IN A SHANTY TOWN ON THE SLOPES OF NORTHEAST LIMA, PERU, children work beside adults in stone quarries. They smash rocks during the day with large hammers, exposed to dust and damaging fumes. Other children can be seen scavenging through the rubbish to find pieces of glass and metal to sell. This is the village of Carabayllo, whose population lives in extreme poverty and lacks the most basic education. Like other Peruvians, many suffer from tuberculosis, a disease that has a huge foothold in the country.

This is also where you could find P&S student Charles Everett’05 last summer, having traveled a long way from the urban environment of Columbia University. He was in Peru to study the risk factors for pediatric tuberculosis. He is among the 10 percent of P&S students who travel overseas between their first and second years.

One day that summer, Mr. Everett sat down to lunch at a women’s collective in Carabayllo with the director of TB programs at the World Health Organization. As the women served them lunch, the director leaned over to him and said, “No one is ever overqualified for anything.” Relating this scene in his P&S research paper, Mr. Everett wrote, “That, to me, beautifully represents a stance of humility.”

He wrote in his summations that a guiding principle for physicians should be “It’s not about me,” which “represents a tremendous challenge, for it calls each of us toward a ‘stance of humility,’ that most elusive of human stances, as humility is the most elusive of virtues.”

This type of humanistic approach to patient care is echoed by many P&S students who have taken preclinical international summer electives. They say they’ve developed an understanding of different cultures that’s invaluable to their clinical education at Columbia.

The great interest to study abroad among Columbia medical students is reflected in the recent results of an AAMC graduation questionnaire—in 2002, 38.7 percent of Columbia medical school students studied abroad, compared with the national average of 20.2 percent.

Many P&S students study abroad to help them relate better to the diverse patient population at home. Students say that cultural and ethnic customs and differing perspectives of the health-care system are more easily understood after they have experienced patients in their native environments.

Juliana Schantz-Dunn’05 went to the Dominican Republic last summer to examine the factors that contribute to the growing rate of pediatric obesity. What she learned there, she says, helped her to better understand the same condition in Washington Heights, which has the largest Dominican population in the country.

Traveling abroad, she says, “improves all aspects of our ability to communicate with a patient who walks into your office. As a physician, it’s important to have a sense of the impact health care has on their lives.”

Ms. Schantz-Dunn and Mr. Everett are leaders of P&S Club’s International Health Organization, which hosts presentations by returning second-year students in September and a slide show in the spring by fourth-year students who participate in clinical electives abroad. Last year the IHO leadership successfully appealed to Dr. Gerald Fischbach, executive vice president and dean, for the creation of a fellowship for international health. The fellowship helps pay some of the expenses of summer travel by first-year students. The proposal resulted in four $1,000 first-year summer travel grants in 2002. The four grant recipients and their destinations were Max Fischer’05, El Salvador; Steve Poon’05, South Africa; Natalie Bowman’05, Peru; and Christine Duzyj’05, Ukraine.

1 Kate Nellans'05 in a mission clinic in Langano, Ethiopia, helping administer a well baby check of a 3-month-old. 2 Brian Su, a fourth-year medical student, spent several months in South Africa designing and overseeing a clinical study for a new device used in flexor tendon surgery of the hand. His time in South Africa was part of his Doris Duke Clinical Research Fellowship. 3 Sheree Watson and Mason Bragg with children in the Dominican Republic who gathered around the visiting medical students. 4 Sheree Watson helped build a new elementary school while she was in the Dominican Republic. 5 Steve Poon'05 as tourist. P&S students visiting other countries to enrich their education often take time to see the sights. 6 Charlie Everett'05 at Machu Picchu in Peru. 7 Max Fischer'05 went to a northern El Salvador rural community to help study the effects of pesticide use. 8 Max Fischer with local high school students in El Salvador, preparing a community health survey to study the connection between pesticide use and health.

The IHO was also instrumental in obtaining an agreement last year from the four Health Sciences deans to create the Office for Global Health Training and Education. The office will coordinate opportunities for studies abroad at all schools and help provide resources in preparation for student travel. The office will develop new funding sources, help students obtain international health grants and fellowships, coordinate visa services and travel insurance options, conduct global health seminars, and maintain a web site.

Mr. Everett and Ms. Schantz-Dunn credit Dr. Edgar Housepian, head of the Office of International Affiliations and professor emeritus of neurosurgery, for his pivotal role as special adviser to IHO. “It’s critical that young people learn about problems around the globe,” says Dr. Housepian. “It gives them a sense of the health-care needs in other countries. They get to see for themselves what the problems are. The exposure to different cultures is a very valuable thing.”

Also in the forefront of preparing students for their international electives is Dr. Linda Lewis, senior associate dean and clinical professor of neurology. “We encourage overseas travel by students,” says Dr. Lewis. “It’s important for their development. International institutions like Columbia should have international doctors. It helps them take better care of patients back home. It’s also important for them to see what medicine is really like outside the United States, especially in developing countries.”

P&S has 18 formal contractual agreements with overseas institutions available to fourth-year students to engage in international clinical practice. The most popular elective locations are France and the United Kingdom, which each attracted nine students this spring. China and Ireland are the next most popular, followed by Australia and South Africa. The other countries that have hosted students or sent students to P&S are Guatemala, India, Ecuador, Spain, Sweden, Italy, Germany, Armenia, Japan, Korea, Lebanon, and Venezuela. In all, 52 students participated in overseas electives this year and 50 foreign students came or are coming to P&S from Lebanon, Australia, China, Sweden, Germany, Japan, France, Ireland, Scotland, and England. Fourth-year students have traditionally created electives of their own in Third World countries, upon approval of the student affairs office.

At least one-third of the fourth-year class elects to travel overseas. When students return, says Dr. Lewis, “they report this has a profound effect on their lives. They certainly see things differently.”

Dr. Lewis and Courtney Walsh, a Student Affairs staff member who coordinates the exchange program, help students find a faculty member with a connection to the country they are interested in. “There’s always someone with a connection,” says Dr. Lewis. Students have orientation sessions with their faculty advisers, who prepare them for ethnic and gender issues and adjustment to a new environment.

Dr. Laxmi Baxi, professor of clinical obstetrics and gynecology, is an adviser. Her connection is in Bombay, India, at the King Edward Memorial Hospital, Seth G.S. Medical College. When a student expresses interest in going to Bombay, Dr. Baxi first interviews the student to find out the student’s motivation to determine if it’s an appropriate destination for that student. “I look for students who really want to explore culture and want to act as a bridge between the two countries and its institutions,” says Dr. Baxi. “They need to portray a positive image of Columbia, because they’re acting as an ambassador for our school.”

Students visit new countries every year as contacts are established. Seoul, Korea, and Tokyo, Japan, have been added as destinations for students. Fourth-year student David Garrett was the first medical student to study at the St. Luke’s International Hospital in Japan during the summer between his first and second years. During his work at St. Luke’s in Tokyo, Mr. Garrett says he learned that Japanese patients typically want to know their medical care options, but then want the doctor to make decisions for them. “That was eye-opening to me. We learn in medical school that the patient is in charge and we shouldn’t be paternalistic unless the patient says to allow the doctor to make the decision.”

Mr. Garrett’s interest in Japanese culture began when he worked at a Japanese import-export company in the United States before entering medical school. The reasons students have for studying in a particular country vary, but they all share a desire to enhance their understanding of an indigenous culture and improve their communication skills with patients. Deidre Sawinski, a fourth-year student who went to Barcelona during the summer between her first and second years, participated in research on Parkinson’s disease and saw patients at a movement disorders clinic. She wanted to improve her language skills to better interact with the large population of Spanish-speaking patients in Washington Heights.

Improving language skills, says Ms. Sawinski, “helped me become more efficient in dealing with patients. Now they’re willing to tell me things they may not choose to tell family members when they’re interpreting for them. It’s very important to speak a patient’s language, especially when it’s concerning life and death issues. Most are delighted that I can speak to them. They’re happy to see that someone is making the effort.”

Faculty Overseas:
Learning Goes On After Medical School
Students aren’t the only ones who get away for enrichment abroad. Since the early days of P&S, faculty have traveled around the world to participate in surgical missions, clinical and teaching cooperatives, lectures, and humanitarian work.
Recent accomplishments among faculty working overseas include surgical missions by Dr. Steven M. Roser, Guttman Professor of Clinical Craniofacial Surgery, who led a team of health-care providers to China, Central and South America, and Mexico to perform surgery for children with cleft lip and palate deformities, and Dr. Neil Feldstein, assistant professor of clinical neurological surgery, who travels with a team to
Guatemala to treat infants and children with hydrocephalus and neural tube defects.
Teaching initiatives include the work of Dr. Solomon J. Cohen, special lecturer in pediatrics, who is part of a team of pediatricians on a children’s ward in Kosovo teaching local physicians the management of outpatient and inpatient complications.
Research endeavors include the work of Dr. Eric Hall, Higgins Professor of Radiation Biophysics and professor of radiation oncology, who has collaborative projects in Australia, China, and the United Kingdom, with studies that range from missed treatments in radiation oncology to hypersensitivity of mammalian cells, and Dr. Howard Worman, associate professor of medicine and of anatomy and cell biology, who is studying nuclear envelope
and muscle diseases with collaborating institutions in France, Japan, and Norway, funded by the Human Frontiers Science Program.
Overseas study by faculty often benefits Columbia’s local communities. One example is the overseas experience of Dr. Jennifer Downey, clinical professor of psychiatry, who won a fellowship from the Kornfeld Foundation to study the cultural aspects of Dominican cancer patients. Working as a consultation-liaison psychiatrist in the Herbert Irving Comprehensive Cancer Center, she had observed that Dominican patients interrupt their treatment fairly often, sometimes with severe consequences to their health. Dr. Downey spent her first trip to the Dominican Republic last year studying the language,
living with a Spanish-speaking family, and attending school. Her next two trips were spent in oncology hospital units. Following a trip in September 2002, Dr. Downey returned with “insight to what our Dominican patients expect from us. It was incredibly educational.” She discovered that although many people live in poverty without access to medical care, they have strong family support. “It gave me an appreciation of what patients miss when they come here for treatment,” says Dr. Downey. “We need to recognize that at points even in the middle of treatment our Dominican patients may have the impulse to go back home for family support. To them, our medical system seems very cold and we need to find ways to make it more friendly and accessible.”

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