Millennium Villages Project

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Course Director: Sonia Ehrlich Sachs, M.D., M.P.H.

Given: Summer between 1^st and 2^nd year

Maximum: Columbia students only

Start Date/Time: 2-3 months

Site/Location: The location of this practicum could be in one of the MVP sites in Ethiopia, Rwanda, Kenya, Malawi, Uganda, Tanzania, Nigeria, Ghana, Mali and Senegal; sites available to be determined by P&S and Earth Institute

Description: This is a public health, non-clinical experience for Columbia students only.  Students are placed in a rural village setting of an underdeveloped country that lacks basic health and disease prevention infrastructure.  They work with a team surveying health related needs and implementing infrastructure for health care delivery, health education and disease prevention.  The Millennium Village Project is a proof of concept that extremely poor villagers can get out of the poverty trap by an investment into practical interventions such as increased food production, health, education, infrastructure and communication, and that the investment that would be needed from donors is quite modest

Objectives:  The student needs to meet with the course director and write up a tentative plan of his/her project. About two thirds of the work of the student must be aligned with work needed to be done at the site. One third may be used to address the student’s own research project. A science coordinator with a Columbia University affiliation and a health coordinator will be the student’s guide on the content of the work.

Learning Experience:

There are three broad activities available to medical students:

1). Assist the scientific work of this project by working with the MVP site’s science coordinator and the health coordinator to gather the baseline information that describes the current status of health. This involves meeting with local experts, scientists and public health specialists. Past students have helped design the logistics of gathering survey data (demographic, socio-economic, energy, water, health and nutrition), anthropometry, stool tests and blood tests. Data analysis opportunities correlating blood test results with anthropometry, nutrition history, disease history, socioeconomic status, harvest results, environmental conditions and interventions in other sectors like clean water, increased food production, etc. are available.

2). Assist the community in setting up clinical services. This involves:

• meeting with regional and local government officials as well as the local community and learning how to forge collaboration between government, villagers, and MVP leaders (who provide technical, scientific and financial support)
• at the village level, participating in meetings with community leaders, chiefs,  members of village health committee, village health facilitator and community health workers to discuss challenges, suggested solutions and plans in each village cluster
• doing a clinic and hospital needs-assessment regarding personnel, adequacy of training and medical equipment and supplies; helping villagers build a clinic where there is none, learning the factors involved in choosing the site given the particular geography and demography; assessing infrastructure: roads, ambulance, phones and connectivity; forging a solid mutually satisfactory referral system to the nearest hospital; learning about electronic medical records being developed for rural clinics.
• hiring clinical staff, hiring Village Health Workers
• setting up best practice of what personnel, equipment, medicines, protocols, educational material, etc. a rural clinic should have in order to provide basic health care
• learning the disease epidemiology specific to the given area
• although the medical students would not take care of patients, they would be exposed to setting up all the basic primary care provisions provided by a rural clinic:
  • Safe child birth (skilled birth attendants in clinic)
  • comprehensive immunization program for children
  • antenatal program (IPT, deworming, folate/iron)
  • malaria prevention (bed nets) and case management
  • malaria and neglected tropical disease integrated protocol of treatment
  • school based deworming
  • HIV prevention and treatment program, VCT in hospital and in clinic ARV in hospital and in clinic
  • community based health education

• school based health screening and education

2).  Students may for up to 1/3 of the time design a short term research project provided that it is within the scope of the overall project.  Potential topics include: school health, school based de-worming, school meals, school attendance, school attendance of orphans, school performance, clinic utilization, clinic effectiveness, clinic education, clinic use of medical records, community health worker effectiveness, community health worker education, villagers’ knowledge of health issues, attitudes to medical interventions, attitudes to family planning,  and a large number of other topics of mutual interest in the many thematic or programmatic areas of health, related to diseases, health care services, prevention, education and interaction with non-health sector.

Feedback:   Ongoing feedback from onsite Health Coordinator and Science coordinator.

Evaluation: Course director will write evaluation based on input from site health and science coordinators.