Global Health Team in El Salvador: July 2012

A team from the NYIT Center for Global Health visited El Salvador from July 8 to 28 to evaluate the use of electrocardiogram (EKG) analysis as a potential screening tool for Chagas disease, a neglected tropical disease that is prevalent in many parts of the world.

Physicians and students from NYIT's College of Osteopathic Medicine and School of Health Professions also worked with local health providers in El Salvador to provide clinical services, conduct health fairs, and teach oral health, health promotion and disease prevention to students at the El Volcan School in Morazán.

Updates from El Salvador

Something at the end

Day 21- July 28, 2012

Something at the end

Something at the endDrs. Ahmed, Lardner, and I decided to let the students do most of the blogging for the trip, but that we would all write something at the end.

For the past three weeks, we have touched the lives of many people.  One can rarely write that statement about an experience without some question to its validity, but I am able to without hesitation.

I am not only talking about the people of El Salvador, but about our own. 

In fact, I think our lives were touched a bit more.

This trip has been successful on many fronts.  First, and foremost, we are all returning safe and sound.  We as faculty already knew we were in a safe place; we ensure that fact wherever we go.  Unforeseen things can occur, but we dealt with nothing of the sort.

The clinical experience of the trip has been nothing short of outstanding.  The students learned how to perform and read electrocardiograms (EKGs).  They also completed multiple blood draws each—just a couple of procedures that may come in handy in the near future.

Something at the endWe walked with the health promoters, or promotores, up countless hills at a seemingly suicidal incline that would make any treadmill laughable.  We visited local homes— checking their drinking water, making sure each abode was chinche-free, and learning about each family’s culture.

One of these visits brought us to a woman who "might be 80;" she shared a knowledge and wisdom in her words that any historian can only dream of hearing.  Find that in a lecture hall!

Working alongside the physicians of El Salvador was another part of the experience.  We learned about the healthcare system in place, and what providers foresee for the system’s future.  We worked with these same physicians, treating both common and uncommon complaints.

Something at the endWe were able to visit a hospital that is more than a century old.

The students developed health fairs that encompassed a variety of topics; we showcased these at several schools. To watch Sarah explain to six-year-old kids why they should eat avocados instead of pizza was hilarious.  Ryan, Mike, and Hau discussed how the human body works—using us to simulate clogged arteries as the students walked in a straight line— and why people should avoid smoking, drugs, and other nasty habits.  Dane’s convincing kids to do push-ups in the summer heat was as funny the last time as it was the first time.

Of course, I am thrilled that we completed the research study on Chagas disease. In between, there were countless translated phone calls, emails, and a 300-page document "lost" for two weeks—somewhere between Old Westbury and San Salvador.  A local TV station (Channel 23 on your Salvadoran dial) interviewed us about the study, spreading awareness of both the disease and the NYIT Center for Global Health.

Something at the endThe project began a year ago with a thought, and ended in a new partnership at San Miguel’s San Francisco Hospital, which happily processed 645 tests on 310 blood vials for us—yielding surprising results.

We had expected to discover approximately 10 people out of 300 subjects to be positive for Chagas disease.

We have 25!

This knowledge is not only powerful for us as researchers, but more importantly, it is powerful in its application. We can share the results with the Salvadoran physicians who treat this neglected tropical disease.

Something at the endIn addition, the whole NYIT community should be proud of third-year medical student Jasmine Beria, who is a 2012 recipient of the Benjamin Kean fellowship sponsored by the American Society of Tropical  Medicine and Hygiene (ASTMH).  She received this award to complete the Chagas research, and did a magnificent job.

People ask me if, with all my travels, it ever gets monotonous—if each trip is similar.

I can honestly say that each experience is unique, whether I go to a country for the first time or I am returning to a location that I have visited before.  The people I meet are different.  The students are different.  The weather is different.  The memories are different.

What I have come to realize is that an experience outside of U.S. borders is not defined simply by where your plane lands, but by where, in front of whom, and with whom you step on that soil.

I cannot end this blog without thanking several people who made this trip a complete success.

Something at the endFirst, the support here at NYIT:  Drs. Ross-Lee and Gotfried for their guidance.  The NYIT Institutional Review Board (IRB) committee for approving the study.  The NYIT Office of Communications and Marketing for editing and posting our blogs and pictures.

Second, the people we worked with in El Salvador:  The health promotores. The nurses and doctors at the clinics and the hospitals. Ron, the owner of the Perkin Lenca, where we stayed.  Renee, our trust-worthy driver.  The Peace Corps Volunteers who helped us with logistics and translation.

Third: Dr. Zehra Ahmed for coordinating a great trip. Dr. Deb Lardner for everything.

And finally, the reason why I went on this trip in the first place—the students:  Jon, Jasmine, Ryan, Mike, Hau, Dane, and Sarah.

Michael Passafaro, D.O., DTM&H, FACOEP
NYIT Center for Global Health
Assistant Professor, Department of Emergency Medicine, New York College of Osteopathic Medicine of NYIT


Reflections on the summer

Day 20- July 27, 2012

Reflections on the summer

Reflections on the summer It’s been a busy summer at the Center for Global Health, with our Global Health Certificate students completing fieldwork in Ghana, El Salvador and Haiti .

Seven students and three faculty experienced both El Salvadoran culture and a healthcare system that is different from our own in the United States— but perhaps the similarities are just as striking.

Although we saw differences that included treating patients with a history of Chagas and dengue,  the similarities were evident in the types of primary care cases we saw — sore throats, runny noses, asthma, bronchitis, hypertension, diabetes, headaches and otitis media—the list goes on. The treatments too were similar.

Perhaps the El Salvadoran healthcare system lacks the huge repertoire of medicines that are more accessible to clinicians in the United States, but the practice of medicine is similar across the two countries— we are all dealing with the same anatomy and physiology.

Reflections on the summer Most importantly, they too respect their patients and have their interests first and foremost at heart.

We are back safe and sound. Dane, Hau, Jasmine, Jon, Mike, Ryan, and Sarah— the students who traveled to El Salvador— had the opportunity to blog and share their daily activities and experiences throughout the three weeks. Reading the entries they wrote with such insight, clarity, and heart, I can see that they gained a better understanding not only of a new culture and healthcare system but also of themselves—such an important part of the journey

At the end of the journey, it’s my turn to reflect on the various endeavors we undertook during our stay in El Salvador.

So what made me most happy?

Our students experienced firsthand what we discussed in the coursework for the NYIT Certificate in Global Health:

Reflections on the summer
  • how the infrastructure of a community or country affects healthcare
  • the effects of health policy, politics and finances on the delivery of healthcare
  • how easy it is for the Aedes mosquito to breed in open ‘pillas of water’ and spread dengue.
  • why there is a lack of water and environmental sanitation due to the extreme poverty that exists in the harsh countryside
  • how easy it is for the chinche to live in adobe or wood dwellings  
  • why male medical students could not enter a clinic where female physicians and medical students were carrying out thirty Pap smears
Reflections on the summer
  • why most women did not particularly care if a male medical student did her electrocardiogram (EKG)—as in many cultures, almost every Salvadoran woman publicly breast feeds her children)
  • the importance of greeting anyone you walk past or meet.
  • why you ask permission before you enter a home or take a picture

In just three words: They got it!

So I’m happy. But there was even more:

  • the maturity and collaboration among the students to support and work with each other – to make data gathering for the Chagas study flow so smoothly and easily and be completed in record time.
  • Reflections on the summer the thought and work that went into creating the health fair charlas and the memorable interactive exercises the NYIT students created so that El Salvadoran students of all ages could benefit was admirable!
  • a group of American health care students met with an awesome group of American Peace Corps volunteers, and the groups were mutually impressed with the other’s work, attitudes, background and humor! Friendships were made…
  • El Salvadoran communities have met a group of young Americans who were respectful, empathetic ambassadors of both the United States and the New York Institute of Technology.
  • El Salvadorans got a glimpse of the diversity of who Americans are today—Vietnamese, Japanese, Chinese, Venezuelan, Irish, Italian, Jewish, and Sri Lankan— this is also the face of NYIT!
Reflections on the summer
  • I met a group of young El Salvadorans who inspire me. They had studied in the US for several years, and helped us out with translating on days when the Peace Corps were unavailable. Elsy, now a tourist guide, said one of the most important lessons her group learned while living in the United States was how important it is to volunteer!
  • We all had the opportunity to visit the National Hospital Rosales in San Salvador. The physicians spent several hours with us, walking us through the emergency room that was overflowing with patients—some of whom had been there for days—the ICU, and the medical and surgical wards. They discussed various cases with our faculty and students.
  • While exchanging ideas and comparing resources, Dr. Passafaro and Dr. Lardner advised the ICU physician that he could contact and get assistance from the Poison Center in New York regarding several unusual cases they felt maybe due to an exposure that was puzzling the physicians.

Reflections on the summer What were my challenges?

Honestly not too many!

  • I had an amazing group of friends and acquaintances in Morazán and San Salvador, and Peace Corps volunteers from around the country who made it look easy—some of these people I’ve never even met and have just spoken to either on Skype or via email! Ah, technology.
  • Dr. Juan Antonio Altamirano of the Ministry of External Relations, who has been a great friend and has guided us through the protocol over the years!
  • Ron, Ena, and the wonderful girls of the Lenca! – my home away from home for many years.
  • Drs. Fuentes, Eric Gomez, Franklin Gomez, Drs. Alba and Allen Burns, and all the other physicians, nurses and health promotores, who made our study and shadowing at the clinics and in the communities memorable.
Reflections on the summer
  • Celina de Sola of Glasswings in El Salvador, who organized our visit to the Hospital Rosales.
  • Rene, our chauffer for the past two and a half weeks in Morazán.
  • The most amazing group of people I have come to know and love – the Peace Corps! Alex, Helen, Jess, Max, Tricia, Jamie, Elsa, Andrew, Mike, Shelby and Koji— and the crew that helped me last year: Krystal, Daniel, Ros and Brady.
  • Elsy, Ever, Luis, Arnoldo and Danny – the El Salvadoran volunteers.

I would like to thank my colleagues:

  • Dr. Michael Passafaro, who was responsible for the Chagas study and whose organization helped complete it in record time.
  • Dr. Deborah Lardner for her guidance and overseeing the students in the clinics and during the house visits with the health care promoters

Last but not least, I want to acknowledge those without whom this journey would not have been possible — all the students of 2012!

Whether I traveled with you or not, thank you for sharing your dreams, your fears, and your hopes with me—I learned some of my most valuable lessons from you!

A. Zehra Ahmed RPA-C, MBBS
Assistant Professor & Coordinator of Community Health Initiatives, Department of Physician Assistant Studies
Assistant Director of Planning, NYIT Center for Global Health
Faculty Associate, NYIT Center for Gerontology


Coming home

Day 19- July 26, 2012

Coming home

Coming homeAfter two weeks in Ghana, and now these past three weeks in El Salvador, it’s been bittersweet coming home.

Leaving the Perquín Mountains, which I call home away from home, has been difficult—but I’m also delighted to be returning to my family in New York.

Each trip away, however, gives me another clue to who I am… what I’m here for… what makes me happy — which is sharing my knowledge and experience and opening up a new world to students.

I’m so grateful for these opportunities.

I take my responsibilities as a teacher extremely seriously—whether it’s in the classroom, the remote villages of Ghana, or the steep volcanic mountainside of El Salvador. I hope that sharing my passion, knowledge, and skills gives students the opportunity to realize their own passions and introduces them to a world beyond what they know — to see that on the surface we may look different, speak differently, dress differently, eat different foods, but that we are all the same.

We all want health, happiness — however each of us defines it — contentment, and security  for our loved ones and ourselves.

Coming homeEach of us has much to offer – you don’t have to be a physician, or a physician assistant, or a nurse or teacher, a journalist; you can be a tourist guide, a Peace Corps volunteer, a farmer, a child, an old woman—each has their own knowledge, experience, skills and friendship to offer. And we grow richer through these bonds.

One of the first lessons we explore in cultural competency is to know ourselves and our own prejudices and limitations. This is important before we can offer a sincere helping-hand to anyone. We must know, and own, our ‘own baggage’. We must also always remember humility – do not assume that your way is the only right way – as there are many different ways to live and be happy.  There are many ways we can give of ourselves and help one another.

Be open to learning a different way to do something, say something or eat something (things do taste better when you use your fingers!). And the list goes on.

We need to respect our differences, learn from one another, and delight in our similarities. These are the first few steps to making the difference that we so yearn to make in the world.

A. Zehra Ahmed RPA-C, MBBS
Assistant Professor & Coordinator of Community Health Initiatives, Department of Physician Assistant Studies
Assistant Director of Planning, NYIT Center for Global Health
Faculty Associate, NYIT Center for Gerontology


Cementing Bonds

Day 18- July 25, 2012

Cementing bonds Cementing bonds

Although this was a travel day, it was also a day for us to cement some of the bonds we made while working in Morazán.  The Ministry of Health provided an air-conditioned bus to take us literally through the clouds, down the mountains, and into the heat.

Headed to San Salvador, we were able to make a few important stops along the way.  

The first was to buy souvenirs with our Peace Corps partners in San Francisco Gotera. Having noticed that no farmer we had ever met in Perquín leaves the house without his machete, we walked through the market desperate to find such a tool for ourselves.

Cementing bondsWe finally found a farming store that carried them— along with straw cowboy hats, shovels and hoes. The machetes were beautifully ornate, with leather fringe, metal buttons, and most importantly, blunt edges.

I think the owner must have thought we were clearing out a huge plot of land.

Our next stop was to pick up the results of the blood testing completed for the research portion of the Chagas study. We were surprised to discover a higher incidence of chronic Chagas in the area around Perquín—the last country data indicated an incidence of just over 3 percent, but our study indicated a rate closer to 7 percent.

We were fortunate enough to have had a partner in Hospital San Francisco in San Miguel. We met with the hospital’s CEO, who had been pleased to provide a service to improve the health of the citizens of Morazán, and wishes to continue the relationship.

Cementing bondsThis private hospital has been in existence for the last century, but just moved into a new facility two years ago.  Although the paint on its new walls is not even completely dry, it is a beautiful building.  

While the students toured the facility, local journalists from Channel 23 filled the hospital’s doctors’ lounge—“the Diamond Club”— to interview Dr. Michael Passafaro about Chagas disease and our study.

Then, we were back on the bus for our last bit of shopping at San Sebastian— searching for a handmade hammock so we could fall asleep back in the States and dream about our time in El Salvador….

Deborah Lardner, D.O., DTM&H
NYIT Center for Global Health
Assistant Professor, Department of Emergency Medicine, New York College of Osteopathic Medicine of NYIT


Perquin's diamond in the rough

Day 17- July 24, 2012

Perquín's diamond in the rough Perquin's diamond in the rough

We have spent the last couple of days in the clinics. Since we completed the screenings for our Chagas study, these visits now mainly consist of shadowing the different types of healthcare professionals and performing electrocardiograms (EKGs) on patients who need them. 

Ryan covered the details of these two days in the clinics; I can elaborate on the other focus of our trip here.

Today, we presented our last charla to the youngsters over at the Amun Shea school here in Perquín. 

The school is a diamond in the rough. 

Compared to the other schools to which we have ventured, not only is the campus itself vastly different, but the attitudes of the students are as well. 

The Perquín Lenca hotel’s owner—whom we all know as "Ron the gringo"— started the Amun Shea school seven years ago. Although his main occupation consisted of construction, he saw the need for a school that both challenged its students and pushed societal and cultural boundaries.

He established Amun Shea with a single group of kindergarteners. Each year, he adds a new grade to the school, so that over the course of 13 years, it will be a full K-12 school. The original group of kindergarteners are currently 7th graders.

Perquin's diamond in the roughOne of the many unique aspects of the school is that it teaches through problem-based learning(PBL)—a format considered progressive in the United States, let alone in a conservative country like El Salvador. The way PBL works is that instead of teaching a group of students by separating each academic subject into mathematics, science, social studies, etc., a teacher will provide students with a problem that they can only solve by incorporating aspects and variables from each of the major disciplines.

For example, last year the teachers asked their sixth graders to assess the quality of the town's water supply. The children needed to investigate how clean the water actually was, and then needed to address how to make their findings known to the public. They used scientific techniques to collect and examine the water supply. They used math and science to quantify how poor the water quality was and to determine who in the town was most affected by poor water quality. Lastly, they honed their social skills and cultural knowledge by not only stating all the ways the quality of the water could affect a town and its future, but also met with employees of the municipal water utility company. The students were influential in establishing changes to better the quality of the water in certain areas of Perquín.

Perquin's diamond in the roughThe students I met at Amun Shea are matchless. Not only are many of them borderline bilingual, which made talking to them easier, but they were also more outgoing than the average El Salvadoran child, which also enhanced our interaction with them. We had no problem getting them to answer our questions aloud or to engage in the activities we had planned. 

The environment at Amun Shea facilitates this type of learning, and I must say that I was extremely impressed. Students there are learning educational basics in a truly interactive way. They are learning not to simply accept the cultural norms around them, but rather to push boundaries. In the process, they inevitably become responsible for their own learning.

Ron will be the first to admit that he's not sure how this is going to turn out. He tells us that we won't know the results of his experimental school for another 10 years. My bet is that one of two things is going to happen for the majority of these kids. One, some will leave Morazán, and possibly El Salvador, to better themselves, their education, and their situation; or two, they will stay in Morazán, but will be equipped with the tools to become community leaders, and therefore better themselves through the advancement of their community. 

Either way, these kids will have an impact on the world around them. Maybe schools in the United States can take note of what is happening here, and learn a thing or two from this diamond in the rough.

Dane Masuda, P.A. 2014


Temperate Tuesdays

Day 17- July 24, 2012

Temperate Tuesdays Temperate Tuesdays

We spent Tuesday with Dr. Gomez at the San Fernando clinic, and it was considerably quieter than Monday.  In his immaculate white coat and with his calm and cool bedside manner, Dr. Gomez is a true professional. He walked Sarah and me through the history of his morning patient load.

For the most part, people came to the clinic with unexplained abdominal pains and coughs, which rarely required much more intervention besides observation.  However, as each consultation progressed, more and more symptoms—usually completely unrelated to the chief complaint— began to surface.  

Dr. Gomez explained how a culture of patients seeking instant cures through injections and/or multivitamins exists in El Salvador, and spoke of the challenges this presents to his instilling in their minds that he is doing what is in their best interests—even if it doesn’t involve a pill or a needle.

It took me a moment to draw the easy comparison of this situation to those we have in the United States, mainly because we were only talking about the use of multivitamins.  Self-diagnosis can be a starting point for a doctor’s evaluation— or it can be running interference that prevents a doctor from seeing the real issues.  Great physicians learn the skill of first, second, and third degree listening.  The amalgamation of these tiers is how a doctor arrives at insight and truth.

Ryan Denley, D.O. 2015