Download independent ISC syllabus - Vanderbilt Institute for Global Health

Vanderbilt Institute for Global Health
Vanderbilt University School of Medicine
Global Health Integrated Science Course (ISC):
Independent Study for student name (please type your name)
Course Code:
Delivery method:
IDIS 5618
Digital and on-site in low- and middle-income countries (LMICs)
Course Director:
Educational Coordinators:
Douglas C. Heimburger, M.D., M.S.
Elizabeth Rose, M.Ed., M.P.H.
Marie Martin, M.Ed.
Office Hours:
By appointment
Introduction
Health promotion, disease prevention and control, and mortality reduction require an interprofessional, multidisciplinary response for multidimensional problems. Whether from the point
of view of humanitarian interest, research competitiveness, full utilization of our educational
resources, or the need for global expertise for modern America, the global health agenda has
emerged as an increasingly important component of higher education in the U.S.
Additionally, health care professionals are noting an increased opportunity and need to work
with patients and families from international backgrounds and other cultures. Health care
professionals have two responsibilities, which include providing excellent medical care with
cultural competence, and working in conjunction with local staff and administration (Crump and
Sugarman, 2010). Health professions students are in an excellent position to provide and receive
global health training and education. The combination of cross-cultural didactics, mentoring, and
first-hand experience can provide a solid foundation on which they can build throughout the
remainder of their careers.
Responding to this growing demand in US academia, the Vanderbilt University Institute for
Global Health and the Vanderbilt University School of Medicine have developed a Global
Health Immersion Course for third- and fourth-year medical students. It is an on-the-ground
experience that introduces students to key topics and concepts in global health including
diseases, root causes, and both clinical and public health interventions common in low-resource
settings. Health and developmental issues across nations and cultures that require collective
(partnership-based) action are highlighted. The course provides an opportunity to view diseases
in low-resource settings through the lens of population science, epidemiology, public health,
health systems, and health policy.
The course is taught through digital modules and distance mentoring sessions. All students
complete a core of digital modules and assessments, plus modules that are site-specific. Students
are placed at Vanderbilt partner sites in various locations around the world.
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Lwala, Kenya
ID, MCH, Nutrition,
Prevention &
Treatment, Primary
Care, Water &
Sanitation
Central America
Amman, Jordan
Cancer, ID, MCH,
NCDs, Pathology,
Pediatrics, Quality
Improvement
Common
Global
Health
Content
Cancer, ID, NCDs,
Nutrition,
Pathology,
Pediatrics, Quality
Improvement,
Water & Sanitation
Special Study
specialties choosen
by student inline
with site
Site specific information
Write two to three paragraphs about the hospital, clinic, and/or other places where you will be
rotating. Please include information about the importance and relevance of these sites to the
community, primary functions of these locations, information about the surrounding community
(i.e. neighborhood, city, and country statistics), disease burden in the region, and other pertinent
background information. Also include contact information for site location(s) and site
supervisor(s).
Course competencies
1. Assess complexities of global health issues, particularly those most applicable in lowresource settings.
2. Examine determinants of global health and development from an interdisciplinary and
interprofessional vantage point.
3. Review foundational science relevant to conditions encountered in low-resource settings
(epidemiology, microbiology, immunology, neuroscience, nutrition science, pathology
and pathophysiology, pharmacology, physiology)
4. Compare public health versus individual patient-care approaches to health issues in lowresource settings.
5. Participate in and analyze interventions used to ameliorate health and developmental
problems in low-resource settings.
6. Encounter, diagnose, and participate in treating medical problems that are uncommon in
the U.S.
7. Understand community development, social justice, and human rights principles as they
relate to global health.
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Course objectives – individualized by sites
Write 3-7 specific objectives that you wish to accomplish during your rotation.
Teaching methods
Digital modules delivered through VSTAR, assessments, weekly mentoring sessions with course
instructor remotely, presentation to site staff, and capstone project.
Course activities and rotation schedule
Write in your proposed activities and the hours per week in which you will spend on these
projects. The table below is an example of activities. Formal and informal instruction should
remain at 6-8 hours per week but the other activities (listed in gray) should be modified to align
with your learning objectives.
Activities
Formal and informal instruction by VUMC faculty (includes digital and live
lectures, small group work, discussion sessions, mentoring sessions).
Patient care
Community outreach/engagement (visiting primary schools, community
organizations, etc., as appropriate to the site)
Discussions, training, teaching, and other learning experiences on-site
Hours/week
6-8
25-30
10-15
2-3
Note: Students are expected to participate in all four weeks of the course onsite.
Rotation Schedule
Amend the rotation schedule to align with your site needs.
Morning Sessions: 9:00am – 1:00pm Monday-Friday plus some afternoons
Clinical rotations, health trainings, mobile clinics and/or community outreach
Afternoon Sessions: 2:30 – 5:00pm
Monday and Tuesday: Continuing Medical Education (CME) seminars with clinical staff
Wednesday, Thursday, and Friday: Clinical outreach, case studies, differential diagnoses,
and personal reflection
Mentoring sessions with Dr. Heimburger (or other VUSM faculty mentor of your choosing) on
day/time (propose a weekly meeting time). These meetings are done via:
1. Skype (first choice, when Internet is working). Dr. Heimburger’s Skype username is
<dougheimburger>, so please send him a Skype Contact request, and/or accept his Skype
Contact request.
2. Microsoft Lync (second choice), which Dr. Heimburger will use to initiate a call to your
local phone number. Once you are in-country please email the number to Dr.
Heimburger.
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3. If all else fails, Dr. Heimburger’s cell phone is 205-790-0871, and his office phone is
615-875-0151, but you do not need to incur the expense of calling him; he will reach you.
These sessions will begin with the students sharing an impressionable experience from the prior
week, and then they will cover a different topic each week. Please prepare for these sessions by
going through the relevant VSTAR modules and required readings for the topic, as shown below.
The first session typically happens just after you have arrived, but do your best to prepare by
going through the VSTAR modules.
Evaluation and Grading
Students are expected to complete all required modules and assessments prior to departing for
their month rotation abroad. Successful completion of the course is based on:
 Digital modules and assessments (30%): Each assignment in the course is designed to
assess students’ understanding of the diverse diseases, conditions and interventions common
in low-resource settings.
 Clinical Rotation / In-country Evaluation (25%): The student’s evaluation will be
conducted by on-site staff (two, if possible). (Evaluation template attached on the final page).
 Weekly readings and guided reflection (20%): Weekly reflection session during the
mentoring calls with course director allow students to reflect on the ISC experience and its
impact on their personal and professional development. Students read about the weekly focus
areas, consider current interventions, discuss new strategies for addressing the issues, and
evaluate potential implications of the alternative solutions.
 Student capstone presentation and assignment (25%):
Below are two suggested projects for the capstone. Capstone projects can be modified by
student to fit the site as appropriate but should be defined and approved pre-departure. If you
wish to modify the capstone project to align with your learning objectives, please do so
below.
o Presentation: Students give a 30-minute medical/health education presentation to a
group on-site (e.g., clinic staff, community health workers) during their final week in
country. (10%).
o Clinical Instructional Sheets: Students develop two clinical instruction sheets (one
or two single-spaced pages) on topics they select from a wide range of issues based
on their interests and the needs of the Lwala Community Alliance. One instructional
sheet should contain a short clinical algorithm that will help the clinical staff. Often,
the other instruction sheet is geared toward incoming Vanderbilt medical students, to
introduce them to national guidelines, local standards, and clinical protocols for
treating common diseases and conditions. All topics must be approved by the course
director and organization, and will be submitted to both Vanderbilt and the
organization. These are due two weeks after the end of the course. (15%).
Incomplete assignments may result in failure of the course.
Academic Integrity
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All students are required to acquaint themselves with the provisions of the Honor System
through the information in the VUSM Student Handbook.
Any incident involving plagiarism will result in failure of the course.
Guest Instructors
Muktar Aliyu, MD, DrPH
Susan Barone, PhD
Phil Ciampa, MD, MPH
Quentin Eichbaum, MD, PhD, MPH
Carol Etherington, RN, MSN
Doug Heimburger, MD, MS
Avery Dickins de Giron, PhD
Doug Morgan, MD, MPH
Deanna Pilkenton, CNM, MSN
William Wester, MD, MPH
Randy Wykoff, MD, MPH
Sten Vermund, MD, PhD
Course Modules and Readings
Below is a list of the course topic modules and readings. An updated list of required and optional
readings for each session may be provided and posted on the VSTAR website. The following
textbook is recommended for students who desire to read one:
Merson, M., Black, R. & Mills, A. (2012). Global health: Diseases, programs, systems, and
policies. Sudbury, MA: Jones and Bartlett.
[Desk copies are available at the Eskind Biomedical Library]
Required Digital Pre-Departure Modules
These digital modules, accessed through VSTAR, are required for all students participating in all
Global Health Immersion Course sites. Students are expected to complete an assessment on each
individual module.
Please note:
All students must submit the Pre-departure Survey at least two weeks before
departure.(https://redcap.vanderbilt.edu/surveys/?s=r8LagGTsPt)
Module 1: Foundations and Current Issues in Global Health
This module (https://www.youtube.com/watch?v=l-b8WwXXHng [audio] and
http://www.etsu.edu/streaming/2012_tenn_global_health_forum.html [slides]) offers a general
overview of global health in the first decade of the 21st Century: addressing the wide scope of
initiatives, programs and actors that impact health and well-being of populations.
Recommended reading:
 Wainaina, B. “How to Write About Africa.” http://www.granta.com/Archive/92/How-toWrite-about-Africa/Page-1
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The Millennium Development Goals Report 2013.
http://www.un.org/millenniumgoals/pdf/report-2013/mdg-report-2013-english.pdf
Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med
2013;369:448-57. PubMed PMID: 23902484.
Requejo JH, Newby H, Bryce J. Measuring coverage in MNCH: challenges and
opportunities in the selection of coverage indicators for global monitoring. PLoS Med
2013;10(5):e1001416. PubMed PMID: 23667336
Garrett, L. (2007). The challenge of global health. Foreign Affairs, 86(1), 14-28.
Merson, M., Black, R. & Mills, A. (2011). Introduction. In M. Merson, R. Black, & A.
Mills (Eds.) Global health: Diseases, programs, systems, and policies (pp. xvii-xxx).
Sudbury, MA: Jones and Bartlett.
Module 2: Travel Medicine
This module (http://mediasrv1.its.vanderbilt.edu/html5/nursing3/streams/_definst_/VIGH_7_FA12_voppt.mp4) addresses
the needs of travelers in low-resource settings abroad. Information on vaccinations, food and
beverage precautions, insect precautions, and general safety tips will be provided.
Module 3: Ethical Issues in Research and Service in Resource-limited Settings
This module (http://mediasrv1.its.vanderbilt.edu/html5/nursing3/streams/_definst_/VIGH_5_FA12_voppt.mp4) covers
ethical issues related to global health research and service and provides recommendations for
ethical engagement with communities and collaborators in resource-limited settings (and
elsewhere).
Recommended reading:
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Crump JA, Sugarman J, Ethics WG. Ethics and Best Practice Guidelines for Training
Experiences in Global Health. Am J Trop Med Hyg 2010;83:1178-82.
Andrew D. Pinto, Ross E. G. Upshur. Global health ethics for students. Dev World
Bioeth. 2009 April; 9(1): 1–10. doi: 10.1111/j.1471-8847.2007.00209.x
Mary White & Jessica Evert. Developing Ethical Awareness in Global Health: Four
Cases for Medical Educators. Developing World Bioethics 12 (3) (2012).
Module 4: Risks, Realities, and Responsibilities of Working in the Field
This module (http://mediasrv1.its.vanderbilt.edu/html5/nursing3/streams/_definst_/VIGH_6_FA12_voppt.mp4) addresses
unique risks and realities associated with global health engagement.
Module 5: Cultural Issues in International Service: Developing Cultural Competence
This module
(https://www.nursing.vanderbilt.edu/mp4/voppt.html?filename=VIGH_3_FA12_voppt.mp4)
covers comprehension of similarities and differences in communication, interpretation and
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activities in cross cultural settings and circumstances will be explored, particularly as they relate
to ethics, values, and actions. A primary goal of this module is to confront the complex
challenges attendant to becoming culturally conscious and competent.
Recommended case studies:
 Standardized patient https://my.vanderbilt.edu/globalhealth/files/2012/09/5-Std-PatientSeinfeld.avi
 Worlds apart: https://my.vanderbilt.edu/globalhealth/files/2012/09/7-Worlds-ApartVideo.avi
Module 6: First, Do No Harm: A Qualitative Research Documentary
This module (http://vimeo.com/22008886) is a qualitative research documentary explores the
ethics of global health clinical electives and volunteer projects in developing regions. It features
interviews from experts and global health providers from Europe, Africa, Asia, North and South
America. It is intended for use in Pre-Departure Training for students and volunteers intending to
participate in overseas projects.
Module 7: General Pre-Departure Orientation
This module (http://prezi.com/1qhulnkbnrr/?utm_campaign=share&utm_medium=copy&rc=ex0share) provides practical predeparture information for travel in low-resource settings including health insurance, financial
considerations, communication, safety, etc.
Module 8: Country-specific Pre-Departure Orientation
List resources that you will use (or have already used) to prepare for the specific country and
context.
You can find a list of VIGH’s country-specific handbooks and resources on our website:
https://my.vanderbilt.edu/globalhealth/travelmed/country-specific-handbooks/
Digital Content-Focused Modules
Choose and complete at least four of the following modules that will augment your clinical
rotation. These modules should align with your course objectives. Students are expected to
complete an assessment for each individual module. Please delete the modules that you will not
be using and leave only the modules (at least four) which you will use during your rotation. You
can preview the modules on our website:
https://my.vanderbilt.edu/globalhealth/travelmed/topical-modules/
Module 1: Overview of health care systems in lower income countries *Required*
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The nature of healthcare in the developing world is rapidly changing. This module explores the
various types of health care systems in lower income countries.
Recommended readings:
 Everybody’s Business: Strengthening health systems to improve health outcomes: WHO
Framework for Action. 2007.
 Chowdhury AM, Bhuiya A, Chowdhury ME, Rasheed S, Hussain Z, Chen LC. The
Bangladesh paradox: exceptional health achievement despite economic poverty. Lancet
2013;382:1734-45. PubMed PMID: 24268002.
Supplemental Activities:
 Create an account with the Global Health eLearning Center and visit their Health
Systems modules, particularly Human Resources for Health (HRH) Basics and
Commercial Private Health Sector Basics.
Module: Infectious Diseases of Global Significance
These sessions will explore issues of importance in the prevention and control of communicable
diseases. The primary foci will be on HIV/AIDS, Tuberculosis, and Malaria as well as neglected
tropical diseases that include but are not limited to soil-transmitted helminthiasis,
schistosomiasis, leprosy, and leishmaniasis.
Video lectures: (developed by Vermund & Wester)
 Dengue Fever, Arenavirus, and SARS
 Rickettsioses, Chaga’s Disease, Echinococcus granulosis, and Liver Flukes
 Malaria, Cholera, Leprosy, and Leishmaniasis
 Schistosomiasis, Filariasis, and Intestial Helminthes
 HIV/AIDS, Tuberculosis, and Endemic Fungi
Required reading:
 Vermund SH, Hayes RJ. Combination prevention: new hope for stopping the epidemic.
Curr HIV/AIDS Rep 2013;10:169-86. PubMed PMID: 23456730.
Supplemental reading to dig deeper:
 Chavers LS, Vermund SH. An Introduction to Emerging and Reemerging Infectious
Diseases. In: Lashley FR, Durham JD, eds. Emerging Infectious Diseases: Trends and
Issues, 2nd Ed. New York: Springer Publishing Company, 2007: 3-24.
 Keiser J, Singer BH, Utzinger J. Reducing the burden of malaria in different ecoepidemiological settings with environmental management: a systematic review. Lancet
Infect Dis 2005;5:695-708. PubMed PMID: 16253887.
 Reingold, A. & Gordon, A. (2011). Infectious diseases. In M. Merson, R. Black, & A.
Mills (Eds.) Global health: Diseases, programs, systems, and policies (pp. 177-232).
Sudbury, MA: Jones and Bartlett.
HIV specific
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Vermund SH, Hayes RJ. Combination prevention: new hope for stopping the epidemic.
Curr HIV/AIDS Rep 2013;10:169-86. doi: 10.1007/s11904-013-0155-y. PubMed PMID:
23456730; PubMed Central PMCID: PMC3642362.
Aizire J, Fowler MG, Coovadia HM. Operational issues and barriers to implementation
of prevention of mother-to-child transmission of HIV (PMTCT) interventions in SubSaharan Africa. Curr HIV Res 2013;11:144-59. PubMed PMID: 23432490.
Lwala- and Vanderbilt-authored articles of interest:
 Andereck JW, Kipp AM, Ondiek M, Vermund SH. Helminth prevalence among adults in
rural Kenya: a stool survey for soil-transmitted helminths and schistosomiasis in Nyanza
province. Trans R Soc Trop Med Hyg. 2014 Dec;108:804-9. PMID: 25359321.
 Peterson, LS, Ondiek M, Oludhe DO, Naul BA, Vermund SH. Effectiveness of a SchoolBased Deworming Campaign in Rural Kenya. J Trop Pediatr. 2011; 57:461-3. PMID:
21212131.
 Riesel JN, Ochieng' FO, Wright P, Vermund SH, Davidson M. High. Prevalence of Soiltransmitted Helminths in Western Kenya: Failure to Implement Deworming Guidelines in
Rural Nyanza Province. J Trop Pediatr. 2009;56:60-2. PMID: 19502602.
Hemorrhagic Fevers
 Peters CJ. Lymphocytic Choriomeningitis Virus, Lassa Virus, and the South American
Hemorrhagic Fevers. In: Principles and Practice of Infectious Diseases (6th edition);
2010, Elsevier; Philadelphia, PA; pages 2090-2098.
 Gates B. The next epidemic – lessons from Ebola. NEJM. 2015; 372;15:1381-1384.
Module: Maternal Child Health and Midwifery
This module focuses on the importance of maternal and child health (MCH) and the disease
burden of reproductive health on the international level. Major causes of maternal, neonatal, and
childhood mortality are explored. The module examines the UN Millennium Development
Goals, the UNFPA’s “State of the World’s Midwifery 2014,” and the critical role of midwives in
MCH prevention. Key MCH indicators in specified nations, recommendations for action, and
additional resources will also be explored.
Video lecture: (developed by Pilkenton)
http://media-srv1.its.vanderbilt.edu/html5/nursing3/streams/_definst_/MCH_1_FA14_voppt.mp4
Required reading:
 Denno, D. Global Child Health. Pediatrics in Review. 2011; 32:e25-38.
 Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic
analysis. Lancet Glob Health 2014;2:e323-33
Supplemental reading to dig deeper:
Maternal health
 Hogan MC, Foreman KJ, Naghavi M, et al. Maternal mortality for 181 countries, 19802008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet
2010; 375:1609-1623.
 Horton R. Maternal mortality: surprise, hope and urgent action. Lancet 2010
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Ronsmans C, Graham WJ. Maternal Survival 1. Maternal mortality: who, when, where,
and why. Lancet 2006;368:1189-1200
 UNFPA. State of the World’s Midwifery 2014. http://unfpa.org/public/home/pid/16021
 United Nations. United Nations Millennium Development Goals. 2013.
http://www.un.org/millenniumgoals/maternal.shtml
 WHO, UNICEF, UNFPA, The World Bank. Trends in maternal mortality: 1990 to 2010.
WHO, UNICEF, UNFPA, and The World Bank Estimates, 2012
Child health
 World Health Organization/The United Nations Children´s Fund: Ending Preventable
Child Deaths from Pneumonia and Diarrhoea by 2025.
http://www.who.int/maternal_child_adolescent/documents/global_action_plan_pneumoni
a_diarrhoea/en/
 UNICEF: Committing to Child Survival: A promise renewed. Progress report 2013
http://www.unicef.org/publications/files/APR_Progress_Report_2013_9_Sept_2013.pdf
Module: Non-communicable diseases
This module focuses on the burden of chronic disease in developing countries. A broad range of
chronic disease and attendant complications are explored with a special emphasis on
cardiovascular disease, hypertension and diabetes.
Video lecture: (developed by Aliyu)
https://freeform.vanderbilt.edu/Video/Includes/Players/Version_1/?id=672
Required reading:
 Hunter DJ, Reddy KS. Non-Communicable Diseases in Global Health. NEJM 2013; 369:
1336-1343
Supplemental reading to dig deeper:
 Ali MK, Jaacks LM, Kowalski AJ, Siegel KR, Ezzati M. Noncommunicable Diseases:
Three Decades Of Global Data Show A Mixture Of Increases And Decreases In
Mortality Rates. Health Affairs 2015;34:1444-1455. doi: 10.1377/hlthaff.2015.0570
 World Health Organization Global Health Status Report on noncommunicable diseases.
2010. Chapters 1, 5, and 6.
Central American-specific reading:
 Cuevas A, Alvarez V, Olivos C. The emerging obesity problem in Latin America. Expert
Reviews in Cardiovascular Therapy 2009; 7:281-8.
Module: Nutrition in Resource-Limited Settings
The Nutrition module covers nutritional issues of particular relevance to developing countries,
including nutrition-related deaths; food security and insecurity; the “Nutrition Transition”;
features of undernutrition and malnutrition; and categories of public health nutrition
interventions.
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Video lecture: (developed by Heimburger)
https://www.nursing.vanderbilt.edu/mp4/voppt.html?filename=VIGH_2_FA12_voppt.mp4
Required reading:
 Global Nutrition Report 2015, Executive Summary and Chapters 1, 2, and 10.
 Imdad A, Sadiq K, Bhutta ZA. Evidence-based prevention of childhood malnutrition.
Current Opinion in Clinical Nutrition and Metabolic Care 2011, 14:276–285
Supplemental reading to dig deeper:
 Black RE, Victora CG, Bhutta ZA, et al. Maternal and Child Nutrition 1: Maternal and
child undernutrition and underweight in low-income and middle-income countries.
Lancet 2013; 382: 427-51.
 Bhutta ZA, Das JK, Rizvi A, et al. Maternal and Child Nutrition 2: Evidence-based
interventions for improvement of maternal and child nutrition: what can be done and at
what cost? Lancet 2013; 382:452-477.
 Ruel MT, Alderman H. Maternal and Child Nutrition 3: Nutrition-sensitive
interventions and programmes: how can they help to accelerate progress in improving
maternal and child nutrition. Lancet 2013; 382:536-551
 Levels and trends in malnutrition. UNICEF – WHO – World Bank Group joint child
malnutrition estimates. Key findings of the 2015 edition.
Module: Pathology and Laboratory Medicine Testing in Low-Resource Settings
Transfusion Medicine is a rapidly developing field in clinical medicine relating to the collection,
transfusion or exchange of blood or blood products in the setting of a broad range of human
medical conditions and illnesses. In resource-limited settings blood is often not readily available
and transfusion facilities may be ill-equipped. This module discusses some of the basics of
transfusion medicine that you are likely to encounter in resource limited settings.
Video lecture: (developed by Eichbaum)
https://freeform.vanderbilt.edu/Video/Includes/Players/Version_1/?id=587
Supplemental reading to dig deeper:
 Owusu-Ofori, S., Temple, J., Sarkodie, F., Anokwa, M., Candotti, D. and Allain, J.-P.
(2005), Predonation screening of blood donors with rapid tests: implementation and
efficacy of a novel approach to blood safety in resource-poor settings. Transfusion, 45:
133–140. doi: 10.1111/j.1537-2995.2004.04279.x
http://onlinelibrary.wiley.com/doi/10.1111/j.1537-2995.2004.04279.x/full
 Abdullah S. and Karunamoorthia, K. (2015). Malaria and blood transfusion: Major issues
of blood safety in malaria-endemic countries and strategies for mitigating the risk of
Plasmodium parasites. Parasitology Research, 1-13.
http://link.springer.com/article/10.1007/s00436-015-4808-1/fulltext.html
Module: Prevention and Treatment Interventions in Resource Limited Settings
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This session focuses on evidence-based as well as potential novel prevention and treatment
interventions policymakers consider when formulating their public health response to the
HIV/AIDS epidemic in sub-Saharan Africa.
Video lecture: (developed by Wester)
https://www.nursing.vanderbilt.edu/mp4/voppt.html?filename=VIGH_9_FA12_voppt.mp4
Required reading:
 Cohen, et al (2011). Prevention of HIV-1 infection with early antiretroviral therapy. N
Engl J Med, 365, 493-505.
 Mathers BM & Cooper, DA (2014). Integrating HIV prevention into practice. JAMA,
312(4), 349-350.
Supplemental reading and videos to dig deeper:
 Aizire J, Fowler MG, Coovadia HM. Operational issues and barriers to implementation
of prevention of mother-to-child transmission of HIV (PMTCT) interventions in SubSaharan Africa. Curr HIV Res 2013;11:144-59. PubMed PMID: 23432490.
 Implementing TB infection control in outpatient settings (CDC)
https://www.youtube.com/watch?v=tsnGi-eLIQc
 In Peru, “elite” AIDS patients boost vaccine research efforts (PBS)
http://www.pbs.org/newshour/bb/health-jan-june10-peru_04-01/ Padian et al., (2011).
Evaluation of large-scale combination HIV prevention programs: Essential issues. J
Acquir Immune Defic Syndr, 58(2), e23-e28.
 Strategies for improving global child survival (CDC)
https://www.youtube.com/watch?v=DOdDhxD6Da4
 Targeting paths to HIV prevention https://www.youtube.com/watch?v=Z69n-BSIsi0
 Wester CW, Bussmann H, Moffat C, Vermund S, Essex M, and Marlink RG. “Adult
Combination Antiretroviral Therapy (cART) in sub-Saharan Africa: Update and Future
Challenges”. Invited review article for Future Medicine; HIV Therapy (2009); 3(5):501526.
Module: Quality Improvement
Q/I in health care and public health will be discussed in this session with a primary focus on
exploring methods to study health system processes and ways to optimize them. Participatory
methods that engage service providers and enhance their capacity to improve service provision
and quality of outcomes is a central theme of this session.
Video lecture: (developed by Ciampa)
http://mediasrv1.its.vanderbilt.edu/html5/nursing3/streams/_definst_/VIGH_1_FA12_voppt.mp4
Supplemental reading to dig deeper:
 Batalden, P. B. and P. K. Stoltz (1993). "A framework for the continual improvement of
health care: building and applying professional and improvement knowledge to test
changes in daily work." Jt Comm J Qual Improv 19(10): 424-452.
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Duncan Neuhauser, P., M. Silvia Myhre, et al. (2004). Personal Continuous Quality
Improvement Workbook. Pages 1-36.
http://gunston.gmu.edu/708/pers_cont_qual_work.pdf
Edwards LJ, Moisés A, Nzaramba M, Cassim A, Silva L, Mauricio J, Wester CW,
Vermund SH, Moon TD. Implementation of a Health Management Mentoring Program:
Year-1 Evaluation of its Impact on Health System Strengthening in Zambézia Province,
Mozambique. Int J Health Policy Manag 2015 Mar 12: 4(6):353-61.
Frenk J. The Global Health System: Strengthening National Health Systems as the next
step for Global Progress. PLoSMed 2010 7(1):e1000089
Module: Water and Sanitation
This session highlights technical capacity requirements needed to provide small and/or
developing communities with clean water and sanitation.
Video lecture: (developed by Vermund)
https://www.nursing.vanderbilt.edu/mp4/voppt.html?filename=VIGH_4_FA12_voppt.mp4
Required reading:
 Curtis V, Schmidt W, Luby S, Florez R, Touré O, Biran A. Hygiene: new hopes, new
horizons. Lancet Infect Dis 2011;11(4):312-21. PubMed PMID: 21453872.
Supplementary reading to dig deeper:
 Food & Agriculture Organization. Rural structures in the tropics: design and
development. Chapter 19 – Water supply and sanitation. 2011.
http://www.fao.org/docrep/015/i2433e/i2433e00.htm
 Gleick PH. Freshwater and foreign policy: new challenges. Great Decisions 2005.
 Tumwine1 JK, Thompson J, Katua-Katua M, Mujwajuzi M, Johnstone N, Wood E,
Porras I. Diarrhoea and effects of different water sources, sanitation and hygiene
behaviour in East Africa. Trop Med & Intl Health 2002;7(9):750-56.
 World Health Organization. Global costs and benefits of drinking-water supply and
sanitation interventions to reach the MDG target and universal coverage. 2012.
Weekly Course Schedule
Outline your weekly course schedule, or learning plan, below. This plan should include a weekly
topic, objectives (from the ones you stated above), content modules (from the list above),
practice, and skills. This plan will guide your learning during the clinical rotation and should
align with your course objectives. (An example learning plan is provided below.)
Week 1: Health care delivery in Jordan
Objectives  Appreciate the different sectors of health care delivery in Jordan
 Identify the manifestations of disease and outline approaches to detecting it in
resource-limited setting
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Content
Modules
Skills
Practice
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Overview of health care systems in lower income countries
Quality Improvement
Pathology and Laboratory Medicine Testing in Low-Resource Settings
Patient intake
Accurate measurement of vital signs
History and physical examination
Start IVs and learn how to set a rate on a manual drip
Participate in psychosocial support mechanisms
Participate in patient education
Clinical Rotations
Week 2: Non-communicable diseases and Cancer
Objectives  Develop an understanding of the growing global problem of NCDs
 Understand the rising burden of global cancers, and infection-associated cancers
 Delineate the molecular epidemiology and pathophysiology of various cancers
Content
 Non-communicable diseases
Module
Skills
 Manage the principal NCDs in the low resource Jordan setting, including
diabetes, hypertension, and COPD
 Contrast cancer control and care in the region with the U.S.
Practice
 Clinical Rotations
Week 3: Maternal Child Health
Objectives  Understand standards for routine antenatal care in Jordan
 Understand the role of antenatal care and health education initiatives
 Review embryonic, fetal, and childhood development principles relevant to
Jordan
 Articulate the epidemiology of MCH morbidity and mortality in Jordan,
contrasted with the U.S.
 Delineate core women’s health issues in the Jordanian context
Content
 Maternal Child Health and Midwifery
Module
Skills
 Take BP and vitals of antenatal moms and weights on babies
 Learn how to record information in the national registers
 Take accurate vital signs of antenatal moms, and weights on babies
 Auscultate using the funduscope, and measure fundal height
 Assist in deliveries of babies
 Understand and assist in community health education activities
Practice
 Clinical Rotations
Week 4: Infectious Diseases
Objectives  Identify the manifestations of infectious disease and outline approaches to
detecting it in resource-limited setting
 Review the virology and pathophysiology of various infectious diseases
Content
 Dengue Fever, Arenavirus, and SARS
Modules
 Rickettsioses, Chaga’s Disease, Echinococcus granulosis, and Liver Flukes
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Skills
Practice
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Malaria, Cholera, Leprosy, and Leishmaniasis
Schistosomiasis, Filariasis, and Intestial Helminthes
HIV/AIDS, Tuberculosis, and Endemic Fungi
Patient intake
Accurate measurement of vital signs
History and physical examination
Start IVs and learn how to set a rate on a manual drip
Participate in psychosocial support mechanisms
Participate in patient education
Clinical Rotations
Emergency Contacts
In the event of an emergency situation and you need assistance, call the Primary VIGH contact.
Primary VIGH Contact:
Dr. Doug Heimburger
Cell phone: 205-790-0871
Home: 615-385-2601
Alternate Primary VIGH Contact (1): Dr. Muktar Aliyu
Cell phone: 615-243-0157
Alternate Primary VIGH Contact (2): Ms. Anne Neubecker
Cell phone: 615-423-3282
Evaluation by Clinical Supervisor
Please provide the following evaluation form to at least two supervisors.
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