International programs promote global view of medicine

By Ruth SoRelle, M.P.H.

International Track

Perhaps Meena Murti, M.D., a pediatrics resident at Baylor College of Medicine, best describes the rationale for the International Track in the BCM curriculum.

"It's strange going through medical school and not knowing what kinds of diseases strike most of the people in the world," she said. "The International Track is a world spin on medicine rather than just what we see in our own developed nation."

She and a few others in the International Federation of Medical Students at BCM were looking for the opportunity to learn about those global afflictions by studies in other countries (called clinical rotations). They were not the first, and the International Track was approved while they were still in medical school.

"We were fortunate," she said.

Rigorous training

A. Clinton White, M.D., professor of medicine in the division of infectious diseases, credits interested students with sparking the push toward an international track. Their interest resulted in formation of a committee under the leadership of Stephen Spann, M.D., chair of family and community medicine at BCM.

"Instead of just providing them the opportunity to travel and do an overseas elective, we decided to set up a rigorous program of training," White said. "We decided to integrate the international health track so that students who completed it would have qualifications equivalent to those gained in graduate training."

Those who completed the program could take the certification examination given by the American Society of Tropical Medicine and Hygiene – making Baylor College of Medicine the first medical school in the nation to offer its medical students that possibility.

Program history

The program started with two directors – White and Dr. Bob Parkerson, associate professor of family and community medicine. Parkerson is president of the Baylor Shoulder-to-Shoulder Foundation, a project of volunteers that promotes public health and the provision of health services for underserved people in the area of Santa Ana, Intibuca, Honduras.

In the first year, students take an introductory course in the area of international medicine, and the second year involves a reading course. It gets tougher in the third and fourth years, with a month-long intensive course in tropical medicine, said White.

"By the end of that course, students have more expertise in tropical and infectious diseases than the typical infectious disease specialist," said White. "Students will tell you that the course is a little like drinking from a fire hydrant. Our first three graduates who took the ASTMH examination and all passed it, compared to a national passing rate of about 65 percent."

The classes have grown since the first group finished in 2004. In the past year, 11 of the graduating class successfully completed the international track.

"It's very hard," White said. Some students drop out, but at least half of the first year classes take the introductory course, giving them a taste of international health.

Track attracts top students

"A number of top students will tell you that they come to Baylor because of the International Track," he said.

Their reasons vary.

"The largest group is students who are first or second generation immigrants," he said. "They are interested in the health problems in their land of origins. A second group has a missionary focus that is largely driven by religion. They want to help in the poor areas of the world. Another group is interested because they want to travel."

The students go into as many types of residencies as there are medical specialties – although few go into hospital-based areas such as radiology or pathology.

White credits many on the faculty with helping to push international efforts. Steve Abrams, M.D., and David Hilmers, M.D., at the USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine and Texas Children's Hospital, are actively involved in international studies as are Spann and Parkerson. Dr. Herbert DuPont, a founder of the field of tropical medicine, has also played a critical role.

The work of Mark Kline, M.D., director of the Baylor International Pediatric AIDS Initiative has garnered wide recognition. Wendy Keitel, M.D., associate professor of medicine and director of the BCM Vaccine Treatment and Evaluation Unit, has done work on typhoid vaccines as well as vaccines against influenza, including the avian strains now being monitored worldwide. White himself works with a number of parasitic infections found in foreign lands.

Halt brain drain

White hopes that the program also can help halt the scientific "brain drain" seen in a number of developing countries.

"I got the idea we should partner with Peru to develop research opportunities for their scientists back home," he said. "They could come here to receive training and then go back."

With a training grant in global infectious disease research funded by the federal Fogarty International Center, White set up a partnership with Universidad Peruviana Cayetano Heredia. Three trainees are in the program. All have returned to Peru with their expertise. Two have obtained funding for their own research and the third is working toward that goal.

HIGHER

There are a variety of international projects at BCM, and White said many are available for students seeking to develop their skills. A new initiative looks beyond BCM and involves a partnership with The University of Texas School of Public Health and its new global health emphasis.

The Houston Initiative for Global Health Education and Research builds on the international programs at both institutions with funding from the Fogarty International Center to provide funding for short-term fellowships to provide students with experience in doing international research.

White said the goal of the program is to interest young physician-scientists in global health research. Already 10 trainees – among them four BCM medical student and one BCM resident – along with five UT School of Public Health trainees are funded to pursue health work in Mexico, Peru, Gambia, Tanzania and Sri Lanka. His co-director for the program at the School of Public Health is Beatrice J. Selwyn, Sc.D.

Student plans

Murti's family is from India, and she did her five-week clinical rotation in an HIV clinic in India. She hopes to go back some day and use her expertise to help people there.

Jordan Whitman, M.D., also a resident at BCM, worked with the Shoulder-to-Shoulder project in Honduras and will work on a research project in Peru next year.

Much of what the volunteers did was help build a public health infrastructure. They also staffed a small clinic that dealt with common health problems – dehydration, headaches, back pain, intestinal parasites.

"It was a great experience. There was almost no one we could not do something for with the pharmacy we took down there," she said. She and some other volunteers designed a questionnaire designed to start a community dialogue on a variety of issues such as substance abuse and domestic violence.

In a series of community chats, she said she was amazed at how eager the women were to become educated about their own health.

"That community is motivated to improve itself," she said. "Listening to them tell their stories. That sticks with me."

So does her training. Whitman, like many of her colleagues, plans to continue taking health care to people around the world.