Center for Global Health 2018 Travel Grant Finalists Announced

Marissa Di Napoli, College of Medicine
Project: "Oral HIV Self Testing in Tanzania"

While HIV testing rates are fairly high among women in Tanzania due to HIV testing and counseling during antenatal care, HIV testing rates are much lower among men. According to a recent Demographic and Health Survey, approximately 40 percent of men in Tanzania have ever been tested for HIV compared to nearly 60 percent of women. Melissa Di Napoli, a first-year medical student, will travel to Bagamoyo, Tanzania, for a summer research project working with Ifakara Health Institute assessing the impacts of HIV oral self-testing to the male population in the community. The trip will provide a unique opportunity for her to work with a population affected by HIV in both a clinical and research context, and will expand her scope of knowledge of HIV epidemiology and interventions. She will develop an understanding of the public health problems that impact the communities around Bagamoyo, shadow nurses and community health workers at local clinics, and work with staff to develop standard operating procedures for the research study. This experience will allow her to gain experience in real-world clinical and population-based research in a low-income setting. Di Napoli and her colleagues hope to break down the barriers to HIV testing and increase testing rates by offering the option of oral self-testing. Previously, Di Napoli studied at the University of Cape Town and volunteered with an organization working with HIV patients in mobile medical clinics. This experience instilled a desire in her to pursue a career in the field of global health, specifically a career combating the HIV epidemic.

“A primary aim of this internship is to marry my passion for serving HIV populations in low-income countries with the research experience that will give me the technical skill set to impact this public health issue,” said Di Napoli.

Kyle Embertson, College of Medicine, Emergency Medicine
Project: "Masindi Kitara Medical Center Rotation in Uganda"

Medical students often travel to low-income countries for clinical rotations, which provide an invaluable opportunity for cultural exposure and hands-on clinical experience. However, without proper training and preparation, visiting students can place an unnecessary burden on the host institution and staff. Emergency medicine resident Kyle Embertson is traveling to Uganda through One World Health for a one-month rotation at the Masindi Kitara Medical Center (MKMC) – a site many MUSC students visit – to address the potential impact of student visitors on the clinic. Working together with his faculty mentor, he will design and implement a formalized, case-based curriculum that will better train students on basic global health and public health concepts, local epidemiology of disease, and diagnosis and management of non-communicable and infectious diseases. The goal is to improve the quality of the global health rotation for the visiting students, while minimizing any burden to MKMC. Embertson plans to provide case-based learning resources to the Ugandan staff and students to help assist with continuing medical education to local health care workers in the community. He hopes this experience will allow him to recognize the importance of cultural sensitivity in health care and gain hands-on clinical experience caring for patients in a low-resource setting while obtaining insight on education evaluation and curriculum development.

“Following residency, I hope to have as much of an impact globally as I do here in the United States,” said Embertson. “I plan to complete a combined global emergency medicine and ultrasound fellowship, and after training I would like to focus heavily on medical education in the U.S. and abroad.”

Heather “Michelle” Greene, College of Medicine, Pediatrics
Project: "Evaluation of Public Health Intervention for Pediatric Hospital in Arusha, Tanzania"

Pediatric resident Heather “Michelle” Greene is traveling to Arusha, Tanzania, for a one-month rotation at Arusha Lutheran Medical Center (an urban medical center) and the Selian Lutheran Hospital (a community hospital), where she will work in the pediatric wards, caring for and learning about the health care of children in Tanzania. She will assist in the treatment of common but potentially fatal infectious diseases, including typhoid fever, HIV/AIDS, and neonatal infections. She will also enhance her skills in diagnosing malnutrition and child neglect. Greene will collaborate with local health care providers to help evaluate an existing treatment plan focused on malnourished and underweight children. She plans to explore the epidemiology of abuse in Tanzania and identify global health interventions that have been successfully implemented. Greene is nearing completion of the MUSC Certificate in Global Health, making this rotation an even more valuable opportunity to strengthen her skill set and learn firsthand about malnutrition and infectious diseases that are not as commonly seen in the United States. Greene is pursuing a dual fellowship in pediatric emergency and child abuse, and hopes this experience allows her to gain a deeper understanding of the health care issues facing resource-constrained communities.

“Approaches to children with acute illnesses have a radically different methodology in Arusha, and experiencing those differences will directly inform my medical practice as a pediatrician, child abuse specialist, and emergency department attending physician,” said Greene. “Knowing that I was able to give back to a global community during residency will be one of the most rewarding aspects of my training at MUSC.”

Sydney Hammond, College of Health Professions
Project: "Promoting Haitian Rehabilitation Autonomy"

Many Haitians with disabilities struggle to perform simple daily life activities, are stigmatized within their own communities, and lack access to rehabilitation services due to the limited number of specialists in Haiti. To tackle this disparity, the Faculte des Sciences de Rehabilitation de Leogane (FSRL) recently formed a rehabilitation department to offer occupational and physical therapy educational programs in-country. Sydney Hammond, a physical therapy student, will return to Haiti for a second time this year to work with FSRL to enhance its current curriculum with the goal to gain accreditation through the World Confederation of Physical Therapy (WCPT). Hammond will teach portions of the musculoskeletal curriculum, evaluate the current rehabilitation curriculum at FSRL, and compare the material currently being taught with the requirements for international accreditation. Her prior experience and familiarity with the culture of Haiti and the existing program will be influential as the team performs a needs assessment to better understand the roles rehabilitation specialists will need to fulfill in Haiti. This will allow the team to make recommendations about how to improve the curricular content and design to better meet the specific needs of patients in Haiti. Through this project, Hammond will gain knowledge about the barriers patients face in low-resource settings and develop the skills that will allow her to be a more effective clinician in primary care settings both in the U.S. and abroad.

“Several of the students at FSRL and their families were directly impacted by the natural disasters that have so severely affected Haiti recently, yet the students recognize the opportunities that their education will bring,” said Hammond. “Their motivation and drive to learn how to best help others altered my own perspective of the field of physical therapy and my future career path.”

Lex Hanna, College of Medicine, Orthopaedics
Project: "South Carolina Orthopaedic Association Mission Trip in Haiti"

Lex Hanna is traveling to Haiti through the South Carolina Orthopaedic Association’s Global Resident Education Initiative, a program designed to promote the global training of South Carolina orthopedic residents and support the training of Haitian orthopedic residents. He will spend his time at two partner hospitals: Hôpital de la Paix, a 150-bed teaching hospital located in the capital, Port-au-Prince, and Hôpital Lumière, a 120-bed missionary hospital located in Bonne Fin, where he will work with medical staff to provide orthopedic clinical care and consultations to inpatients and outpatients. This program will allow Hanna, a fourth-year orthopedic resident, to gain the cultural experience of interacting and caring for patients in a foreign country, learn from local orthopedic medical staff in-country, and enhance his understanding of the health care issues and needs in the local community. Prior to this trip, he will dedicate a significant amount of time studying the culture and customs and creating educational lectures and case presentations on key orthopedic procedures for discussion with local clinicians. He will benefit from the opportunity to see rare and unusual orthopedic conditions while gaining exposure to practicing in a limited resource setting. Hanna is eager to understand how cultural practices and beliefs impact the presentation and treatment of medical conditions and become better educated on environmental and social factors, such as alternative health practices, socioeconomics, and family dynamics, that influence care in low-income countries.

“Through this experience in a medical trip to Haiti I hope to gain the necessary experience and expertise to turn this into a lifelong pursuit of service and dedication to those less fortunate,” said Hanna.

Jennifer Hunnicut, College of Health Professions
Project: "A Medical Mission to Guatemala: Establishing Connection and Evaluating its Impact on Guatemalan and Mayan Health"

Jennifer Hunnicut is traveling to San Pedro La Laguna, Guatemala, a remote village three hours from Guatemala City, through the Diocese of Charleston. The diocese has sponsored mission trips to this region over the last ten years to provide health care to the Guatemalan and Mayan people. One of Hunnicut’s goals is to evaluate the impact of these missions by analyzing the number of patients and types of conditions treated over the years, as well as interviewing health care workers to gain qualitative data on the impact of the mission on health care delivery in San Pedro and its surrounding villages. Many of the Guatemalan people face significant knee pain due to heavy manual labor in the fields and suffer from a number of orthopedic and musculoskeletal problems. As a board-certified athletic trainer, Hunnicut is well-positioned to work with local providers and patients to address the prevention and rehabilitation of injuries – including teaching proper ergonomics to improve knee health and to help individuals recover from knee pain. Her clinical background, combined with her current research as a student in the Health and Rehabilitation Science program, align well with the work she will be doing in Guatemala. She hopes to connect her clinical and research experiences to a greater cause that will not only result in personal development but also expand her ability to teach future generations of health care providers.

“The global health travel grant will provide me with an opportunity for career development in the following ways: growth as an athletic trainer, experience for my future faculty position, and early exposure to global health research,” said Hunnicut. “It will serve as the foundational experience to always remind me the importance of utilizing my education and training to serve others who are less fortunate.”

Virginia Lesslie, College of Medicine
Project: "HIV Oral Self-testing Research in Bagamoya, Tanzania"

According to AVERT, in 2016, 1.4 million people were living with HIV in Tanzania. In the same year, 55,000 people were newly infected with HIV, and 33,000 people died from an AIDs-related illness. Virginia Lesslie is traveling to Bagamoyo, Tanzania, for a summer internship where she will be working with Ifakara Health Institute (IHI) assessing the impacts of HIV oral self-testing on the male population in the Tanzanian community. This trip will provide Lesslie, a medical student, the opportunity to work with a male population affected by HIV and identify aspects of the Tanzanian culture that facilitate or obstruct HIV self-testing and treatment. She will gain insight into the specific health needs in the Bagamoyo community in both a clinical and research setting, and observe a community-based research intervention that addresses a preventable and treatable infectious disease. She will shadow nurses and community health workers at local clinics, work with staff to develop standard operating procedures for the research study, and gain experience in data collection and management in a low-resource setting. Previously, Lesslie studied in Tanzania where she had the opportunity to immerse herself in the Tanzanian culture and learn Swahili, the local language. Her prior experience in Tanzania and familiarity with the culture will help her gain a better understanding of the barriers to HIV testing and potentially increase testing rates by offering oral self-testing in underserved areas.

“My life goal for this internship is to expand my research skillset and integrate these skills into my passion for global health. Working in a village community addressing sensitive health topics like HIV status requires finesse and a high-level cultural competency that I hope to acquire during my internship,” said Lesslie.

Mariah Ramsey, College of Health Professions
Project: "Text Message-Based Health Education in Uganda"

The use of mobile phones in low- and middle-income countries is growing rapidly, making way for them to increasingly be utilized as a part of community health interventions in developing countries. Studies have shown that mobile interventions can reduce barriers to care - such as long distances and lack of access - while making better use of existing but limited human resources. Mariah Ramsey, a student in the Physician Assistant program, will spend her women’s health rotation in Masindi, Uganda, with One World Health as part of a team working on a text message-based health program to help educate the local community on preventive health measures. The team worked in partnership with Masindi’s community-based health educators, who provide services in their local communities, to develop health education content around two key issues: prevention of malaria for prenatal mothers and diabetes prevention and management. Ramsey will train the health educators to use a web-based portal to disseminate customized text messages to patients, which will educate participants on lifestyle changes, preventive strategies, and motivational reminders prior to the health educators' home visits. This project has the potential to set the stage for a long-term telehealth program that could improve the efficiency and outreach of health care service delivery to rural communities in Uganda. During her time in Uganda, Ramsey hopes to identify the barriers to telemedicine and gain a better sense of which populations will most benefit from telemedicine education.

“The telemedicine project will allow me to see how the education aspect of telemedicine can be implemented in my future practice,” said Ramsey. “I will need to adapt the project to fit the needs of the community, just as I will need to adapt my practice to my future patients and their specific needs.”

Gerald Roettger, College of Health Professions
Project: "reCycled"

According to the Wheelchair Foundation, an estimated 109 million people in developing countries need wheelchairs, though less than 10 percent of people who require a wheelchair have access to one. Affordability is one of the many barriers that prevent individuals in low-income countries from accessing mobility devices. As a result, many countries rely on charitable donations of wheelchairs, which are often unsuitable for the physical environment. In addition, local maintenance and repair are in short supply, making this an unsustainable solution. Gerald Roettger, a physical therapy student, is traveling to Masindi, Uganda, through One World Health, where he will have a unique opportunity to address this gap by developing a manual wheelchair using locally sourced scrap materials such as metal and plastic pipes, bicycle parts, wood, and welding equipment. As a Navy veteran who has served as a nuclear engineer and mechanist mate on an aircraft carrier, Roettger is no stranger to challenging engineering projects and recognizes the importance of collaboration. He will work with Clemson engineering students to improve the wheelchair model, collaborate with the local community to create training manuals, and provide workshops on the maintenance of the wheelchairs. The experience of developing a device from limited materials in a low-resource setting will be instrumental in enhancing Roettger’s problem-solving and critical thinking skills. This intervention has the potential to impact mobility in the Uganda region, and in the future, Roettger hopes to create a nonprofit organization to educate others in designing appropriate mobility devices for rural settings.

“Every patient is different because every person is different. Learning how to communicate and educate Ugandan patients and health providers in an unfamiliar language would build my communication and instructional skills,” said Roettger. “I would love to think that in the future, I am able to support the manufacturing of wheelchairs in Uganda for individuals with disabilities.”

Taylor Ross, College of Health Professions
Project: "Educational and Evaluation Resources for Haitian Rehabilitation Program"

According to the World Health Organization, approximately 10 percent of Haiti’s 10.2 million residents have a disability. There is no shortage of need for rehabilitation services in Haiti – a gap that became quite evident after the 2010 earthquake left an increased number of Haitians disabled. To address the lack of professional training for rehabilitation providers in-country, the Faculte des Sciences de Rehabilitation de Leogane (FSRL) recently formed a Rehabilitation Department to offer a four-year degree in physical and occupational therapy in Haiti. Taylor Ross, a physical therapy student, is part of a team at MUSC working with FSRL to enhance its curriculum to meet the international standards of the World Confederation of Physical Therapy. She has prior experience in Haiti and familiarity with the culture and existing program needs, which will be instrumental as she develops educational resources to address different learning styles and to aid FSRL faculty with a method for standardized student evaluations. Tools include a video demonstrating musculoskeletal skills and techniques, resources for learning outside the classroom, and a grading rubric for exams. She aims to provide physical therapy knowledge framed in a way that fits the Haitian culture, taking people’s occupations, common musculoskeletal injuries, beliefs, and views about the medical field into consideration. This experience will allow Ross to develop a greater understanding of the demands placed upon rehabilitation professionals and the educational needs of students in low-income countries where language and cultural barriers play a significant role.

“I have a passion for people and a desire to help people, something you typically hear from a prospective or current graduate student in the medical field,” said Ross. “But my passion extends to a passion for diversity and an appreciation of learning from people as well as teaching people who are different than myself.”

Noah Trump, College of Medicine
Project: "Christian Fellowship Hospital Observational Program"

Noah Trump is traveling to India for a one-month rotation at Christian Fellowship Hospital (CFH), a community teaching hospital located in Oddanchatram, a town in the Tamil Nadu region of India. There, he will gain insight into the local health care needs and management of a wide range of patients in a low-resource area. This program will give Trump, a first-year medical student, exposure to a variety of cases that are not as commonly seen here in the United States, such as snake bites, rashes, thalassemia, and infectious diseases. He will learn how physicians in different clinical settings provide high-quality care with limited resources. Shadowing the local health care team during patient ward rounds, outpatient clinics, and in the operating theater, he will develop an appreciation for the barriers to health care in low-income countries and better understand how culture and beliefs affect patient care in India. Trump plans to visit CFH’s village health outreach base centers, where he is interested in comparing their provision of health to more rural, remote communities with MUSC’s telehealth efforts providing care in underserved areas in South Carolina. Most importantly, this opportunity will give him a first-hand experience of medicine in a developing country and reinforce his continued desire to focus on community health and outreach to vulnerable populations during medical school and as a practicing physician.

“This experience is a place where passion for medicine intersects a desire to serve,” said Trump. “It offers me exciting clinical work in a variety of fields, a focus on care for the poor, and community health outreach, all while immersing myself in an unfamiliar culture. This program provides a unique chance for me to learn and grow.”

Christopher “CJ” Seitz-Brown, College of Medicine, Psychiatry and Behavioral Sciences
Project: "Tailoring Counseling for Non-Communicable Diseases in Kisaware, Tanzania"

Christopher “CJ” Seitz-Brown, a resident in MUSC’s clinical psychology program, is traveling to Kisarawe, Tanzania, where he will help develop and implement a counseling intervention for diabetes and hypertension as part of a larger NIH study assessing the integration of non-communicable diseases (NCDs) and HIV screening. He has worked with the research team to translate and code the first set of qualitative interviews with individuals who previously received counseling for diabetes and hypertension. The next step is to conduct and code the second round of qualitative interviews with community members who have not received any counseling to obtain their feedback on the intervention. The interviews are designed to gather feedback on participants’ lifestyle habits and their views on counseling for diabetes and hypertension. This data will inform the development of a protocol for NCD counseling that will be used by local providers as part of the larger trial. While in Tanzania, Seitz-Brown will train the staff on qualitative interview techniques through role-playing and work with the local counselors to implement the adapted intervention. Through this research study, he will enhance his skills in adapting an intervention based on qualitative feedback, providing guidance to counselors on implementation of the intervention, and establishing relationships with in-country staff and collaborators. This project is a natural fit for Seitz-Brown, who lived in Tanzania for several years and had the opportunity to immerse himself in the culture and become fluent in Swahili, the local language. His prior experience will be invaluable to developing culturally informed counseling for NCDs in Tanzania.

“Traveling to participate in this important research would jumpstart my progress toward establishing a career as a clinical scientist focused on reducing the impact of HIV and substance use in international contexts including Tanzania,” said Brown.

Nicholas Valencic, College of Health Professions
Project: "Injury Prevention and Wound Care Maintenance in Uganda’s Rapidly Motorizing State"

Nicholas Valencic’s project focuses on the growing global health threat of road traffic injuries in low- and middle-income countries. Due to Uganda’s rapid urbanization and motorization, road traffic accidents (RTA) are a major source of trauma, often proving fatal. Many patients in rural areas fail to receive immediate care due to a lack of access or transportation. Valencic, an occupational therapy student, plans to address these barriers by developing patient-friendly educational materials related to the prevention of RTA and wound care management. He will create a short, four-page packet consisting mostly of pictures and short phrases in the local languages, highlighting common preventive measures, such as helmet use, as well as various stages of wound healing and when to seek medical attention. The innovation of using this educational tool will help patients with limited health literacy achieve a deeper comprehension of traffic safety and wound care management. He will travel to Masindi, Uganda, this summer with the nonprofit One World Health to see if this tool can provide patients with more effective training to address and prevent road traffic accidents. Valencic hopes that the basic education of helmet safety, water purification, and wound care management can help decrease mortality rates from trauma in rural areas. This experience will enhance his ability to address risks and injuries in community settings. In addition, he will gain a deeper appreciation about health literacy as it relates to underserved populations and the importance of matching the educational information within the context of the individual’s cultural sensitivities and literacy abilities.

“The thought of being able to help someone who may not otherwise receive medical care, or just the basic education of care, lights a fire in my soul,” said Valencic.

Joseph Wortkoetter, College of Medicine
Project: "Medical and Dental Expedition to Pangi Valley with Himalayan Health Exchange"

Joseph Wortkoetter is traveling to Pangi Valley, a rural village in India, with the Himalayan Health Exchange (HHE), a nongovernmental organization that provides health care to underserved populations in remote areas of the Indian Himalayas and Indo-Tibetan Borderlands. As a first-year medical student, Workoetter will have a unique opportunity to learn how to function as part of a large mobile medical team in a challenging environment, while developing clinical skills in a rural area with limited supplies and technology. He will gain exposure to various diseases and ailments, such as vitamin and nutrient deficiencies, tuberculosis, and altitude sickness that are prevalent in Pangi Valley but uncommon in the U.S. Having visited the Himalayas before, Wortkoetter is aware of the many hardships the local community faces on a daily basis. This trip will allow him to build on his previous experience, observe the necessary skills to provide health care to rural populations and provide a better foundation to understand the interaction between health, social, cultural, and environmental issues. During his time in Pangi Valley, Wortkoetter hopes to learn more about the sustainability of short-term health care expeditions, gain a better understanding of the barriers patients and health care providers face in underserved areas, and develop increased confidence in patient interviewing skills. As a member of the Health Professions Scholarship Program with the U.S. Air Force, he plans to utilize these skills to participate in military humanitarian efforts in the future.

“I hope to gain a better perspective on the hurdles that rural and under-resourced patients face when obtaining health care,” said Wortkoetter. "Despite being a unique region of the world, I feel that many of the lessons I learn from these patients will be able to be applied to our under-resourced population domestically."

Bianca Villalobos, College of Medicine, Psychiatry and Behavioral Sciences
Project: "Training a Direct Care Team to Manage Trauma Symptoms in a Honduran Group Home"

Mental health problems affect 10 to 20 percent of children and adolescents worldwide. Addressing youth mental health care needs is of particular importance in Honduras, where 35 percent of the population is under the age of 15. Bianca Villalobos’ project will take place in a youth group home in San Buenaventura, Honduras, where she will work with The Lamb Institute to develop a training program to improve youth mental health care. She will conduct interviews via videoconferencing with the group home’s direct care staff (non-mental health care professionals), which will inform the team as it develops an in-person training to teach staff about trauma and how to manage problematic behaviors resulting from traumatic experiences. The ultimate goal of the training is to provide the direct care staff with the resources and skills to manage crises, behavioral difficulties, and other stressors, and reduce staff turnover at the group home. Villalobos, a resident in the Department of Psychiatry & Behavioral Sciences, looks forward to conducting research that takes place within a cultural framework and addresses the influence of social disparities on mental health. Being of Mexican descent, she credits her experiences navigating a bicultural world for fueling her interest in understanding how culture impacts help-seeking behaviors and mental health.

“The skills I acquire during the proposed service project will aid me in developing the tools necessary to address mental health issues for Latinos abroad and in the United States,” said Villalobos. “This travel grant will ultimately support my career development goals of becoming a cross-cultural independent researcher that contributes to ameliorating health disparities for Latinos around the world.”