Christy Boraas Alsleben
University of Minnesota Medical School
The Future of Emergency Contraception Access: Patient and Future Provider Perspectives from Guatamala and the United States

Despite the nearly universal commitment to the issue of reproductive health the ability of a woman to choose the number and timing of her pregnancies, nearly 40% of the 205 million pregnancies that occur each year are unplanned. Between the years of 1995 and 2000, nearly 700,000 women died from causes related to unplanned pregnancies. Of these 700,000 women, 400,000 died as a result of complications from unsafe abortions. Emergency contraceptive pills (ECPs) are a method of contraception that can significantly reduce the number of unplanned pregnancies. Ms. Alsleben used her Fellowship to survey knowledge, attitudes, and practices related to emergency contraception of future health care providers in the United States and Guatemala. She discovered that while 97% of the medical students surveyed in the United States had heard of ECPs, only 51% of the medical students surveyed in Guatemala were familiar with this birth control method. Ms. Alsleben, through her research, has determined that medical students, no matter what country they live in, must receive accurate scientific information regarding emergency contraceptive pills. Speaking of her experience in Guatemala, she says, “We, as a global community, need to target the conditions that undermine women’s abilities to make the best choices for their health and the health of their families.”

Ashita Satish Batavia
Weill Medical College of Cornell University
Field Evaluation of the Acceptability to Health-Care Providers of Using Rapid Syphilis Diagnostics

Ms. Batavia used her Rogers Fellowship for two different projects in Haiti. The first project examined the application of rapid syphilis diagnostic tools and the second examined the high occurrence of rape in Port au Prince. Ms. Batavia conducted individual and small group interviews with 23 health care providers to survey the best use of the rapid syphilis diagnostic tool (RST). While working on the RST study at GHESKIO (a non-governmental organization dedicated to voluntary counseling and testing for HIV/AIDS), Ms. Batavia also worked with rape victims who were sexually assaulted between June 2000 and June 2005. She discovered that just after the departure of President Aristide, the long-time President of Haiti, the number of rape victims increased three-fold. Through her research, Ms. Batavia links the political turmoil in Haiti to the higher than average number of rapes. While Ms. Batavia’s time in Haiti was filled with anxiety and fear, it served to remind her of her intentions post-graduation. “My brief time in Haiti strongly reaffirmed my desire to live and work in the Third World once I complete my residency. The particular challenges of politically unstable countries hold strong appeal for me.”

Emma Ester Bendana
Albany Medical College
Evaluation of Systemic Lupus Erythematosus (SLE, lupus) in Nicaraguan Women

Systemic lupus erythematosus (lupus) is an autoimmune disorder with a wide range of symptoms. It can manifest itself as a mild dermatological disease, through pain in the bones and joints, or through life-threatening organ failure. Recognizing that lupus is more prevalent and severe in Hispanic populations, especially among women ages 20-30, Ms. Bendaña used her Fellowship funds to study lupus in Nicaragua. Her project was two-pronged: to study the Nicaraguan public’s knowledge of the disease and to conduct a retrospective case-control study that looked for risk factors that may have contributed to pre-term deliveries in lupus patients. She discovered that 25% of the respondents in her public knowledge study had never heard of lupus and of those who had, none had been educated about the disease through a medical professional. Because most information about lupus is provided by general media sources and people who are not in the medical profession, Ms. Bendaña believes that public education regarding lupus must be improved. Her study of pre-term deliveries among women with lupus in Leon, Nicaragua found that one of the greatest risk factors for having a pre-term delivery is receiving a lupus diagnosis after pregnancy (when compared to those women who received their lupus diagnosis before becoming pregnant). She says the following of her time in Leon, “My study provided the Leon clinic with an instrument to focus their educational, fundraising and clinical efforts. Overall, this study has not only sparked my interest in women’s health, but it has also reminded me of the importance of taking into account the social as well as medical components of a disease.”

Gina Marie Clark
University of Iowa College of Medicine
The Impact of Migration on HIV Vaccine Development in the Western Cape, South Africa

In late 2005, a phase I HIV vaccine trial was scheduled to begin in Masiphumelele, a township located 25 miles south of Cape Town, South Africa. There is significant migration in South Africa due to a number of issues including rapid urbanization, unemployment, and refugees from surrounding countries. Ms. Clark conducted a study of 24 Masiphumelele residents prior to the beginning of the clinical trial to better understand migration patterns in the township. She found that while every participant in her study had moved at least one time in his/her life, no one anticipated moving away from Masiphumelele. Most of the participants reported having secure employment in Masiphumelele, which is the main determinant in whether or not a person migrates. A large percentage of the study participants said that HIV had a big impact on their lives and they (or the community at large) would be interested in participating in the vaccine trial. Speaking of her experience in South Africa, Ms. Clark says, “I learned a vast amount this summer about HIV, South Africa, the interplay between society, politics, and health, how privilege or the lack thereof is often a function of a number of things outside of one’s control, and how this has direct ramifications for so many aspects of one’s life, not least one’s health.”

Rishikesh Prudip Dalal
Washington University School of Medicine
Documenting the Incidence of Acute Primary HIV Infection (PHI) within Various Risk Groups in Johannesburg, South Africa

Primary HIV infection (PHI) is the time period between when a person first becomes infected with HIV and when a HIV test comes back positive. Primary HIV infection typically lasts two months. During this time the virus is very active and there is a higher probability of passing it on to uninfected individuals. The reduction of transmission increases significantly with early detection of PHI. Unfortunately, PHI is rarely diagnosed in sub-Saharan Africa despite high incidences of HIV. Mr. Dalal used his Rogers Fellowship to support two months of research in Johannesburg at the Esselen Street Clinic. He developed a screening tool that would gather information about the signs and symptoms of PHI. Patients who were found to have symptoms of PHI but did not test positive for HIV were counseled about their status and asked to come back to the clinic for a follow-up visit which would either confirm or deny the presence of HIV. Mr. Dalal is hopeful about the work that he did in Johannesburg, saying, “It is too soon to tell, but hopefully the combination of the questionnaire with counseling and follow-up visits for suspected PHI will allow identification of patients who are in the acute, highly virulent phase of HIV infection.”

Alissa Detz & Hemal Kanzaria
University of California, Irvine School of Medicine & University of California, San Francisco School of Medicine
Improving Epidemiologic Surveillance of HIV/AIDS in San Lucas Sacatepequez, Guatemala

The Global AIDS Project of the Center for Disease Control and Prevention (GAP/CDC) is working to expand HIV/AIDS monitoring in countries across the world including Guatemala where the public health impact of HIV/AIDS remains largely an unknown. Ms. Detz and Mr. Kanzaria collaborated with GAP/CDC to create an electronic system to be used in the Hospicio San Jose to enter patient data and analyze patient information. Using the charts of 41 in-patient children at the hospice facility, Ms. Detz and Mr. Kanzaria created an electronic data entry system with the intention that it be implemented throughout the entire facility. Use of an electronic system will have many benefits, including easier updating of patient information, the ability to find specific data rapidly, and the sharing of patient data with the CDC which will improve HIV surveillance in the country. Speaking of their work in Guatemala, they say, “This project serves as an important initial step in improving HIV surveillance efforts in Guatemala. Further analysis of Hospicio San Jose patient information will help elucidate trends in disease transmission and guide future intervention strategies.”

Elnaz Firoz & Lauren Wasson
Columbia University College of Physicians and Surgeons
Prevention of Mother-to-Child Transmission at Salud Publica in La Romana, Dominican Republic: Programmatic Needs Assessment and Planning for Improvement

Using prior research compiled by former Rogers Fellows, Ms. Firoz and Ms. Wasson addressed the underutilization of voluntary and confidential testing (VCT) by Haitian women living in the batayes of La Romana, Dominican Republic. Batayes are sugarcane field-worker villages where many Haitians reside. Voluntary and confidential testing has been shown to effectively reduce the transmission of HIV from mother to child. Working with a local physician, Ms. Firoz and Ms. Wasson developed a pilot program to improve Haitian women’s utilization of VCT. The pilot program also sought to increase the use of other services provided by the Mother to Child Transmission program, such as the use of anti-retroviral treatment during childbirth and cesarean sections. The pilot program went into effect in the fall of 2005 and Ms. Firoz and Ms. Wasson plan on returning to La Romana in the next year and a half to help with both the implementation and the improvement of the program. Working in the Dominican Republic, particularly in the batayes, gave Ms. Firoz and Ms. Wasson a firsthand look at the factors that influence care. They said, “While setting up a day-long clinic in a church in the batayes, we were struck by the community’s response. More than 200 people in the small community signed up to be seen by a doctor because they worried that the doctors would not return in the near future. It was an important realization that we cannot simply practice medicine, we must deliver it.”

Michael Gee
Emory University School of Medicine
Effects of Rapid Response HIV Testing on Risky Sexual Behavior in MSM Youth

Mr. Gee initiated his research on the prevalence of HIV in the men who have sex (MSM) community with the assumption that sex education was the primary preventative measure in curbing the recent increase of HIV infection on the community. However, after analyzing the results of earlier studies done in the San Francisco MSM community, he discovered that the participants showed high levels of awareness of HIV prevalence, modes of transmission, and disease course. Deciding, instead, to focus on the long-term factors of why the MSM community continues to expose themselves to high-risk situations such as having sex without a condom, Mr. Gee chose to study the self-esteem issues among members of the MSM community. One area of focus was the high rate of unemployment among HIV infected participant. His determined that lack of self-esteem is a major barrier to gaining employment even though many of the men expressed an interest in working. Through interviews with 20 men of the MSM community, Mr. Gee discovered that a large number of the men left their jobs after receiving their HIV diagnosis for a variety of reasons including being forced out of the workplace and making a personal decision to leave because of the negative stigma surrounding their infection. Recognizing the many benefits that employment can have for HIV positive people, Mr. Gee suggests that cities devote more resources to the development of vocational rehabilitation programs. He is personally committed to such a cause, saying, “I aspire to eventually build upon the work I’ve done this summer to evaluate existing HIV vocational rehabilitation programs and, ultimately, design improved programs to assist people with HIV/AIDS seeking employment.”

Mary Ellen T. Gilder
Albany Medical College
Health Needs Assessment of Internally Displaced Persons in Karen State, Burma

Internally displaced people (IDP) are defined as refugees who cannot seek asylum in another country or do not have access to protective infrastructure such a refugee camp where they are protected by a neutral force (such as UN peacekeeping forces or regional peacekeeping armies). They are often the most medically underserved populations in the world. Burma has the second highest number of IDPs in the world with members from the Karen ethnic minority making up a largest percentage of the IDP population. Ms. Gilder used her Rogers Fellowship to develop Vitamin A and anti-parasitic programs for internally displaced, ethnic Karen children. The combination of Vitamin A and anti-parasitic treatments has been shown to reduce morbidity and mortality caused by diarrhea, anemia, and acute respiratory infections. With the help of local editors and medics, Ms. Gilder created a packet of resources in the Karen language that can be used in the upstart of vitamin A and anti-parasitic programs. Speaking of her experience in Burma, she says, “Since returning to medical school, I have continued to be in touch with the staff in Thailand and have worked to raise awareness of the plight of the Karen in Burma at my medical school. I have published a short story in the student newsletter about sacrifices made by Karen medics and presented this project in a poster at our Student Investigations Day. I am also actively investigating long-term sources of support for the future costs of maintaining this project and have hopes of doing a follow-up trip sometime this year.”

Katie Greenzang
Columbia University College of Physicians and Surgeons
Immune Reconstitution Inflammatory Syndrome (IRIS) in Sequential as Compared with Integrated Treatment in Patients Co-Infected with HIV and Tuberculosis in Durban, South Africa

South Africa has over 5.3 million HIV/AIDS infected people, making it the country with the highest rate of HIV in the world. In addition to the HIV epidemic, there is also a tuberculosis (TB) epidemic with 2 million adults co-infected with both HIV/AIDS and TB. Immune Reconstitution Inflammatory Syndrome (IRIS) causes deterioration in health among HIV positive patients after anti-retroviral treatment has begun. Through a retrospective patient chart review of suspected IRIS cases, Ms. Greezang confirmed earlier studies that showed a link between a previous history of TB and an increased risk of IRIS. Recognizing the effects that TB has on the efficacy of HIV treatment, Ms. Greenzang moved on to a different project where she investigated the success of re-treatment for those patients who have recurring cases of TB. The re-treatment protocol for TB, which involves adding Streptomycin to the standard four-drug regimen used in the treatment of an initial TB infection, is a controversial treatment. Many experts believe that defies a central rule in medicine to “never add a single drug to a failing regimen.” After comparing the standard four-drug regimen to the re-treatment regimen, Ms. Greenzang found no significant difference in their outcomes. She did find, however, that daily treatment showed significantly more success than weekly treatment. And while she found the research component of her time in South Africa very interesting, she says the most meaningful experiences were the patient encounters she had. “My summer experience provided me with invaluable first hand exposure to the interplay between medical, social, political and cultural elements in South Africa and reminded me how all of these factors impact a doctor’s ability to both care for and communicate effectively with her patients.”

Joyce Imahiyerobo & Nneka Offor
Weill Medical College of Cornell University
Exploring the Viability of Community Health Insurance Programs (CHI) as a Mechanism for Financing Health Care in Poor Communities of West Gambia, Africa

Community health insurance programs have been shown to have success in financing health care in poor communities. However, in many cases, there are barriers to enrollment in the insurance program. As Ms. Imahiyerobo and Ms. Offor discovered, this was not the case in the village of Keneba in West Kiang, Gambia. Almost every pregnant woman in the village was enrolled in the community health insurance program. Therefore, Ms. Imahiyerobo and Ms. Offor decided to look at the factors that may have influenced the success of the program. They developed a survey tool that helped them evaluate the program which was administered to 63 women, half of whom were part of the insurance program and the other half which was not involved in the program. After an initial data analysis, they found that the involvement of a third party may be the reason behind the success of the community health insurance program. The Medical Research Council, a politically unaffiliated organization, has worked in The Gambia for over 50 years as a health care facility. The surveys completed by the women showed that the community had a high level of trust in the Medical Research Council. Ms. Imahiyerobo and Ms. Offor believe that this level of trust has increased the willingness of the women of Keneba to enroll in the program. Ms. Imahiyerobo and Ms. Offor were honored to be welcomed into the Keneba community and believe that their experiences have reaffirmed their decisions to go into medicine. “Although we were not in our own native lands, we were made to feel at home and this has further reaffirmed the decision we made to enter the medical profession, knowing that as doctors we can bring about both physical and social healing to communities most in need.”

Naana Afua Jumah
Harvard Medical School
Cultural Valuation of Obesity and Healthy Body Weight Education Program

Ms. Jumah chose to use her Rogers Fellowship to identify cultural factors that influence the ideal body image of women in Ghana as well as to assess a woman’s willingness to change her body shape in exchange for better health. Anonymous interviews were conducted with 366 women at the Korle Bu Teaching Hospital at the University of Ghana. The results showed that just over half of the participants were satisfied with their current body image. One-third of the participants were moderately dissatisfied with their body image and 26 women were dissatisfied. The results also showed that more than half of the women had tried reducing the amount of food they ate in order to lose weight. Half of the women also reported that they had tried exercising in an attempt to lose weight. These results came as a surprise to Ms. Jumah because dieting and exercising are considered to be culturally inappropriate activities for women. It was obvious to Ms. Jumah that messages regarding the dangers of obesity were reaching the Ghanaian women—95% of the respondents said they knew of the negative health consequences related to obesity. Speaking of her experience in Ghana, Ms. Jumah writes, “One of the most rewarding experiences was speaking with the women who came into the hospital. It was a privilege for me to be given this window into intimate aspects of their life, and I did my utmost to convey how much I valued their contribution to not only the study but also to my personal spirit.”

Meera Kotagal
Harvard Medical School
Exploring the Cultural Context of HIV/AIDS Care Provision in Cape Town, South Africa

Ms. Kotagel spent her Fellowship summer in Cape Town, South Africa where she worked at the Desmond Tutu HIV Centre. While there, she conducted interviews with 20 patients from the Xhosa communities of Masiphumelele and Guglethu. The purpose of the interviews was to better understand HIV patient’s adherence to treatment as well as the barriers to care that the patients experienced. The results showed a number of positive outcomes which highlights the success of HIV education campaigns in the communities. Most participants had a good understanding of how HIV is transmitted as well as how the virus attacks the body. Almost half of the participants stated they had no problems adhering to their anti-retroviral treatments. However, despite these positive findings, Ms. Kotagel also found that over a quarter of the participants experienced negative stigmas because of their HIV status. Ms. Kotagel’s time in South Africa was a very positive experience for her. She says, “My time in Cape Town this summer, at the Desmond Tutu HIV Centre, was incredibly inspirational and has confirmed for me that I would truly like to dedicate my career to providing HIV medicine in resource-poor settings. Throughout my education up to this point, I have had a sense that I might be interested in infectious diseases, and I have known that I care deeply about equity in global health. But this summer, those vague conceptions were crafted into a real vision and I now have a much stronger sense of the path I would like to pursue in medicine.”

Alexandra Leader
Mount Sinai School of Medicine
Development of International Maternal-Child Health Education Program for Mothers Living in New York and Bolivia

Developing an adaptable maternal-child health education program was the goal of Ms. Leader’s Rogers Fellowship. Her objective was to develop a curriculum to be used in Queens, New York and then adapted and piloted in a medically underserved community in Santa Cruz, Bolivia. The project involved two phases—the first phase was a six-month class for mothers and children in Queens. After the six months, the class was adapted to fit the needs of the Santa Cruz community and a six-week comprehensive course was designed. Ms. Leader, along with the help of a local pediatrician, conducted the course for a small group of pregnant women in Santa Cruz. She also took advantage of her time in Bolivia to conduct a general maternal-child health class to a larger group of men and women in the community. Speaking of her time in Bolivia, she writes, “The experience of developing a maternal-child health education curriculum and putting it into service in Santa Cruz, Bolivia was an invaluable foundation for a life in international health and community medicine. One of the most fulfilling aspects of this experience was having the opportunity to see local women and men become true protagonists in a historically humble community, bearers of information and skills that we together realized to be critical to the health of their families.”

Carter Charlotte Lebares
University of Minnesota Medical School
Powderhorn Park Peer Pregnancy Prevention Program (P6)

Ms. Lebares decided to conduct her Rogers Fellowship work in the neighborhood where she lives—the Powderhorn Park area of Minneapolis, MN. She devised a teen pregnancy prevention program called the Powderhorn Park Peer Pregnancy Prevention Project (P6), which included classes with a small group of teenagers that aimed to enhance resiliency, support empowerment, and ultimately prevent pregnancy. After two days of promotion for the P6 program (posting flyer on the streets), 50 young adults of all backgrounds volunteered to interview for the peer education positions. A fifteen-person group was established and the P6 program was initiated. Twenty-seven speakers were invited to educate the young adults about teen pregnancy in sessions throughout the summer. While it is too early to ascertain quantitative data, she reported many positive stories from the P6 program. Throughout the entire program, the teens were reminded that each of them has incredible self-worth and the ability to do great things with the gifts they possess. One of the male participants, speaking of his experience, said “No one ever told me that stuff about myself. Y’know, that I’m special.” It is this kind of story that has given Ms. Labares the most satisfaction. She says, “This experience, of reaching out to the ‘throw away’ kids of my neighborhood with hope and a set of internalized tools, has been one of the most satisfying things I have ever done. The kids are unbelievable and they reaffirm in me that my road to becoming a physician is utterly worth it if I am able to serve young people in this kind of amazing work.”

Michelle Moniz
Washington University School of Medicine
Prevention and Therapy of HIV/AIDS Lusaka, Zambia

Ms. Moniz’ Fellowship activities were directed towards examining the HIV/AIDS crisis in Lusaka, Zambia. She was specifically interested in the unique role that a family care giver often plays when another family member becomes infected with HIV. Her question was whether family volunteers acting as first-line medical responders with the aid of a trained nurse could provide sustained, quality care in the home setting to pediatric HIV/AIDS patients. To collect the data needed to address this question, Ms. Moniz made home visits to observe the care giver’s activities, solicit opinions from the care giver about their role, and study the interactions between the care giver and the nurse. While the data is still being collected and analyzed, Ms. Moniz is confident that the research she conducted will help build an evidence-based set of recommendations for other communities to introduce the family care giver model into their protocols. Ms. Moniz’ experience in Zambia taught her many lessons. She shares one of those lessons here, “I recognize and look forward to collaborating with public health officials, economists, grass-roots organizations, community members, and patients themselves to generate complex responses to a disease with such a multi-factorial etiology as AIDS. It is becoming increasingly clear that some simple medical interventions are not enough to lead to long-term solutions.”

Neil Anthony-Smith Nixdorf
Case Western Reserve University School of Medicine
The Impact of a Human Rights Approach Towards AIDS Prevention: A Ugandan Case Study

Mr. Nixdorff’s project was designed to analyze the impact of human rights theory on the development of and implications for AIDS interventions and treatment in Uganda. This analysis was completed through surveys of healthcare providers, educators, advocates, and policy makers. In addition to the surveys, site visits were conducted at an array of organizations throughout the country. At this time, only preliminary, qualitative data is available. It shows that AIDS is a disease that has affected the majority of the population, either through direct infection or through the infection or death of a family member or close friend. In response to this crisis, over 2500 nongovernmental organizations focused on HIV/AIDS have registered throughout the country. In regards to human rights, people who were surveyed identified three potential means of human rights theory to address some of the problems associated with the HIV/AIDS epidemic in Uganda (the include the status of women, research ethics, drug provision/allocation, and discrimination). Study participants believed that there should be legal obligations and binding agreements for the government and healthcare organizations in order to ensure that human rights are not being violated. They also supported enhanced protection for organizations providing prevention messages (e.g. condom promotion). Finally, study participants favored educating the population about human rights. While this project dealt with the substantial topic of human rights, Mr. Nixdorff came away from it with a very personal lesson. “I traveled to Uganda as a medical researcher looking for a dissertation topic and I returned an inspired future physician. Working on the wards with doctors and AIDS patients in Kampala (Uganda) as I was waiting for my IRB approval, I realized that my place is by the bedside helping patients instead of developing statistical algorithms or researching broad solutions.”

Eugene T. Richardson
Weill Medical College of Cornell University
An Ecological Analysis of the Factors that Contributed to the 1998 Global Dengue Epidemic

As a Rogers Fellow, Mr. Richardson conducted an analysis of the yellow fever migration in South America, specifically looking at the use of the yellow fever vaccination in at-risk countries. He developed an initial report which the World Health Organization is already planning on expand. Of his Fellowship experience, Mr. Richardson’s reflected, “I have learned that I do not want to work for such agencies (UN agencies, such as the WHO) in the future. And it was good for me to learn this first hand, because I often aspired to work at the WHO. So I am truly thankful for an experience like this summer to help me refine where I am heading with my career.”

Shonali Saha
Mount Sinai School of Medicine
Urban Village Community Determines the Agenda for Programming: A Three Fold Needs Assessment Conducted by Female Peer Educators of Delhi, India Regarding HIV/AIDS Services, Substance Abuse Treatment and Other Holistic Crisis Recovery Services

Ms. Saha’s work as a Rogers Fellow led to the creation of a sustainable peer education program in the village of Chattarpur, near South Delhi, in India. The peer education group was established to conduct a needs assessment among women in the community. Through the assessment she ascertained what female community members perceive their health needs to be compared to the local clinicians perceive the women’s health needs are. Using eleven women ages 14-26 as peer educators, 54 women in the community were interviewed. Most of the interviewed women felt that they did not receive adequate health education from their doctors and the government at large. However, most of the doctors interviewed stated that health education for their patients would be a waste of time because the patients were largely illiterate and unable to comprehend any advice given to them. As a result of these findings, the Nada India Foundation (who supported Ms. Saha’s work in Delhi) has continued to use peer educators as an effective and inexpensive way of providing health education to the community. Speaking of her experience, Ms. Saha writes, “I feel privileged to have been able to watch the group of individuals who felt that they had little to contribute to their community transition into a collective of women who believed that they could improve access to health information and care for their peers.”

Justin Adam Schram
University of Pennsylvania School of Medicine
Assessing Community Health in a Tz'tujil Maya Village upon Reconstruction of Hospitalito Santiago Atitlan: A Synthesis of Ethnographic and World Health Survey Data

In 1990, a massacre of thirteen Tz’tujil Maya near the Hospitalito Santiago Atitlán shut down the hospital and ended services provided to residents in the Guatemalan province of Sololá. Realizing the benefits that the hospital brought to the community, a grassroots organization dedicated itself to the reconstruction of the hospital, nearly twelve years after it was closed. In order to help the hospital most effectively serve the community, Mr. Schram used his Rogers Fellowship to collect survey data about the health status of people in the community. He initiated this project because the hospital physicians and community leaders indicated that having data on the health of the community would help outline priorities for and track changes in community health over time. A 200-question survey tool was developed and administered to 208 residents in the community. The survey assessed a wide variety of health characteristics, including burden of disease, mortality, and health system access. The results of the survey offered six important conclusions: gastrointestinal disease is the most common health problem in the community; there is great concern in the community around HIV/AIDS; chronic pulmonary and acute respiratory disease is highly prevalent in the community and may be a result of poor ventilation inside homes; an alarmingly high number of respondents showed signs of depression; there is poor continuity of treatment for chronic disease in the community; and the hospital can play a key role in providing low-cost care for residents who say that cost is the main barrier in receiving proper treatment. Based on the level of involvement in this study, it was obvious to Mr. Schram that people wanted to take an active role in their health. “Oftentimes the survey questions elicited rich accounts, ranging from detailed descriptions of the experience of illness and difficulties accessing health care to broader narratives about the local history of political violence and the struggle to raise a family in poverty.”

Scott Alan Simpson
University of Pennsylvania School of Medicine
Health Utilization and Outcomes Among Patients of Medical Student-Run Health Clinics

In looking through large amounts of research, Mr. Simpson could not find any published account of the role that student-run health clinics play in the health care system in the United States. As an example, he used his Fellowship to examine a student-run clinic in West Philadelphia. Mr. Simpson developed a qualitative, interview-based study which was administered to fourteen patients at the University City Hospitality Coalition in West Philadelphia, PA. One of the major findings of the study showed that patients perceive advantages to using the services at the student-run clinic versus other health venues. Some of these advantages include short waiting times, courteous and communicative staff, personal attention, and no-cost services. The medical students who staffed the clinic were also interviewed, and they listed many benefits to the clinics, including an opportunity for skills acquisition, meeting and examining patients, and doing community service. Overall, Mr. Simpson found that the student-run clinic in Philadelphia was met with strong support by both patients and the student volunteers. He hopes that student-run clinics will continue to garner support and become part of the medical safety-net for uninsured and poor patients. “Student-run clinics are just one product of gritty altruism and creativity that suggest that health care need not be unattainable, and this report is but one step in the growth of student-run clinics into more sophisticated and better-understood sites for medical education and service.”

Eliza Hayes Slate
University of Pennsylvania School of Medicine
Effects of Maternal Health Literacy on Infant Access to and Utilization of Health Care Services

Children from minority groups, low socioeconomic status, the uninsured and those living in medically underserved communities face disproportionate difficulties in accessing care. Parents are responsible for providing health care for their children and there is little research available on how parental attributes, attitudes, and abilities affect children’s access to the health care system. Using a longitudinal study of Medicaid enrolled women and their infants, Ms. Slate evaluated whether health literacy levels (the ability of an individual to read and comprehend basic medical information) had any effect on the challenges women have in accessing health care for their children. A total of 131 women completed the Test of Functional Health Literacy in Adults (TOFHLA). Results showed that TOFHLA scores (whether high or low) is not significantly associated with prenatal care or gaps in health care coverage over the previous year. However, the study did confirm concerns that a large percentage of Medicaid enrolled mothers are young and have low education levels. Ms. Slate hopes that her research will give a voice to populations who often suffer from lack of adequate health care services. “My hope is that the information gathered as this study continues will at least start to give a voice to their stories and that by doing this research, it will be possible to better understand the problems, pitfalls, and successes of the current healthcare coverage system. I certainly believe that my experiences will help me to become a better physician and perhaps a health policy researcher some day.”

Matthew C. Swan
Mount Sinai School of Medicine
The Need for and Beliefs about Counseling in Urban Kenya: A Study Towards Expanding Services in a Community-Based Clinic

While counseling services were once seen as an option only for the wealthy, they are now being introduced into the model of primary care for the general population. Mr. Swan’s study focused on understanding the need for and perceptions of counseling services at a community-based primary care clinic in Nairobi, Kenya. The study was conducted at the RAFIKI clinic which serves people living in Kibera, one of the largest slums in sub-Saharan Africa. Using a questionnaire of addressing the desire for counseling services, 372 individuals were surveyed. In addition to the questionnaire, a standardized tool for screening anxiety and depression was included. Approximately 30.9% of the study population presented with high anxiety and 19.6% of the study population showed signs of depression. These results indicate that counseling services would be beneficial for the community. The study population expressed a strong desire for counseling services—88.1% of the participants said they would like counseling services made available to them. Participants said that they would like the confidentiality afforded by counselors as well as the unbiased opinions that counselors can provide. Recognizing the wishes of the population, Mr. Swan hopes that his research does not stop with a report or poster presentation. “I have been introduced to a community I want to continue serving, both by helping to design a counseling service for it, and by returning to it when I have more skills to provide medical care. Medicine as a field appears to me much broader than it had before this project, and it calls me ever more ardently. I am most especially grateful to those I met in Kenya—doctors, students, and research participants—who helped me remember why I came to medical school in the first place.”

Geoffrey Huang Tison
Johns Hopkins University School of Medicine
Safeguarding Blood: Understanding the Culture and the Epidemiology Behind the Threat of HIV on China's Blood Supply

Due to the unpredictable nature of executing a research project in a foreign country, Mr. Tison had to adjust his initial research goals to focus on a more narrow topic—a study of the attitudes and fears toward blood donation of different populations in China. Mr. Tison organized a very comprehensive study that involved a survey by three different groups of people—volunteer blood donors, “planned blood donors” (people who donate with their work/company), and non-donors (university students). In all, 1399 questionnaires were completed. Data analysis is currently ongoing but there are some preliminary results. Nearly 47% of the non-donors felt that there was a significant risk of contacting a blood borne disease (including HIV) from giving blood. The non-donors also felt that the blood lost from donation was enough to disrupt their flow of Qi. These results were interesting to Mr. Tison, particularly the unwillingness among the younger, highly educated group of people (such as the non-donor, university students) to donate blood. This was clearly not the case. Mr. Tison found his experience in China to be a seminal step in his career development. “Within the context of my four years in medical school, I will always see the summer after my first year as encompassing that elusive combination of a powerful educational/growth experience and also a productive, purpose-driven project. And beyond these four years of medical school, I am confident that this experience will serve not only as a foundation, bolstering all future research endeavors, but also as fertile soil from which to cultivate the many future interests which I know will cross my path.”

Christopher Julius Trindade
UMDNJ-Robert Wood Johnson Medical School
Expression of IL-7Rá and IL-15Rá in CD8+ Memory T-cells in SIV251 Infected Rhesus Macaques

Mr. Trindade carried out his Rogers Fellowship work at the National Cancer Institute in the Animal Models Retroviral Vaccine Section. His work focused on the role of highly active antiretroviral therapy and its ability to decrease morbidity and mortality by controlling viremia in patients infected with HIV. Building on existing research showing a correlation between the production of virus specific CD8+ T-cells and the ability to control viremia, Mr. Trinidade analyzed the ability of two cytokines, IL-7Rα and IL-15Rα, to create a population of stable memory CD8+ T-cells. After a ten-week period, Mr. Trinidade’s research was complete and he was able to show that IL-7Rα did play a role in developing a stable pool of CD8+ memory T-cells. Low expression of IL-7Rα in the T-cells was associated with increased viremia. Mr. Trinidade’s original research was published in the Journal of Immunology on September 15th, 2005. While Mr. Trinidade’s interest and success in immunological science is obvious (he recently helped start an Immunology and Infectious Disease elective at his school), he is also interested in the role that health policy may play in controlling infectious disease. He says, “While my primary goal is to finish my medical degree and start my residency, I am also deciding whether to take a year off to seek a Public Health Policy degree to better understand the health policy and economics in controlling infectious diseases.”

Katharine Anne Willoughby
Univeristy of California, Davis School of Medicine
Breast and Cervical Cancer Screening Among Muslim Women in the Sacramento Area

Approximately 35,000 Muslims reside in the Sacramento, California area and this number continues to rise due to high rates of immigration and conversion. Muslims are found to be understudied in health research, particularly Muslim women. Ms. Willoughby used her Fellowship to study the exposure and utilization of women’s health preventive screenings (clinical breast exams and cervical cancer screenings) among Muslim women in the Sacramento area. She developed a 44 question survey that addressed the following areas: demographics, knowledge of women’s health preventive screenings, utilization rates of screenings, attitudes towards screenings, and general barriers to healthcare. With the help of a number of women in the Muslim community, Ms. Willoughby surveyed 230 women. Data analysis is ongoing but there are significant preliminary observations already detected. The survey found that the majority of married women have undergone regular women’s health screenings but nearly 0% of the unmarried women have undergone such screenings. Also, a significant number of women reported that they feel misunderstood in the medical setting due to their cultural or religious beliefs. Ms. Willoughby is looking forward to the completion of data analysis which is being done by a medical school staff statistician. In the meantime, Ms. Willoughby is happy to report that the Susan G. Komen Foundation has awarded her study with a grant that will allow for the provision of education and free breast cancer screenings to eligible women who are surveyed. Speaking of her experience, Ms. Willoughby says, “Now that I have had the opportunity to gather data on this understudied population, I look forward to working further with the community to raise awareness regarding health issues and to help those without health insurance gain some limited healthcare in a culturally sensitive setting. This, of course, would not have been possible without the initial data collection to begin gaining the trust of the community while simultaneously assessing their needs.”

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