Model Partnerships & GH: Demetri Blanas

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The Kendeya Community Health Partnership: Connecting a metropolis and the Sahel

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  • “Value of direct experience and immersion for students” – better clinical skills,
    “Technical assistance and research-based advocacy” = two real ways in which students from the Global North can help their partners, community orgs and health sector workers, in the Global South – “give back” for the privilege of the experience.
  • “Serves patients from the Upper East Side of Manhattan as well as the community of East Harlem. “ – discuss demographics: affluent patients from the Upper East, predominantly Latino and African American demographics in Harlem, with greater burden of disease (cardiovascular 3-4x, childhood asthma 4x)
    “Department of Community and Preventive Medicine” – Established in 1967 at the time of founding Mount Sinai School of Medicine. Is a nationally and internationally recognized center of excellence in preventive medicine, occupational and environmental medicine, community health, and environmental pediatrics. Among the largest medical school departments of preventive medicine in the United States. Has worked closely with WHO on issues pertaining to children’s environmental health. Mission: “to prevent disease, protect the environment and promote good health in East Harlem and in all the communities that Mount Sinai serves.”
    “Students experience significant immersion and perform volunteer work throughout the pre-clinical and clinical years.” – one of the most significant experiences is a student-volunteer-operated free clinic that serves patients from the community.
    “High level of interest in global health among incoming students.” – in an informal survey by one of the authors of this presentation, over ¼ of the incoming first-year medical students expressed interest in learning more about global health and public health .
  • So, what are the principle causes of this situation: a 30-year cohort study in Saraya’s region found that the direct causes of maternal death are generally the same as they are in much of the developing world: they are mostly due to obstetric complications during child birth, most of which consisted of hemorrhaging. However, indirect factors also play a key role: distance (some villages are up to 250 km from EOC; isolation (the vast majority of villages do not even have phones); low general levels of education (no girl has ever graduated from the middle school in Saraya); early marriage (girls are often married as early as 13 years of age); the vast majority of women experience their first pregnancy before the age of 18; most women have had more than five children by the age of 28; there is a general lack of primary health services; and type II and type III Female Genital Cutting complicate births further; Finally, anemia, and malaria - which go hand in hand also play important roles.
  • We also run a student practicum program that is open to a limited number of medical, public health, and sustainable development students. Students have the opportunity to participate in all district health activities and initiatives.
  • I want to thank the audience, as well to give credit to the local communities and the partners that we work with.
  • Model Partnerships & GH: Demetri Blanas

    1. 1. The Kendeya Community Health Partnership Connecting the Metropolis and the Sahel: Communities, the Public Health Sector, and Students
    2. 2. The Kendeya Community Health Partnership Overview: • Student-driven non-profit organization • Formed in 2006: facilitates collaboration between the Senegalese Ministry of Health, communities in Saraya district, and US students • Works with the district health team to identify key health needs and develop interventions: • Examples: – Implementation of an effective adverse-effect monitoring system for anti-malaria therapy – Development of maternal mortality reduction projects
    3. 3. Introduction: Global Health Partnerships One side. . . • A surge in interest among health professional students in global health • Academic engagement with global health: from curriculum content to research support • Value of direct experience and immersion for students. The other side . . . • Specific community public health needs • Technical assistance and research-based advocacy • Up for debate: In a setting of limited health resources, what is available for education of “outsiders”?
    4. 4. Where We Work: NYC Mount Sinai Medical Center • Serves Upper East Side and East Harlem. • Works closely with underserved through Department of Community and Preventive Medicine (est. 1967). • School values stress ethical and socially responsible practice • Student engagement in community and volunteer work • Mount Sinai Global Health Center : – Global health opportunities for medical students, residents, faculty – Long-term partnerships for sustainability and higher impact • High level of interest in global health among
    5. 5. Where We Work: Southeastern Senegal • Under-five mortality: 254 deaths per 1,000 live births • Maternal mortality: 826 per 100,000 (~1 in 19 women) • Life expectancy: 48 years (female), 45 (male) • Malaria is largest cause of mortality and morbidity Saraya Source: Google maps Sources: Pison 2005; Guyavarch 2007.
    6. 6. District of Saraya: Barriers to Access District health post nurse packing a month’s supply of medication on the back of his dirt bike Villages are located up to 90 km from nearest health facility; laterite roads are in disrepair • Population of 35,000 •1 government doctor, 3 nurses, 1 midwife •1 health center Villages up to 90 Km on laterite roads from closest health facility
    7. 7. The Kendeya Health Partnership: Reinforcing the work of communities and the government health service • Activities: - Primary health care - Nutrition - Evacuation for emergency obstetric care - Health communication and promoting women’s education - Malaria (RTDs/ACTs/ITNs) - Outreach: screening through a mobile clinic Community birth attendants during a training session - Family planning: increasing access to contraceptives - HIV: increasing voluntary testing - Maternal mortality reduction: training of community birth attendants
    8. 8. Current Interventions: Adverse effects monitoring of anti-malarials • New drugs introduced in 2006 in response to chloroquine resistance: 1. Artemisinin-based combination therapy (ACT) 2. Intermittent preventive treatment of malaria (IPT): Sulfadoxine- Pyrimethamine (SP). • Priorities: - Monitor safety of ACTs and SP • Health staff and CHWs were trained to recognize and report adverse effects from the drugs. • 24 total cases of adverse effects were identified and treated in 2008. A falciparum rapid diagnostic test being administered at the Saraya District Health Center
    9. 9. Working toward reduction of maternal mortality • Maternal mortality in Saraya: - Maternal mortality: 826/100,000 - Births attended by trained health practitioner: <13% - Total Fertility Rate: 6.2 •Our Work • Mobile clinic: Perinatal care. • IPT of pregnant women with SP • Training birth attendants in safer birth practices and triage. • Promoting secondary education of girls through scholarships. Community birth attendants at a training in Saraya
    10. 10. Student Practicum Program • Students of medicine, public health, and sustainable development have the opportunity to do a practicum program • Participate in long-term relationships and research to inform future interventions and priorities for the health district NMSA Scholars at KCHP in Summer 2007
    11. 11. How can we do better? • Suggestions? • We are looking for partners, particularly in improving emergency obstetric services: – Ultrasound equipment; obstetric equipment; training; visiting OB/GYNs… • Contact information: – Demetri Blanas: dab2108@gmail.com – Dr Youssoupha Ndiaye: youndiaye@hotmail.com
    12. 12. Thank You Saraya Community Birth Attendants During a District Training •Local Communities •The Saraya District Health Team •The Senegalese Ministry of Health •UNICEF •ASBEF •Enda Santé •The Hesperian Foundation
    13. 13. Works Cited • AbouZahr C, Wardlaw, T., Hill, K., Choi, Y., Mathers, C., Shibuya, K., Lwin, N.. Maternal Mortality in 2000: estimates eveloped by WHO, UNICEF, and UNFPA. 2004. • Collumbien M, Gerressu M, Cleland J, Non-use and use of effective methods of contraception. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors, vol 2. Geneva, World Health Organization, 2004. • Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, and Gardner P. Global Health in Medical Education: A Call for More Training and Opportunities. Academic Medicine. 2007. 82(3):226-230. • Family Health International. Maternal Mortality and Morbidity < http://www.fhi.org/en/Topics/maternalmort.htm>. Accessed 2008 March 12, 2008. FHI, 2008. • Hunt P. Special Report on the Right to the Highest Attainable Standard of Health. United Nations. October 19, 2006. • Kanter, SL. Global Health is More Important in a Smaller World. Academic Medicine. 2008. 83(2):115-116. • Kodio B, Bernis, L., et al. Levels and Causes of Maternal Mortality in Senegal. Tropical Medicine International Health. 2002;7(6):499-505. • Luthra R. Safe Motherhood: A Matter of Human Rights and Social Justice. UN Chronicle Online Edition. 2007. • Maine D, Yamin, A. Maternal Mortality as a Human Rights Issue: Measuring Compliance With International Treaty Obligation. Human Rights Quarterly. 1999;21:563-607. • Marston C, Cleland JC. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Population Studies. 2003, 57:77–93. • Pison G, Guyavarch, Emmanuelle, Sokhna, Cheikh. Bandafassi DSS. Senegal. Population and Health in Developing Countries. International Development Research Center. 2005. • Starrs AM. Safe Motherhood Initiative: 20 Years and Counting. The Lancet. 2006. 368:1130-2. • Serrano AMT and Jensen J. The New Route to Safer Childbirth in Rural Senegal. UNFPA New Feature. 2004. • Women's Human Rights Programme. Susan B. Bora Laskin Law Library. 2008. • World Health Organization. The World Health Report 2005 - A safer future: global public health security in the 21st century. Geneva: WHO, 2005.

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