Year
Country
Organization
Year
Country
Organization
1997
Russia
Healing the Children North East
2007
Honduras
Gift of Life, Rotary Club
1997
China
Healing the Children
2007
Honduras
Medical Students Making Impact
1998
Russia
Healing the Children North East
2008
Liberia
Mount Sinai
1999
China
Healing the Children
2008
Dominican Republic
Healing the Children
2000
China
Healing the Children
2009
Vietnam
Gift of Life, Rotary Club
2000
Romania
Humana
2009
Liberia
Mount Sinai
2000
Dominican Republic
Healing the Children
2009
Thailand
Healing the Children
2000
China
Children of China Pediatric Foundation
2009
Ecuador
Healing the Children
2001
Romania
Humana
2009
Dominican Republic
Healing the Children
2001
Kenya
Healing the Children
2010
Guyana
Caribbean Heart Institute
2002
China
Healing the Children
2010
Liberia
Mount Sinai
2003
China
Children of China Pediatric Foundation
2010
Liberia
Mount Sinai
2004
Romania
Humana
2010
Haiti
Partners in Health
2004
Bolivia
Healing the Children
2010
Ecuador
Montefiore Medical Center
2004
Dominican Republic
Medical Students Making Impact
2010
Ecuador
International Surgical Health Initiative
2005
Honduras
Medical Students Making Impact
2011
Liberia
Mount Sinai
2005
Dominican Republic
Healing the Children
2011
Peru
Komedyplast
2005
Honduras
Medical Students Making Impact
2011
China
Healing the Children
2006
Vietnam
Rotary Club
2013
Peru
Komedyplast
2006
Honduras
Medical Students Making Impact
2014
China
Healing the Children
2006
Dominican Republic
Healing the Children
2014
Peru
Komedyplast
2006
Honduras
Medical Students Making Impact
The department of anesthesiology at the Icahn School has also provided continuing support and mentorship for Medical Students Making Impact (MSMI), founded in 2001, orchestrating international medical/surgical teams that have completed service trips to Honduras, Belize, Zambia and Nigeria (Table 25.2). Anesthesiologists, surgeons, fellows, residents and a cadre of highly motivated medical students are currently raising funds and collecting donations of medical supplies for the next “Brigada” (a group of people organized for special activity) as they are called by the locals in San Pedro Sula, Honduras. Our teams demonstrate surgical techniques while providing care to as many people as possible by day. Evenings are spent with local government and health officials as well as medical school students and administration expanding our knowledge and understanding of global health issues and offering lectures and presentations to local colleagues. MSMI team members often gain first-hand knowledge of diseases, syndromes and poverty that they would otherwise see only in textbooks.
Table 25.2
Anesthesiologist and medical students under their supervision have provided care in many countries over the past 14 years
Year | Country | Component of Mount Sinai |
|---|---|---|
2000 | China | MSSM & Children of China Pediatric Foundation |
2003 | China | MSSM & Children of China Pediatric Foundation |
2004 | Dominican Republic | Medical Students Making Impact |
2005 | Honduras | Medical Students Making Impact |
2005 | Honduras | Medical Students Making Impact |
2006 | Honduras | Medical Students Making Impact |
2006 | Honduras | Medical Students Making Impact |
2007 | Honduras | Medical Students Making Impact |
2008 | Liberia | Mount Sinai |
2009 | Liberia | Mount Sinai |
2010 | Haiti | MSSM & Partners in Health |
2010 | Liberia | Mount Sinai |
2011 | Liberia | Mount Sinai |
2011 | Honduras | Medical Students Making Impact |
2011 | Haiti | Mount Sinai |
2012 | Dominican Republic | Mount Sinai Global Women’s Health |
2012 | Liberia | Mount Sinai |
2012 | Jamaica | Mount Sinai |
2012 | Bolivia | Mount Sinai Cardiac Anesthesiology |
2013 | Dominican Republic | Mount Sinai Global Women’s Health |
2013 | Liberia | Mount Sinai |
2013 | Nicaragua | Mount Sinai Cardiac Anesthesiology |
2014 | Dominican Republic | Mount Sinai Global Women’s Health |
2014 | Liberia | Mount Sinai |
2014 | China | Mount Sinai |
Most dramatically, an e-mail was sent to all employees at Mount Sinai Medical Center asking for volunteers for an international surgical team to Haiti 2 days after the earthquake of January 2010. The rapidly assembled group included orthopedic and general surgeons, nursing staff to provide OR and PACU support and our anesthesiologists. Armed with narcotics and minimal equipment for performing regional anesthesia, we performed 75 procedures. We the providers of international surgical care gained much from the experience. The group returned to Mount Sinai with an understanding of the global burden of surgical need and a determination to affect sustainable change in Global Health.
We describe the development of a coherent, multi-level, interdisciplinary program in global health in the Icahn School of Medicine, a large, urban, hospital-based medical school in New York City. Our goal is to share lessons learned and offer guidance to programs in other institutions.
Evolution of Global Health at Mount Sinai
Phase 1: Initiating Factors and Design
The Global Health program at Mount Sinai School of Medicine was founded in 2005. Its creation was both catalyzed and supported by increasing trainee demand. This demand was evidenced by growing numbers of resident and student international electives and by expanding participation in student-led international health interest groups. Critical events were informal surveys of incoming, first-year medical students in which nearly two-thirds of these incoming students indicated an interest in spending at least a portion of their careers serving the underserved in low- and middle-income countries (LMICs). This response represented a dramatic increase from preceding years and was very important in demonstrating the need for global health programming to institutional leadership.
The global health initiative was developed and designed through a series of structured discussions among senior faculty from the Departments of Pediatrics, Preventive Medicine, and Medical Education as well as the Center for Community and Multicultural Affairs.
An important early decision was a plan to focus scarce program resources on education. A small grant was secured from a private foundation to support curriculum development. The intent was to develop a three-tiered educational program that may be visualized as an inverted pyramid:
Tier One: At the top of the inverted pyramid is the broadest of the three levels. It was designed to provide introductory courses for the entire medical school class. The goals were to introduce all of our students to key issues in global health and give them an introduction to the concept that these problems are soluble and that there exist rational approaches to problem solving.
Tier Two: In the middle of the inverted pyramid was seen a transitional tier. It consisted of elective offerings for those medical students and physicians who had become intrigued by the introductory material presented in Tier One. Through these electives, medical students, residents and physicians are given the opportunity to work for weeks or months in underserved areas either in the United States or abroad.
Tier Three: The tier with the fewest number of people at the bottom tip of the inverted pyramid consists of longer term training programs for physicians who have made a serious commitment to serving the world’s poor. These could be special fellowships of 6, 12, or even 24 months in duration. They could be located geographically either in the United States or abroad, so long as the focus is on devising sustainable solutions to long-term health problems in poor communities.
To launch the program, four junior faculty members from four departments were recruited by the Dean of Medical Education based on their past experience in global health and their responsibilities for oversight of international activities within their home departments. These four junior faculty members each maintained a primary appointment within their own departments, that is, Pediatrics, Preventive Medicine, Emergency Medicine and Internal Medicine. In addition they were each given partial salary support from the global health planning grant to work on development of the multi-level global health training program. Leadership was provided by one of the senior founding faculty from the Department of Pediatrics and the Dean of Medical Education. The program was initially created as an Office of Global Health housed within the Department of Medical Education. The Dean of the Medical School provided a modest amount of funding through the Department of Medical Education to defray program costs as well as office space and administrative support.
To build a philanthropic base for the Global Health program, a Global Health Advisory Board was created. This board consisted predominantly of contacts of the senior founding faculty. The board had no fiduciary or programmatic responsibility for the program, but participated in fundraising and promotional events, including the hosting of an annual fundraising event. In 2006, a formal proposal was successfully presented to the family foundation which had granted the initial planning grant, and the program received a grant of $1,000,000 to be disbursed over 3 years. This grant gave the program the foundation for its growth. It supported part-time salaries for faculty, provided stipends to support global health field experiences for trainees, and supported travel expenses to allow faculty to build partnerships with organizations across the globe.
Phase II: Growth of Programs and Partners
Global Health in the Medical School
At the time of formation of the Global Health Office in 2005, student global health activities consisted of independently organized clinical electives in the third or fourth year of medical school and short clinical “mission” trips organized by volunteer faculty. With the exception of a brief preparatory curriculum for students participating in the clinical trips, there was no formal teaching in global health.
To address this gap in global health education, development of a formal curriculum was an early goal of the Global Health Office. Global Health faculty introduced many different curricular offerings over the succeeding 8 years, including a semester-long elective “Introduction to Global Health” course, a Global Health Career Speaker Series, and an annual Global Health Conference. All of these programs continue to the present, but have been continuously refined and improved in response to continuing program evaluation.
Related posts:
The Evolution of Surgical Humanitarian Missions
Management of Pain in Less Developed Countries
Trauma, War, and Managing Vascular and Orthopedic Injuries
Legal and Ethical Issues in Global Health: A Trip Through the Vagaries of Truth and Culture
Anesthesia Disparities Between High-Income Countries and Low-and Middle-Income Countries: Providers, Training, Equipment, and Techniques
Medical Missions: A Short History from There to Here
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