|PHOTO CREDIT: CHRISTOPHER BOYLE
CHRISTOPHER BOYLE’10 ENTERED P&S IN 2006 WITH AN INTERESTin health in the developing world. By the end of the summer of 2007, he had spent nearly eight weeks in some of the poorest villages in Rwanda.
Mr. Boyle was one of 12 first-year and fourth-year P&S students who traveled to Africa as part of the school’s inaugural partnership with the Millennium Villages Project (MVP), an integrated development initiative meant to demonstrate that the poorest people in Africa can lift themselves out of poverty through a multidisciplinary approach that simultaneously addresses many sectors of extreme poverty, including health, education, infrastructure, and agriculture.
What sets MVP apart from other P&S international experiences is that medical students pursue non-clinical projects rather than provide clinical care. Students focus on tasks of importance to individual villages.
Operated by Columbia’s Earth Institute, the United Nations Development Programme, and a non-profit organization called Millennium Promise, MVP has been working since 2004 with local communities, non-governmental organizations, and governments in 10 African countries at 12 sites to break the cycle of poverty. “MVP is not philanthropy or development in the usual sense,” explains Sonia Ehrlich Sachs, M.D., MPH, senior scientist at the Earth Institute, health coordinator of Millennium Villages, and director of the P&S student program. Her husband, Jeffrey Sachs, the world-renowned economist who spearheaded MVP, is director of the Earth Institute, has faculty appointments as the Quetelet Professor in Sustainable Development and in health policy and management at the Mailman School of Public Health, and is special adviser on the Millennium Development Goals to the Secretary-General of the United Nations.
“It is evidence-based,” Dr. Sonia Sachs adds. “All the interventions recommended have a consensus of opinion and are science-based. We are not researching new interventions but proving to the world that the keys to development already exist but the missing element is the integrative approach to using them.” Ongoing field research in the villages measures the effectiveness of interventions.
Students spurred partnership
Although Mr. Boyle had never been to a developing country, since college he has been interested in Rwanda and the progress in the country after recent political events. In 2003, Rwanda held presidential and legislative elections, nine years after the genocide estimated to have killed approximately 800,000 people, the majority of them Tutsis, the country’s minority ethnic group. In the first semester of medical school, Mr. Boyle expressed his interest in international health to Jake Doll’09, who had gone to Uganda from July through August of 2006 through MVP aegis but not a formal P&S program.
Mr. Doll told Dr. Sachs about his passion for international health and his work as a Peace Corps volunteer in Mozambique from 2002 to 2004. During his first semester at P&S, Mr. Doll helped research and write a handbook for MVP on best practices in diagnosing and treating hookworm, schistosomiasis, and trachoma, common and treatable diseases in Africa.
Mr. Doll went to Uganda with funding from the Arnold P. Gold Foundation, which supports humanism in medicine. While there, he helped the MVP team in Ruhiira, Uganda, begin a health needs assessment. When Mr. Doll returned to P&S, he shared his enthusiasm about MVP with Lisa Mellman, M.D., senior associate dean for student affairs, and with other P&S students. Meetings with students and Earth Institute administrators led to the creation of a formal MVP program in the fall of 2006.
The Harold Brown International Travel Fellowship and a newly created Houston Foundation pays for four first-year students (two Brown Scholars and two Houston Scholars). James Houston’08, a fifth year M.D./MPH student, helped create the Houston scholarship. “In my fourth year, an opportunity came about in the creation of a small family foundation by my grandmother, and I was able to persuade the foundation to donate $25,000 to support medical student internships in public health, which was matched by the Brown travel fund,” Mr. Houston says.
Dr. Brown was an internationally recognized infectious disease expert and legendary P&S teacher. The P&S Class of 1953 initiated an endowment in his name to support travel in the developing world, including fourth-year student participation in MVP. Other support is available. David Antonio Sola-Del Valle’10, who went to Senegal, obtained a dean’s international scholarship, and Nicholas Donin’10, who went to Uganda, received a Gold fellowship.
Many types of projects
Mr. Boyle, like his classmates, worked on several projects while in Africa. At first, he helped the MVP team in Kigali, Rwanda’s capital, in its development of epidemiological surveys for five neglected tropical diseases — schistosomiasis, elephantiasis, river blindness, soil-transmitted
helminthiasis, and trachoma — to pinpoint their prevalence. In Nyamata, his major project was to organize photography drives to enable people to enroll in health insurance programs. “Insurance requires a photograph,” Mr. Boyle says. “The problem for the villagers is that
getting a picture taken means taking their whole families
50 kilometers along dirt roads to a studio and paying more for each photo than the entire yearly premium on their health insurance.” So Mr. Boyle went to each of the health centers in the villages and took photographs with his own digital camera. He printed the pictures using a laser printer in the Nyamata hospital and took prints to each clinic.
Mr. Boyle also proposed a way to improve ambulance service in 11 villages. Three of the villages each have an ambulance to transport patients to the hospital in Nyamata, Mr. Boyle explains. The other eight share one ambulance parked in Nyamata and frequently unavailable because of high demand. The closest village is 30 minutes away from Nyamata; the farthest, 90 minutes away. Mr. Boyle proposed either increasing the number of vehicles available or redistributing the four ambulances to be shared among two or three villages.
Mr. Sola-Del Valle worked with Alison Binkowski, a graduate student in the Columbia School of International and Public Affairs and the Mailman School of Public Health, in Senegal to develop a computerized medication tracking system for Leona, one of the villages. The clinic had used a paper system to track up to 500 drugs distributed free to approximately 1,000 patients. The students created a database to determine the amount of each medication distributed, its use by a patient, and the ongoing need for the medication.
They took a computer to Leona’s health clinic — the clinic’s first computer — and trained a staff member to run the tracking program. The staff member, a woman from the village, became the first woman in Leona to use a computer. “The medication tracking program developed because both of us — with our different backgrounds and skill sets — were there together,” says Ms. Binkowski, who is studying for a master’s degree in international affairs and an MPH. “One of the greatest advantages of the MVP experience is the ability to cross-pollinate ideas and collaborate across disciplines.”
Charles Daniel Schnorr’10 went to Malawi to refine the health curriculum. “Although a curriculum existed for all eight years of primary school, it was not being used,” Mr. Schnorr says. He and the Malawi team met with Ministry of Education officials and teachers and surveyed students about their health knowledge. Teachers said they didn’t know how to teach the existing curriculum, so Mr. Schnorr recommended MVP devise 10 major lessons, including lectures about HIV prevention and transmission, as part of a new curriculum that teachers can follow.
David Wing’07 (now an orthopedic surgery resident at Massachusetts General Hospital), Matthew Wessel’07 (now an ophthalmology resident at Cornell), and Judy Chertok’07 (now a family medicine resident at Columbia) were in the first group to participate with MVP during their fourth year. They assessed the hospital and clinics serving the Mbola village cluster in Tanzania during January and February 2007.
Determining whether villagers who received bed nets actually used them was the project Scott Fruhan’10 undertook in Mali. Members of the villages received the bed nets nine months earlier. He surveyed 100 random families in 30 villages.
Impact on their future
The students say the people they met and their experiences in Africa with MVP were meaningful for them as individuals and as future physicians. “The experience made me very sensitive to people who have no options,” says Nicholas Donin’10, who surveyed attitudes toward family planning in Uganda. “I met so many people who are very smart, but there are no jobs. If I were born there, I too would be a subsistence farmer. The idea that people can pull themselves up by their bootstraps is absurd if there are no boots or straps.”
Akhila Kosaraju’07 went to Tanzania in the summer of 2007 to assess how MVP could work with the government and other NGOs on prevention and treatment of HIV/AIDS. She has since accepted an appointment with the U.S. Department of Defense. “As this job is grounded in international health, it will apply many of the lessons I learned with MVP. I would love to stay involved with MVP in the future. There is so much room for positive change,” Dr. Kosaraju says.