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Rad Impact/ECUREI – Christina Kinnevey, MD

Written by Christina Kinnevey, MD, Fellow at Kaiser Permanente Napa-Solano Community Medicine & Global Health Fellowship Program while on Global Health rotation with Rad Impact in partnership with ECUREI in Kampala, Uganda in June 2018

“A Lesson in Flexibility”

If there is one thing I learned in leading this trip to Uganda for the past two years, it that no matter how much we plan ahead, we still need to plan for plans to change.  Last year, two of us on the team arrived at the airport on the morning of our travels to discover the tickets to Uganda we had purchased had not actually gone through and been ticketed and we did not have a seat on the plane.  This year, while our journey started out smoother, during our route to…

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Labor and Delivery, Traditional Birth Attendant Training, and Women’s Health – Sarah Simmons, MD

Written by Sarah Simmons, MD, PGY-2 at Kaiser Permanente San Francisco Obstetrics & Gynecology Program while on Global Health rotation at Funbichoco/Hospital San Francisco de Asis, E.S.E., in Quibdo, Choco, Colombia in January-February 2017.

I had been to Colombia before, but under much different circumstances as a tourist visiting the country’s largest tourist attractions of Bogota and Cartagena. This time I flew into Quibdo, a small city of 100,000 inhabitants that many Colombians have never been to, let alone foreigners.

Quibdo is humid, densely packed, surrounded by thick rainforests, and located near the Pacific Coast. It is separated from more major cities by muddy, unpaved roads and a network of rivers. Quibdo is located in the poorest state of Colombia (Choco) and is inhabited largely by Afro-Caribbeans, although there is a minority indigenous population who live on the city’s outskirts and neighboring villages reachable by boat.

Our first week was spent working shifts on Labor and Delivery at San Francisco Hospital working side by side with local Family Medicine and OB/GYN physicians delivering babies, triaging consults, and rounding on antepartum patients. Particularly unique cases included

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Kapenguria District Hospital – Chemtai Mungo, MD

Written by Chemtai Mungo, MD, PGY-3 at Kaiser Permanente San Francisco Obstetrics & Gynecology Program while on Global Health rotation at the Kapenguria District Hospital in Kapenguria, Kenya in December 2016.

I spent my 3rd year rotation at Kapenguria District Hospital (KDH), in Western Kenya. Kapenguria is a small town of approximately 300,000 people, located in West Pokot District, in Western Kenya. The District hospital in Kapenguria is a regional referral hospital serving this population, as well as the surrounding region. The West Pokot District of Western Kenya is a rural, marginalized area of Kenya, where the population faces a heavy burden of maternal and neonatal mortality due to lack of timely access to medical care, inadequate numbers of providers, as well as the burden of the HIV/AIDS. Maternal mortality and morbidity are exacerbated by the practice of female genital cutting, which women in

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Karvan Public Health Center – Bhakti Patel, MD

Written by Bhakti Patel, MD, PGY-3 at Kaiser Permanente Oakland OB/GYN Program while on Global Health rotation at Karvan Public Health Center in Kayavarohan, Gujarat, India from November-December 2016.

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My Global Health Rotation was in India, specifically at an urgent care clinic in a rural town outside of the large city of Vadodara (Baroda) in the state of Gujarat, which is a few hours north of Bombay. The site is a government-run Primary/Public Health Center (PHC) which has two employed physicians, one as the chief Medical Officer (MO) who supervises the site and faculty, and one Ayurvedic doctor, as well as an onsite pharmacist, lab technician (who does on-site AFB and malaria culturing), medical assistants, and employed health care workers who draw blood work, give vaccinations, and travel to nearby villages to promote health care and prevention. I worked with both doctors but primarily Dr. Mewada, the MO at the site. But I did have the opportunity to learn some insight into Ayurvedic medicine and patient views on disease and illness particular to the culture of Gujarat. I also had the opportunity to improve my

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Matibabu Foundation – Deepika Parmar, MD

Written by Deepika Parmar, MD, PGY-2 at Kaiser Permanente Oakland Pediatrics Program while on Global Health rotation at Matibabu Foundation in Ukwala, Kenya in October-November 2016.

Matibabu Foundation Hospital is a Level 4 hospital located in Ukwala, Kenya serving the community at large. *Note: Kenya Level 1= pharmacy; Level 2= dispensary; Level 3= Clinic with pharmacy; Level 4= inpatient hospital with outpatient clinic, lab, pharmacy; Level 5= inpatient hospital with intensive care unit and some sub-specialties; Level 6= referral center.* It is primarily privately-funded via Tiba Foundation, Dutch Rehabilitation non-profit organizations for the disabled and other private donors. They have an inpatient unit with laboratory services, maternity services (pre-/post- labor), maternal child health services but does not have ICU level care. They see patients in on-site outpatient medical clinics, HIV clinic, optometry clinic, dental clinic, and pharmacies. They excel in community health-based projects including reproductive health services, cervical cancer screening and cryotherapy, disability support/physiotherapy/orthopedic device fitting, HIV screening, and many other community based projects. Social services and fieldworkers identify families in greatest need qualifying for government subsidies. Many families have been

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Hospital de la Familia – Jonathan Lin, MD

Written by Jonathan Lin, MD, PGY-3 at Kaiser Permanente Oakland Otolaryngology Program while on Global Health rotation at Hospital de la Familia in Nuevo Progreso, Guatemala in November 2016.

As a third year resident physician in Otolaryngology-Head and Neck Surgery,
I had the amazing opportunity to be part of a surgical mission trip to Nuevo
Progreso, Guatemala. As a resident in a busy surgical residency, I cherish any
opportunity I have to get away from the usual “grind.” In this case, it meant going
somewhere new to try and improve the health of people living in a community.
Having gone on mission trips as an undergraduate, I learned early on that as
foreigners visiting a country, the residents of that community often

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Hospital de la Familia – Alexander Rivero, MD

Written by Alexander Rivero, MD, PGY-4 at Kaiser Permanente Oakland Otolaryngology Program while on Global Health rotation at Hospital de la Familia in Nuevo Progreso, Guatemala in November 2016.

A known entity – this time, I was less nervous and more confident as we took our 12 plus hour journey from San Francisco to Nuevo Progreso, Guatemala. I felt empowered, sharing with my co-resident, Dr. Jonathan Lin, the ins-and-outs of the trip like when we would have a rest stop along the long way or to make sure and wear pants because they blast the air conditioning on the bus. We were greeted by the staff and locals with a small fireworks display as per custom and unloaded our bags quickly as we dawned our scrubs to start a planned clinic that same day. We immediately began signing several patients up for surgery the following day. As a senior resident on the trip, I was able to have first pick at the complex cases as well as provide guidance on OR planning and scheduling. The transition from spectator on my first trip to Hospital de la Familia (HDLF) to active learner and organizer this time was perhaps the most notable change for me. I quickly realized that

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Reflections on Belize

Written by Luke Rohlwing, MD, PGY4 at Kaiser Permanente Oakland Internal Medicine Program while on Global Health rotation with Hillside Health Care Center in Eldridge, Belize in February-March 2016.

I had never traveled to a developing country prior to my trip to Belize.  Prior to embarking, I naively thought that the combo of my upbringing in a lower-income rural town in the Midwest, and later travel and studying abroad in Europe, were the right combination to prepare me for my trip.  Although my prior time outside the U.S. was mainly in developed nations, I was a seasoned traveler and well-prepared for a good amount that I might encounter, whether it be socially or culturally.  What I hadn’t considered though, is despite having worked with underserved populations and communities back home, this was the first time I had ever traveled outside the U.S. to serve as a physician.

The connecting flight on a twin engine prop plane – the type where a form asks for your weight before getting on so they can pre-assign your seat to distribute weight properly – and the seven-hour school bus ride along the length of the country were both new to me, but were a strangely exciting welcome.  However, I recall being struck by the reality of my location and situation when the bus pulled to the side of the road to let me and a colleague off in what I could best describe as farthest-suburb-of-distant-city meets dense jungle.  My caution was also slightly heightened when the bus driver gave the directions of “walk up that (gravel and dirt) road a little ways and you’ll find the clinic.”  What had I gotten myself into?

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Vivekananda Memorial Hospital – Morgan Gilani, MD

Written by Morgan Gilani, MD PGY2 at San Francisco Internal Medicine on a Global Health rotation in Sargur, India with the Swami Vivekananda Youth Movement.

Gratitude.  My time working with the Swami Vivekananada Youth Movement (SVYM) this spring has been an integral part of my residency training. I joined a group from Kaiser Woodland Hills which included mostly family practice doctors, some in training, a rheumatologist, a pre-PA student, and an attorney. We were greeted at the airport in Bangalore and quickly whisked off to Mysore, currently ranked the cleanest city in India on a very hot and humid Sunday morning at 4 AM. Our visit in Mysore was brief and only a layover on our journey farther south to Sargur.  However, during our brief day and a half, we were very graciously introduced to SVYM, its main campus, and had the honor of meeting with two of the doctors who had founded the NGO about 30 years ago including Dr. Balasurbramaniam, or as he shortens- Dr. Balu. What started as a 9 bed hospital on the forest’s edge outside of Sargur has grown into a 90 bed hospital with subspecialty care. The populations served includes rural and 5 different tribal communities which have been displaced from the forest, now two National Reserves. In their longitudinal involvement and growth over the past 30 years in working with these communities it was interesting to

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Daet, Philippines – Bay Area Surgical Mission – Stephanie Cizek, MD

Written by Stephanie Cizek, MD, PGY3 at Kaiser Permanente San Francisco OB/GYN Residency Program on a Global Health rotation with Bay Area Surgical Mission in Daet, Philippines.

Mary has fibroids.  Common, benign tumors on the uterus, which for her have grown disproportionately large, causing abdominal pain and heavy bleeding with her periods.  She has lost so much blood that she is chronically anemic, and her fibroids have grown so large on her tiny frame that she appears 20 weeks pregnant.  She has had surgery for this problem before — 15 years ago, a group of surgeons on a surgical mission trip landed near Mary’s hometown in the Philippines for a week to provide free surgery.  She has a large 15cm scar across her abdomen, but the surgery

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