story of AntonHennepins Year in Review

by Ron Johannsen, MD
Editors Note: Dr. Johannsen directs the Global Health Pathway at Hennepin County Medical Center in Minneapolis, MN

My HCMC Global Health Pathway resident,

Manoj Ray, was just one week into his
international rotation with me here in the
central highlands of Madagascar at the Anseribe
Hospital, a 150 bed facility that serves a
population that makes the equivalent of $2 US
per day, when I met up with him as he was
running across the hospital courtyard on one
warm evening. Dr. Ray was carrying a limp four
year old named Anton, and was accompanied
by the Malagasy Nurse holding an oxygen tank
that was connected to a mask over the childs
face. A quick report and assessment delivered
in the moonlight of this hospital compound
revealed that Anton had been admitted 36
hours previously with severe recurrent asthma.
He had been making progress until he suddenly
deteriorated 30 minutes previously. His oxygen
saturation was in the 50s, respiratory rate was
40-50, and pulses were faint and barely
palpable. This facility had never intubated a
patient on the wards, so the patient was
receiving intermittent support with bag
ventilation. My resident was rushing the
patient to X-ray when I informed him that X-ray
facilities at this hospital are available routinely
during the day and only by call-in at night. It
would take perhaps as long as one hour to get a
tech on site. We re-routed the patient to the
Block (operating room) where our nurse
anesthetist was fortunately working late and
intubated the child. A used portable ultrasound
machine that we had previously brought to this
hospital was quickly utilized to try to identify a
sliding lung sign in the right upper and left
upper anterior thorax. The absence of a sliding
lung sign, confirming our percussion findings,
allowed us to confidently diagnose tension
pneumothorax on the right. There were no
small chest tubes available, but cutting side
holes in a pediatric nasogastric tube served us
well as a chest tube. The intensive care unit
nurse traveling with us (my wife, Colleen) and
the Malagasy nurse anesthetist, collectively
jerry-rigged a system of partially fluid-filled
bottles to act as a water seal for the chest tube.
Anton showed significant improvement in vitals

over the next 15 minutes, but he needed a higher

level of care than was available on the wards.
Over the next three days, until Anton recovered
enough to go on general ward care, my resident
resourcefully worked out a 1:1 nursing ratio with
a moonlighting system. With hospital permission,
he provided a $5 payment for each 8-hour
moonlighting nursing shift (an economic
opportunity that led to many volunteers). Our
accompanying American intensive care nurse
used it as an opportunity to train the revolving
nursing staff in higher level care management.

Anton, 24 hours after treatment of his tension pneumothorax,

with his mother and moonlighting Malagasy nurse. Picture
was taken with permission for teaching purposes.

This is one example of the many opportunities

during an international rotation where a global
health resident can resourcefully manage patient
care in resource-limited areas and work
creatively with local staff to learn from each other
as they manage such patients. This case alone led
to great enthusiasm by the Malagasy physician
staff to learn emergency ultrasound techniques. It
also prompted discussions by the Malagasy
hospital team to begin plans for a step-up unit for
critically ill patients and specialized training for
nurses manning such units as well as
development of a rapid response nursing team
for acutely deteriorating patients on the wards.
The demographics of patients managed in
resource-limited intensive care units in the
developing world represent younger patients
with more curable conditions in contrast to older
patients with more chronic disease that we see in
the western world intensive care units.
continued on page 4

continued from page 3

As director of Global Health at Hennepin County

Medical Center, it has been my pleasure to work
with our IM and EM/IM Global Health Pathway
residents. During calendar year 2014, HCMC
resident participants in international health
rotations have included: Dr. Adam Kolb
(currently our Global Health Chief Resident) at
Kalra hospital in India, Dr. Ricky Dhaliwal at
Selian Hospital in Tanzania, Dr. Rachael Krob at
Nazarene Hospital in Papua New Guinea, Dr.
Johanna Bischof at Mahosot Hospital in Laos,
and Dr. Marco Salman at Mfangano Island
Health Center in Kenya. At HCMC we have also
started offering an international rotation for our
Cardiology Fellowship Program. Dr. Louis Kohl
worked at Mabingo and Banzo hospitals with
me on a secondary rheumatic heart disease
research project, and Dr. Ankur Kalra
participated in a one month international
rotation at AIMS Hospital in New Delhi, India.
His experience along with an accompanying
editorial by the past president of the American
College of Cardiology will be published in the
Journal of the American College of Cardiology in
December of this year.

Dr. Rachael Krob, HCMC EM/IM resident, evaluating an

infant in Papa, New Guinea with failure to thrive. Picture
was taken with permission for teaching purposes.

Dr. Adam Kolb, seated and wearing the blue shirt, on his
international rotation at Kalra Hospital in India with
ICU staff members where he focused his project on
teaching bedside ultrasound in critically ill patients.

A junior staff member is using ultrasound to place a

central line. Prior to Adam Kolbs visit, central lines were
placed by anatomic landmarks. Dr. Kolb is the Global
Health Pathway Chief Resident at HCMC.

HCMC/ANW Cardiology fellow, Louis Kohl, Dr. Ron

Johannsen and Cameroonian Pediatric Physician Assistant,
Vera, assessing CVP by imaging the IVC to adjust hydration
prior to chemotherapy induction in a young Burkett's
Lymphoma patient. With this pre-hydration approach, we
have reduced the 28% tumor lysis syndrome 30 day
mortality to near 0%. Results soon to be published and
incorporated into standard practice at multiple sites in
sub-Saharan Africa.

New additions to our global health family at

Hennepin County Medical Center include Dr.
Rosemary Quirk, the new director of the HCMC
Internal Medicine Residency Training Program.
She has a diploma in tropical medicine from the
University of Liverpool, England, and in the
recent past has set up a residency program at
Mahosot Hospital in Laos. Dr. Rachel Sandler
also joined our staff this year. She has special
interest and experience with immigrant health
and will work with us to set up a site in Peru as
well as coordinate our monthly global health
morning reports with our residency program.
Dr. Steve Dunlop continues with his overseas
activities in Tanzania and has been an
important champion in bringing portable
ultrasound skills to overseas sites and training
our residents who participate in international
rotations to further disseminate this important
skill set in the developing world.
continued on page 6

continued on page 6

continued from page 2

My global health focus at the University of Minnesota, outside of hospital medicine, is in Migrant
Health. I am working in a multi-disciplinary collaboration with other faculty to create a Migrant Health
rotation which I hope to have approved and available by the summer of 2015. Initially for residents in
internal medicine and medicine-pediatrics, I hope to offer this rotation to medical, dental, and public
health students as well as those in other disciplines. During this first year, I will collaborate with
community-engaged partner organizations and work to establish trust with the migrant farmworker
population, that is very marginalized, and traditionally very difficult to access due to fears of
immigration. The rotation will include readings, online learning, and video instruction to teach the
social determinants of health for migrant and seasonal farmworkers in addition to clinical care in a
mobile health unit and, hopefully, experiential learning alongside farmworkers. I will also be
collaborating with colleagues in other departments to create a needs assessment or resource map to
better understand the needs of the migrant and seasonal farmworkers in Minnesota.

Intern Spotlight
by Darin Ruanpeng, MD
Internal Medicine, PGY-1

Western medicine became popular in Thailand 120 years ago when a group of American missionaries
arrived. Not long after that, King Chulalongkorn founded and subsidized the first public hospital and
medical school. When Prince Mahidol returned back from the United States after studying medicine, he
asked the Rockefeller Foundation for assistance with the Thai medical and education system. Since
that time, Thailand has continued to train people and develop a health care system. As medicine
advances, young Thai physicians continue to obtain advanced training in Europe, Japan, and America,
to remain current and help deliver the best care possible to 67 million people in the country and
nearby.
I am a board certified internist in Thailand, and I worked for the Research Institute for Health Sciences
at Chiang Mai University for 2 years (2012-2014) in multi-center clinical trials in the field of HIV as a
research physician. The HPTN 052, iPrEx OLE, and Encorel trials have been published, and the START,
1077HS, SECOND-LINE, and A5279 trials are still ongoing. I am also working on an anal cancer
screening for men who have sex with men in Thailand. I came to Minnesota to further my internal
medicine training. Being away from home and training abroad provides magnificent opportunities to
learn and grow. Working at three hospitals and at Health Partners Center for International Health
(CIH), I experience different systems that I might bring back to improve patient care in Thailand. One
particular thing from the CIH that triggers my interest is immigrant health. Thailand has more than
one million working immigrants from Myanmar, Laos, and Cambodia. Now these people pay about 80
US dollars per year with about one dollar co-pay for health insurance from the Ministry of Public
Health, which covers most, but not all health problems. Extrapolating immigrant health benefits here
to those in Thailand, a middle-income country, will be challenging.
5

continued from page 4

Dr. Hernando Gonzales is the Costa Rica site

director for our residents and University of
Minnesota residents. We are in the process of
further formalizing our relationships with
Kalra and Duncan Hospitals in India, Mbingo,
and Banso Hospitals in Cameroon, Tenwick,
and Kajabi Hospitals in Kenya and Germania
Hospital in Upper Egypt.
HCMC Global Health Pathway alumnus, Dr.
David Vandyke, currently a Hospitalist in
Wisconsin, continues yearly trips to Mbingo
Hospital in Cameroon where he helped
establish and continues to support an Internal
Medicine training program. Quality graduate
medical education is an exception in many
resource-limited counties.
HCMC Global
Health Pathway alumnus, Dr. Manoj Ray, now
an
Infectious
Disease
specialist
in
Minneapolis, is working with me to develop
cost effective microbiology laboratory
services in hospitals in Kenya and
Madagascar. This will lead to overall cost
savings, mortality reduction, and good
antibiotic stewardship at these sites.

Dr. Lou Kohl and Colleen Johannsen, RN running an echo

based secondary prevention Rheumatic Heart Disease
screening program at a school in NW Cameroon (RHD). This
study is evaluating a single view with color doppler versus
multiple echo views to screen for asymptomatic RHD. When
screening thousands of children in a district the amount of
necessary imaging time is critical. Data supporting the single
view method will be published soon. Pictures of patients were
taken with permission for teaching purposes.

The story of Anton, our child in Madagascar, goes

well beyond preserving one important life. This
international collaboration matures in a unique
way as our global health residents make a
difference in the world around them, teaching and
learning from their colleagues overseas. Lessons
learned during these rotations are applied locally
especially with the immigrant population that we
all serve in the Twin Cities.

Resident Spotlight
by Anteneh Zewde, MD
Internal Medicine, PGY-2

Ethiopian farming

Anteneh with King Holmes, ID researcher

from the University of Washington, Seattle

Returning to Ethiopia to do a one month research project was not only a continuation of my
commitment in fighting infectious disease, but also a return to my past. Asella Hospital is where my
mom delivered my brother and where I was admitted for Nefase (wind, or pneumonia) as a young
child. As an Ethiopian trained physician, now with the experience of one year of residency in the
United States, returning home brought mixed feelings.
continued on page 7

continued from page 6

My research project is focused on cryptococcal meningitis, with Dr. David Boulware as my mentor. I
spent one month setting up the groundwork for this operational research project. We studied the
practicality and clinical outcomes of using fluconazole prophylaxis for patients with positive serum
cryptococcal antigens. It was challenging to make logistics of a research project a reality in a setting
without electronic medical records. We established ways of providing continuity of care and research
follow-up that were appropriate in that setting.

Anteneh working on Cryptococcal research project

with colleagues in Ethiopia (Tafese Tufa,
microbiologist with white shirt, Dr. Abera Balcha,
internist with gray sweater).

I also participated in clinical and teaching activities at the hospital. I rounded with interns and
presented a few morning reports. I taught medical students and led an Advanced Life Support Class
for interns. Most of the clinical medicine was very familiar to me since I completed medical school and
internship in Ethiopia. However, I now have a completely different system to compare it to.
At times I felt helpless; I had to sit through a patient dying due to lack of an oxygen cylinder, while
knowing that patients in the U.S. could compare mask choices. I have treated tuberculosis in the US,
wearing my N95 mask, with patients placed in negative pressure isolation rooms. In Asella, there were
far more active pulmonary TB patients sharing an open space, often next to another patient who was
immunosuppressed. Patients seldom finish their anti-TB therapy and are lost to follow-up. It is often
not known if we are dealing with MDR/XMDR, which contributes to a huge public health issue globally.
If we talk about health as a human right, from what I have seen, we are very early in the fight.
Infectious diseases do not respect boundaries. We need to find a sustainable way of making global
health care standardized, instead of acting only in times of crisis.
When I was training in Ethiopia, I was aware of these gaps in our medical system. We read Harrisons
and knew what ideal treatment was, but didnt necessarily have it available. With the perspective of
having participated in the US medical system for one year, the differences are more clear and more
painful. Not only are resources lacking, but the infrastructure is broken. Doctors training there leave
in part because they know medicine but cannot practice it as it should be done. This is an injustice; the
underprivileged deserve more. I feel strongly that I need to give back to my country and reverse the
brain drain. Through clinical work and operational research, I will do this in my future. It is an
obligation for me to do so, as I become part of the privileged from the unprivileged. As people, we are
morally obligated to make an effort towards sharing. My grandmother used to say, You will not get
buried with your wealth, but people will always talk about your greed, so learn to share.
---When we move beyond sentiments to action, we of course incur risks, and these deter many. But it is
possible, clearly, to link lofty ideals to sound analysis.--- from Pathologies of Power by Paul Farmer

U of M Hosts Third Humanitarian Crisis Simulation Course

by Bridget Scott

The University of Minnesota hosted its third

Humanitarian Crisis Simulation Course the
weekend of September 5-7, 2014 at Phillippo
Scout Camp in Cannon Falls, Minnesota. The
simulation is one of a handful of such programs in
North America that brings together students and
academics with humanitarian practitioners to
provide hands-on training in a life-like
humanitarian situation.
The Department of Medicine Global Health,
School of Public Health, and Hubert H. Humphrey
School of Public Affairs co-hosted the simulation
that included 48 students and more than 150
volunteers during the 48-hour experience. It was
designed to immerse students in an environment
that resembled a typical humanitarian crisis.

The goal of the simulation was to equip

students with the knowledge and skills
necessary to respond to humanitarian crises
and to address a variety of emergencies with
large populations in distress. The course
started with an intensive first day of training
on the fundamentals of humanitarian
aid. Students learned by working in small
groups where discussions and hands-on
learning took place.
Minnesota
National Guard
strategizing at
the Simulation
Course.
Photo credit
Bridget Scott

Participants
collaborate at the
Humanitarian
Crisis Simulation
Course.
Photo credit
Bridget Scott

Course director, Sarah Kesler, MD, CTropMed, is

an assistant professor in the Division of
Pulmonary, Allergy, Critical Care, and Sleep
Medicine at the University of Minnesota. Coteacher, Eric James, PhD, is the executive director
of FieldReady and has worked for over 15 years
with humanitarian emergencies. Co-teacher,
William Stauffer, III, MD, MSPH, CTropMed, is
an associate professor in the Department of
Medicine at the University of Minnesota and
serves as the director for the Department of
Medicine Global Health Course as well as
medical/technical expert for the Division of
Global Migration and Quarantine for the CDC. He
has worked extensively overseas in clinical
medicine as well as public health.

The core of the weekend was the simulation

itself, an opportunity for participants to
respond as if they were facing an actual
humanitarian crisis. Participants were then
divided into emergency response teams and
immersed in the simulated crisis area. The
crisis involved a large population living in an
unstable border area with very poor
infrastructure. Team members worked
together to apply the skills and knowledge
acquired during the first day of training to
assess and respond to the crisis. The goal of
the participants was to develop a plan that
addressed the various problems of the region,
including malnutrition, poor infrastructure,
insecurity, and the violation of human rights.
continued on page 11

The Fight for Equal Rights Varies Around the World

by Kristina Krohn, MD
Editors Note: Dr. Krohn is a 4th year Medicine-Pediatrics resident and has completed a one year Global Health and Media
Fellowship co-sponsored by Stanford University and NBC News.

Time magazine included "feminism" as a possible word to ban in the New Year (see their poll
http://time.com/3576870/worst-words-poll-2014/ for words to remove from the English language due
to over use, other words include literally and om nom nom nom). I think it is still underused and too
few people are practicing the ideas of feminism.
Yeah, totally underused, when 18.3% of American women are raped according the Centers for Disease
Control and Prevention. I do not mean slept with a boyfriend or date and regretted it. I mean forced
against her will, beaten, drugged, or threatened - raped. I think this statistic is horrifying. In this day
and age, it should be horrifying that any woman or child is raped. There are safer places in the world
than the United States, but there are more dangerous places as well. For example, 71% of Ethiopian
women report being raped by a stranger or being raped or beaten by their partner, according to the
World Health Organization.
Over 7 months after Our Girls in Nigeria were kidnapped from their school, the girls are still missing.
Stolen from their families. Boko Haram leaders now say they "married them off a long time ago,"
according to National Public Radio (NPR). NPR also reports that the group continues to abduct young
women. Even after a so-called cease-fire in late October, they invaded a town, killed 4 men and abducted
60 women. While Boko Haram leaders says married, sold as property or slaves is probably a more
accurate description. I don't want to picture what these "marriages" are like.
You don't have to go back very far into the past in any country, before most women had no rights in a
marriage. No property rights. No rights to their children in a divorce. No rights to a divorce. No right to
say no to "performing duties of marriage.
continued on page 14

Tropical & Travel Medicine Seminars

Since 1999, the Tropical & Travel Medicine Seminars (# UOFMTTMS) have been a tradition,
reflecting our core value of providing medical education in the global village. Seminars are held
monthly through May 2015 on the 3rd Wednesday of each month from 6pm-8pm at the Twin Cities
Shriners Hospitals for Children.
Upcoming Seminars:
December 17: SocMed, Dr. Michael Westerhaus
January 21: HCMC EM, Dr. Steve Dunlop
February 18: UMN Pediatrics
March 18: UMN Center for Global Health & Social Responsibility
April 15: TBD
May 20: TBD
*Recordings of past presentations available on our website
Ryan Fabrizius, MD, presents the Nov
Global Health Update at TTMS

U of M Global Health Chief Residents Corner

by Hope Pogemiller, MD, MPH
This year has been a fantastic whirlwind of increasing structure in the U of M Global
Health Pathway, with overwhelming resident interest in global health. We are
introducing education about working with an medical interpreter into the curriculum,
and we have had monthly Balint Group meetings with Georgi Kroupin, PhD to talk about tricky patient
interactions at Health Partners Center for International Health. Global health topics covered in morning
report have been well-received, with residents including global health diagnoses in the differentials and
considering collections of symptoms, areas of endemicity for particular diagnoses, and unique exposure
risks. Faculty, residents, and alumni have been published and are active in the American Society of
Tropical Medicine & Hygiene. We had many residents travel to take the ASTMH exam in New Orleans,
and a large group was able to stay for the 4 day conference (see ASTMH section on page 15). The
recruitment season has been filled with Internal Medicine and Med/Peds Interviewees interested in
global health.
Residents will be matched with mentors soon, the International Rotation Applications are due in early
December, and information about each of the U of Ms Partner Sites is now on the Global Health webpage
with a short site description and a few slides of explanation. Members of the U of M can find detailed
information about each of our Partner Sites in Google+, with video presentations explaining details for
each location. Its an exciting time to be in the realm of global health at the U of M.
Click on icon to view our facebook account.

Click on icon to view our twitter account..

UMN faculty and residents who would like to join our google +community,
please email Hope Pogemiller (poge0008@umn.edu)

Department of Medicine

Global Health
December 2014
Published by Medicine Global Health, Department of Medicine, University of Minnesota
To find out how you can make a difference, please contact:
Russell Betts, Development Officer 612-626-4569 or rbetts@umn.edu
www.globalhealth.umn.edu
Click here to donate
The University of Minnesota is an equal opportunity educator and employer
Copyright 2014 University of Minnesota
All rights reserved
The University of Minnesota respects the privacy of all individuals. We do not and will not have access
to your medical records. We will not sell, trade, or exchange your name or mailing address with
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10

continued from page 8

More than 150 volunteers supported the event via instructing and role-playing capacities throughout
the weekend. Volunteers included the Minnesota National Guard, the University of Minnesota, and a
number of additional universities including Case Western, the New School, the University of Manitoba,
and the Mayo Clinic. Numerous individuals from non-profit organizations were also involved, including
professionals with experience at the UN, WHO, International Crisis Group, American Refugee Committee,
New American Alliance for Development, and other groups. Volunteers were fully committed to their
assignments and created a lifelike experience for students. This unique dynamic pushed the learners to
enter into the simulation without hesitation and to work collaboratively to come up with solutions for
the problems they were faced in real time.
The simulation introduced and highlighted the knowledge, standards, and best practices in
Humanitarian Aid. It allowed participants the opportunity to apply acquired skills in a realistic setting
utilizing collaboration and teamwork to respond quickly to a crisis. The Humanitarian Crisis Simulation
Course offered students the opportunity to experience and navigate humanitarian crisis management in
a hands-on environment.

Global Health Expands Instructional Design Position

by Shawn Haag, BS

This year I joined the Department of Medicine (DOM) as the instructional designer for Global Health.
In this role, I primarily provide instructional design and project management support for Global
Health courses and the Pathway. I also provide other management and project support for DOM
Education projects.
I was previously with the Center for Transportation Studies at the University of Minnesota, where I
provided project management and curriculum development support. I have a bachelor of science
degree from the University of Minnesota, and I am one semester away from completing my master of
education in learning technologies degree, also from the University of Minnesota.
I am an avid Gopher football and basketball fan, and I enjoy spending time with my wife, Nina, and our
goldendoodle, Teddie.

Shawn, Nina, and Teddie at Vadnais

Lake, in Vadnais Heights, MN.

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continued from page 1

However, over the course of the month I was deployed, I observed a constant struggle to implement what
in theory seemed so simple. And Ive spent a great deal of time since I returned trying to think about
why.
Sierra Leone is made up of 14 districts, and each district is subdivided into chiefdoms made up of
sections, which include multiple villages. When I arrived in Africa I found out I was assigned to a roving
team consisting of three people: an epidemiologist, an infection prevention and control (IPC) specialist
(me), and our driver. My role was to provide technical advice and training in IPC; I would not be
providing any direct patient care. The plan was for our small team to perform assessments of districts
where CDC had not yet established itself. During the last two weeks of my trip, our team traveled
throughout Koinadugu, the northernmost district in the country and the last district to report a
confirmed Ebola case.

Left: Malini with her driver

Suma using chlorinated
water to wash hands
Right: Malini with Tim, her
roving team partner.

Koinadugu has some of the worst roads in the country it took us more than 4 hours to travel the 50
miles from the district capital to one village and extremely limited cell phone coverage villagers
would often have to travel 1 to 2 miles or more to a hilltop to find a cellular signal. These logistical
hurdles meant that routine surveillance activities were either not taking place or only to a very minimal
extent. Because of the districts location along the Guinean border and the high burden of disease in
neighboring districts, it was very suspicious that Koinadugu did not have any Ebola cases almost five
months into Sierra Leones outbreak. However, by mid-October, rumors of Ebola cases in one of the
southern chiefdoms reached the district medical team who sent surveillance team members to
investigate the situation. The first three confirmed Ebola cases in Koinadugu were reported on October
20, all from the same chiefdom. In the three weeks that followed, case counts grew almost exponentially,
overwhelming an already taxed and inadequate medical system.
There were no Ebola Treatment Units (ETUs) in Koinadugu, and the nearest facilities for dedicated Ebola
care were at least 5 hours away. Initially, suspect cases were first brought to a holding center in the
districts capital (a 4-5 hour, hot, jarring ambulance ride from their village) and if positive, patients
would then be transferred to an ETU another 4-5 hours away. However, these long journeys were often
too taxing for those who had suspected cases, some of whom died en route. To decrease transit times,
WHO started construction of a community care center in a village with a large number of reported cases.
While awaiting completion of the center, they used an old school building as a temporary facility to
isolate suspect patients. The care team did all they could with their severely limited resources to try and
keep people alive as safely as possible until test results confirmed a patients status and arrangements
were made for transport to a treatment facility if necessary. The district medical team stationed case
investigators, burial teams, lab teams, and ambulances in the same village, an attempt to improve case
management and surveillance activities. But, the workload was too much for the small number of staff
available and rather than get ahead of the curve, they were doing all they could to keep up with the ever
growing current case investigation and burial needs.
continued on page 13

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continued from page 12

Things were far from perfect: at times there was

not enough oral rehydration solution (ORS) at
the care center, lab teams were not readily
available to draw blood so patients stayed at the
temporary facility longer than necessary while
waiting for test results to tell them their fate,
contact tracing was slow and far from
exhaustive, and we frequently identified
breaches in personal protective equipment
(PPE). The response teams were in constant
need of supplies case investigation forms, PPE,
basic oral medications, etc. And, local response
teams were tired; they didnt have the luxury of
leaving after a month, this would be their dayto-day reality for the foreseeable future.

outbreak has been complicated at best and is a

constantly evolving process.
I remain hopeful that the situation on the
ground will improve and with growing
international support, increased manpower, and
sustained commitment of the local communities
the response teams will be able to beat the
disease. However, none of these things are
guaranteed and in the absence of these
resources the future of this outbreak and
stability of Western Africa remains uncertain.

Figuring out the logistics of implementing

control interventions for this unprecedented

Roads
around
Koinadugu

Global Health Research Update

by David Boulware, MD, CTropMed
Nate Bahr, Global Health Pathway alumnus and current ID fellow, has published a recent manuscript
on the Methods of Rapid Diagnosis for the Etiology of Meningitis in Adults in the October 2014 issue
of Biomarkers in Medicine. Available at: dx.doi.org/10.2217/bmm.14.67
New ID faculty -- Radha Rajasingham, UMN IMER alumnus, in collaboration with Global Health course
participants Abdu Musubire (2014) and Henry Nabeta (2013) have a manuscript on the
Epidemiology of Meningitis in an HIV-Infected Ugandan Cohort published in the November issue of
the American Journal of Tropical Medical Hygiene. In this study, cryptococcal meningitis accounted
for 60% of meningitis in adults in Uganda. Available at: dx.doi.org/10.4269/ajtmh.14-0452
continued on page 15

Global Health Chief Resident Announcement

The Global Health Pathway is pleased to announce that we have chosen Global Health Chief
Residents for 2016-2017. Matt Goers and Aarti Bhatt will be Internal Medicine Global Health
Chief Residents, after Sheiphali Gandhi and Ryan Fabrizius during the 2015-2016 academic year.

Sheiphali Gandhi PGY3, Ryan Fabrizius PGY4, Aarti Bhatt PGY3, and Matt Goers PGY2
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continued from page 9

Even in enlightened places, the remnants of centuries of devaluing women can be seen everywhere;
decreased pay, decreased promotions and the characterization of successful women as unlikeable are just
a few examples. #HeForShe with Emma Watson specifically invites men to participate more in equal
rights for women around the world. Lean In by Sheryl Sandberg encourages women to be more involved
at the world place in order to not be discounted. So no, I don't think feminism is an overused word. I
think this is a sad push back against more people speaking up for women all over the world. Human
rights should include all humans. They are something women and men should continue to fight for.
However, there are reasons feminism was placed in this list of potentially bannable words. First,
suggesting a change to the status quo always has some backlash. Second, feminism has a bad reputation
in the eyes of many young people. Feminists have been portrayed in the media as man haters for a long
time. The word puts many men and women on the defensive. Some suggest that it is better, and more
effective, to talk about equality rather than feminism.
Cathy Young, a writer for Time, suggested that feminism was a First World Problem. I could not
disagree more. Arguing about the meaning of the word, sure, but the root of the problem devaluing
people due to their sex is not a first world problem. It is a world problem.
I hope that the discussion about the use of the word feminism is because people are finding their voices
and are moving from words to deeds. Now is the time to move beyond the hashtags and really bring back
our girls. Provide access to education for all. Equal pay for equal work. Equal opportunities for maternity
and paternity leave. Equal opportunities to stay home with a family. When men can stay home and care
for children, all children around the world can have access to an education, all people have access to
work, everyone feels safe and has control of his/her own body, and every parent receives respect for
caring for a family, then, maybe, the word feminism may be over used. But not until then.
Editors Note: Time Magazine has now apologized on their website for including the word feminist in a list of words
to ban.
continued from page 2

The creation of a Global Health Chief Resident position in 2013 has been a major positive addition to
the pathway, supporting the early global health career goals of the Chief, as well as serving as a major
resource for residents and faculty.
After our successful global health graduation and research symposium this May, we have 85 full
graduates of our Pathway, all of whom have completed all the requirements to sit for the ASTMH
Certifying Exam in Clinical Tropical Medicine and Travelers Health. In fact, this year the University of
Minnesota prepared the most candidates world-wide to sit for this exam, a testament to our
commitment to preparing the next generation of clinicians, educators and researchers in global health.
We sponsor the price of membership in ASTMH for residents and have 17 resident members. Global
Health faculty have key leadership positions in ASTMH nationally and three are Fellows of the Society.
This year the faculty approved a mission vision and values statement, (see box on page 15), as well as
core values for our international rotations. We have worked to be true to those values all year, as you
will read in our year end newsletter. In addition, faculty have had a busy year lecturing locally and
nationally, publishing case reports, and contributing an UpToDate article on immigrant health as well
as commentaries in key journals and research findings.
continued on page 15

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continued from page 14

New faculty members this year include Mark Jacobson, Kate Venable, and Jonathan Kirsch. We added
three new international sites: SocMed Northern Uganda, (Mike Westerhaus), Haiti (Ben Trappey), and
Nepal (Chhabilal Sharma). To help us keep track of all of our activities, Ann Fandrey and I designed and
implemented a Where in the world are we? map featured on our website, which in 2015 will be used
as a model for tracking Academic Health Center wide global health activities.
I would like to end this year with an inspiring example of the incredible resident physicians we have in
the Pathway. Dr. Jon Alpern (GH 2013 graduate), Dr. Bill Stauffer, and Dr. Aaron Kesselheim published a
commentary in NEJM in November, 2014 which speaks to the high price of generic drugs, such as
albendazole, and their impact on the global community. Their commentary received a great deal of press
nationally, and reflects the best outcome we can have as a Pathway: graduates with a set of core values
in global health, who combine scholarly activities and passion to help improve health worldwide.
Many thanks to all those who contribute their time, energy, and expertise to our work in medical
education in the global village, and best wishes in 2015.

Global Health Pathway, Department of

Medicine, University of Minnesota
Mission
We are committed to improving the health of individuals and communities globally.

Vision

We are engaged in global health teaching, research, and clinical care which is values
based and which improves the health of individuals and communities in
Minnesota and the world.

Values

We value compassion, excellence, and equity for all, with a focus on the
disenfranchised.

continued from page 13

Joshua Rhein, Nate Bahr, and colleagues from Uganda and South Africa have written a manuscript
on Detection of High Cerebrospinal Fluid Levels of (13)--d-Glucan in Cryptococcal Meningitis
in the fall issue of the Open Forum Infectious Disease reporting that the dogma that beta-d-glucan
is not detected in Cryptococcus is incorrect. Higher levels of beta-D-glucan in CSF were
independently associated with increased mortality in persons with cryptococcal
meningitis. Available at: dx.doi.org/10.1093/ofid/ofu105
Henry Nabeta, Nate Bahr, Nicholas Fossland, Steve Dunlop, and colleagues have published on the
Accuracy of Noninvasive Intraocular Pressure or Optic Nerve Sheath Diameter Measurements for
Predicting Elevated Intracranial Pressure in Cryptococcal Meningitis in Open Forum Infectious
Diseases. Available at: dx.doi.org/10.1093/ofid/ofu093
15

ASTMH November 2014 in New Orleans, LA

47 of 129 people worldwide who took the ASTMH exam on November 1st were graduates from our
UMN/CDC Live Global Health Course!

Above left: Dr. Nate Bahr, ID Fellow at UMN, presenting about his cryptococcal meningitis research
Above right: Dr. Pat Walker continues to serve on the ASTMH Council (Board of Directors) and had
the opportunity to meet with Bill Gates with other council members at the annual meeting

Left: Dr. Jim Wallace,

PGY3 presenting a case
vignette poster
Right: Dr. Hope
Pogemillers case
vignette poster
Left: Dr. Brett HendelPaterson presenting a session
about travel medicine
Middle: Bill Gates delivering
keynote speech
Right: U of M Residents
enjoying New Orleans Jazz

16