Another one of our stellar MPH students, Jasmine Jones, is interning at a non-governmental organization in Botswana focusing on HIV/AIDS advocacy and support for youth and vulnerable populations. Check out her travel blog here!
Check out the Travel Blog of our amazing MPH/MSN student, Joshua Littlejohn. He is working in Mozambique with Y-Center, a social innovation company that operates in Mozambique and India, for 12 weeks during the summer of 2015. The larger project that he is a part of is called Connect The Dots and is an SMS text-based system for disease reporting and supply inventory designed to connect community health workers (CHWs) with the central Ministry of Health. Josh’s project will be to work with the CHWs and local resources to create new visual media for use in education campaigns. These materials should be low-cost, easily reproducible, low-tech, and locally relevant.
He just uploaded his 2nd post: Map to Nowhere
First, I’ll give the basic run down of my week and then we’ll talk about some of the more existential stuff, that’s the fun part anyway. My week is pretty structured for not having a formal schedule or anything. Since I can’t sleep with all this friggin sunlight (hey, I’ve almost only ever worked night shifts, even before I was a nurse) I get up between 6 something and 7 something every morning, even without an alarm clock. My bucket bath in the morning is a great eye-opener and by the time I’m done with that I *almost* don’t need coffee… almost…
This week was the first actual week of work since Dr. Arlindo (the director of CoH) was back from Maputo (the capital) and the three missionaries were in the office. Actually, I think only two of them, Rose and Elfie, are missionaries and the third woman, Pastor Marcia, is local and works for Dr. Arlindo. Elfie is a nurse and Rose did a degree in health sciences and management. They are with the Methodist Church and Rose does the accounting and such for projects while Elfie works on developing the health projects that CoH conducts.
They get here between 7:30 and 8:30 and we have a small breakfast together usually. I’ve most likely had two cups of coffee by that point. Dhairya and I take our stuff into the work room down the hall on the work-side of CoH and make camp for the day at the collection of tables down there. I’ve been working on prototypes of the materials and gathering information about the area, thinking about the realities of life here, and how best to integrate what little information I have collected so far into some sort of meaningful messages.
I’m most likely not done doing whatever it was that I was working on, so I move back to my room and use the desk in there to work some more. I’ve thoroughly spread myself out over the entire room and used every surface that I could. In fact, I’d probably go crazy if there was another person in here with me to share the space… it’s been a long time since those undergrad years when I actually had to share a *room* with someone (not just an apartment).
I’ve taken a few afternoon trips…
On Sunday, May 3, 2015, Kelsey Sheak, a 2015 Master of Public Health Candidate at the University of Pennsylvania, woke up and prepared to run the 10K Broad Street Run. Shortly after starting the race, she noticed a crowd gathering around a collapsed man. Upon arriving at his side, Kelsey immediately put her CPR training into action. Kelsey was one of the many bystanders who helped this fallen runner survive from his cardiac arrest. Read her full story below.
CPHI: We heard you performed a life-saving procedure at the Broad Street Run on Sunday, May 3, 2015.
Kelsey Sheak: I did! I was running and between miles 2 and 3 I saw a crowd of people. There was a gentleman in the center of the crowd and he was clearly having a medical emergency. Shortly after I arrived, he lost his pulse. Once he lost his pulse, a group of bystanders and I started administering cardiopulmonary resuscitation (CPR). We communally performed CPR – one person would start, another person would step in, and so on. After about ten minutes in, the Philadelphia Police Department came with an automated external defibrillator (AED). The police are trained on how to use AEDs and to provide emergency medical care. They took over for all the bystanders and the patient was shocked and taken to the hospital. We were sent on our way and told to continue running. It was a little weird!
CPHI: Let’s back up for a minute. You are a Master of Public Health (MPH) student, but clearly you are well trained in CPR. What is your background?
KS: It’s crazy because 40,000 people ran the Broad Street Run and for me to come upon this is just mind-blowing – really serendipitous. My background is in cardiac arrest research and education. By profession I spend my days learning as much as I can about CPR and ways to improve it, ways to disseminate it, and ways to make survival much better. To come across this situation where I needed to use it was crazy.
CPHI: Who were other bystanders?
KS: Most of the people that were helping the collapsed runner had medical backgrounds: nurses, a physician, and me. The most important take-home message is that he didn’t need a medical professional; he just needed someone to recognize that he was in cardiac arrest and that he needed CPR. Anyone who is trained can do that. If you’re not trained in CPR, you should be!
CPHI: How was it meeting the collapsed runner the next day in the hospital?
KS: I went to the hospital after he arrested and I was able to meet his family. They were very nice and very thankful. I’m happy to know that he will go back to having a normal life.
CPHI: I want to take a moment to address a common misconception: many people think a heart attack is the same as a cardiac arrest. Can you help clear up this confusion?
KS: A cardiac arrest is when your heart stops and blood flow stops to the entire body. With a heart attack, your heart doesn’t stop; rather, there is a blockage. Generally, people who have a heart attack have chest pain, they go to the hospital, and they can recover. Cardiac arrest generally happens with little to no warning and people are generally healthy when it happens. It can happen for a lot of different reasons and everyone’s reason is different.
CPHI: Is there a most common reason why cardiac arrest happens?
KS: There isn’t a most common reason – but there are situations that are most savable. The gentleman at the race had a savable arrest because he had a shockable arrest. This means that his heart was in a rhythm that a defibrillator could recognize and turn into a healthy heart rhythm. Places like airports, casinos, and races are places where lots of cardiac arrest victims do well – there are numerous educated people around and these places are heavily watched. But there are also places where people don’t do well – like low-income neighborhoods, which are less likely to receive bystander CPR.
CPHI: After you helped save a fellow racer, did you continue running?
KS: Yes, I finished the race!
For more information about CPR and cardiac arrest, please visit the Penn Medicine Center for Resuscitation Science website.
We recently celebrated National Public Health Week (April 6-10) – with a twist! The Center for Public Health Initiatives (CPHI), Penn HR, Student Health Services (SHS), and the Penn Public Health Society (PPHS) collaborated to present “Make Penn Your Gym” to Penn’s campus. This pilot campaign was based on “Make NYC Your Gym”, a program dedicated to showing New Yorkers how they can take advantage of the surrounding built environment, get in their necessary exercise, and fit daily activities into busy schedules. Added bonus: it’s free! No gym membership required. For “Make Penn Your Gym”, SHS identified various jogging routes (1-, 2-, and 3-miles) throughout Penn’s campus and University City. PPHS and CPHI then designed and printed trifold maps of these routes, which were distributed from a table on Locust Walk between April 6th and April 10th. The table also featured some public health “swag” – travel hand sanitizers, SPF 23 lip balm, granola bars – as well as a simple survey for those interested (for example, “How could YOU make Penn your gym?”). Going forward, those survey responses will help shape the future of “Make Penn Your Gym”. Thank you to those who participated and stay tuned for more opportunities to “Make Penn Your Gym”!
Written by: Matthew Kearney, MPH Candidate 2016
In the week that I have been doing field work in remote rainforest village of Bosquet in east Cameroon, I have become extremely proficient at asking people if they are able to give a fecal sample. I recognize that this is a strange thing to be “proficient” at, but me and the team that I am working with will have to do this hundreds of times to get enough samples as part of my and the Tishkoff Lab’s research. Walking people discreetly to a side of the school we are using for “base operations” this week, I ask them in my fledgling French, “Vous pouvez faire des selles?” (Can you make stool?). For people who agree, I hand them a new, sterile plastic container with a lid and provide them with toilet paper. After this, we will freeze a portion of the sample in liquid nitrogen for analysis and use another portion to do fecal microscopy directly in the field to identify any infectious agents present in the stool, which can then be treated by a physician working with our collaborators at the University of Yaounde 1.
I’m here for two months with eight other team members- one, Dr. Alessia Ranciaro, is a senior research scientist in my lab, and our other colleagues are from Cameroon. We are conducting research as part of Dr. Sarah Tishkoff’s investigations into phenotypic (what you see when you look at someone) and genotypic (a person’s genetic makeup) variation in diverse Cameroonian populations. I’m also collecting fecal samples for my PhD research on the gut microbiomes (the microorganisms in your gut including bacteria, fungi, and archaea that have functions in many aspects of our physiology, including immunity and digestion) of Cameroonians practicing different kinds of subsistence, with a focus on how infectious gut parasites, including various soil transmitted helminths and schistosomes endemic to the region may have a role in shaping the composition and diversity of the gut microbiome. This fieldwork will also be part of the required field experience for the MPH degree at Penn.
Cameroon is a country of immense cultural, linguistic, and environmental diversity, with populations that practice pastoralist, agriculturalist, and hunter-gatherer subsistence and have diverse diets. The people of Bosquet are Baka, a recently settled hunting and gathering group of approximately 2,000 people. Their ethnic group, along with those of other equatorial African rainforest hunter gatherers, are more commonly known as pygmies due to their short stature, although this term is considered pejorative by many Baka. Nowadays, the Baka live primarily in mud brick huts with dirt floors, and have very limited access to electricity. While many of them have small gardening plots to cultivate yams, cassava, plantains, and bananas, and they no longer travel in small, mobile bands through the forest, they still rely heavily on the forest to hunt bushmeat such as antelope, giant forest rats, and monkeys, in addition to providing various wild fruits and honey, and several traditional medicines to treat common (and potentially life threatening) ailments such as malaria and diarrheal disease. The Baka of Bosquet have access to a covered well, which provides them with a source of clean water for drinking and bathing, although streams are often used, too.
All of these dietary changes we are observing in indigenous groups are important to understanding the structure of the gut microbiome; some groups may possess certain kinds of bacteria that have allowed them to better digest particular kinds of foods as an example of adaptation to local environments. As their diets and health change, we can hypothesize about the kinds of shifts we may see in the microbiome, and consider the downstream implications for disease. For instance- as groups like the Baka become more settled, and potentially rely less on foraging in the rainforest and increasingly eat processed foods, will their gut microbiomes start to look like those of neighboring Bantu agriculturalist groups? This has implications for the kinds of chronic diseases we may begin to see in many of these groups.
Presently, some of the greatest threats to Baka health are issues like food scarcity, access to clean water, infection with intestinal worms, malaria, hernias, HIV, and tuberculosis. The nearest major hospital is over an hour away in the town of Lomie, so the team has brought a doctor to help treat the Baka, who can elect to receive free medical treatment regardless of whether or not they partake in our research. Cameroon has a national deworming campaign that provides periodic, free deworming agents, but populations like the Baka, who live far from major cities in dense rainforests traversable primarily by rough dirt roads, are often logistically hard to treat. The medications provided to the community of Bosquet will be able to alleviate some of their ailments; hopefully, the downstream results of our research can provide evolutionary and health clues as to not only why some groups get more sick than others, but what we might be able to do to help these groups in the future, and to be aware of how rapidly shifting cultural and subsistence practices could affect the health of groups like the Baka.
Written by: Meagan Rubel, MPH, Rubel@sas.upenn.edu
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King Jr.
Nearly half a century after Dr. King’s observation, the Affordable Care Act made tremendous strides towards equality of access in health care. Equality promotes fairness, however it’s only effective if everyone starts from the same place and has the same needs. When it comes to breaking the barriers to health care equity—we still have a long road.
Dr. David Satcher was the keynote speaker for the Perelman School of Medicine Health Equity Symposium, held at the University of Pennsylvania in January. He was the first African American Surgeon General of the United States and is the current director of The Satcher Leadership Institute at the Morehouse School of Medicine. “In order to eliminate disparities we need leaders who care enough, know enough, will do enough, and are persistent enough,” he said. He encouraged attendees to delve deeper into the realities of health inequity in America. The symposium provided a glimpse into some of these inequities.
According to the CDC Health Disparities & Inequalities 2013 Report, Non-Hispanic Black adults are 50% more likely to die of heart disease or stroke prematurely than Caucasians. Until recently, scant efforts in organizational quality improvement were made in health care to address racial disparities. This was evident in the health care inequities of our Veterans population.
Said Ibrahim, co-director of the U.S. Department of Veterans Affairs Center of Health Equity Research, posed the following question at the Symposium,
“How do we make sure the equality of opportunity translates to the equality of health outcomes?”
According to the Department of Veteran Affairs Health Service Research & Development Services, minority veterans are receiving less and lower quality health care, despite needing more and higher quality care (suggesting a form of “regressive” healthcare delivery).
Another population that is currently experiencing health care inequities are Asian Americans. They are currently the fastest growing minority group with a growth rate increase of 46% from 2000 to 2010. Ironically, this group receives little attention in the statistical analyses of health and health care inequities. The labeling of the “model minority” for Asian Americans is quite paradoxical —simultaneously successful and marginal. The notion has often led to the tuning out of the hardships of prejudices, health disparities, and health care inequities, Asian Americans face.
Although the Affordable Care Act benefited Asian Americans in increasing health care access, cultural competence and community engagement is necessary to successfully eliminate the gaps in health care equity. A concerted effort by public health professionals on local, state, and national levels will help bridge the gap in health care access in the Asian American & Pacific Islander communities.
The LGBT community faces health care inequity as well. Risk of psychiatric disorders, substance abuse, and suicide are elevated as a result of social stigma and discrimination, calling for a need for culturally competent medical care.
Increasing coverage promotes greater access to care but it won’t translate to equity of health outcomes. Quality improvements in health care delivery must place emphasis on social determinants of health and culturally competent care. Our health care approach should not be one size fits all, but rather it must be modified to fit the specific needs of vulnerable populations.
Written by: Amy Rajan, RN, MSN/MPH Candidate, Class of 2016
PHILADELPHIA—Americans represent 4.6% of the world’s population, yet we consume more than 97% of all the hydrocodone produced worldwide. In 2012, the CDC reported health care providers wrote 259 million prescriptions for painkillers, which is enough for every American adult to have a bottle of pills.
The Center for Public Health Initiatives dedicated a week in November to focus on the opioid epidemic and how to reduce the level of prescribing these drugs. In her talk, “From the Streets to the ER,” Dr. Jeanmarie Perrone from the University of Pennsylvania’s Department of Emergency Medicine proposed that health care providers should begin to focus on patient education, “It takes 30 seconds to prescribe and 30 minutes to educate.” So which one is a more viable option?
The fine line between compassionate pain management and encouraging addiction is often hard to distinguish when prescribing opioid medications. Larger patient loads and shorter doctor-patient visits (average, 7-9 minutes) may encourage physicians to prescribe chronic non-cancer patients opioids instead of spending time to educate them on alternative options.
Is the solution to the opioid epidemic as simple as a half hour of education? A team approach to patient education has consistently worked well. Dr. Perrone and her colleagues conducted a study involving two urban emergency departments in Philadelphia and investigated the use of a multidisciplinary team approach to decrease the amount of opioid packs dispensed at discharge. The interventions included educating a multidisciplinary team of nurses, residents, nurse practitioners, and attending physicians. The number of opioids dispensed at discharge for individuals who were at risk for opioid dependence decreased significantly from 21.8% to 13.9% in the primary ER investigated.
Studies involving a multidisciplinary approach and state regulations implementing prescription drug monitoring programs led to a successful reduction in rates of opioid abuse.
State Successes After Implementing Prescription Drug Monitoring Programs
Emerging research shows that the increased opioid regulations may be linked to the increase in heroin use. Over the past three years, opioid related fatalities in New York City have leveled off, while deaths involving heroin use have increased by 44%.
As opioid regulations increase across the nation, public health practitioners should pay close attention to an unintended rise in heroin use, particularly in areas where heroin is readily accessible.
Written by: Amy Rajan, RN, MSN/MPH Candidate, Class of 2016