As Bedoor Alabbas raised her stethoscope, the 9-year-old Haitian girl she was examining shyly flinched away. What was this thing? Bedoor asked permission of the girl’s mother, then placed the earpieces on the girl’s head and the chestpiece on her own heart. Lub-dub, lub-dub. The child’s eyes widened and she began to giggle. “Then I asked if I could listen to her,” Alabbas recalled, “and the girl agreed.”
This was not something Bedoor might have experienced — or even imagined — at home in Saudi Arabia. “My experience in Haiti taught me to appreciate the basic things we have,” said the 28-year-old who recently completed the GW Medical Research Fellowship Program and began her residency at GW in June. “Medically, it increased my critical thinking, the ability to assess a patient quickly, and it definitely increased my confidence.”
Since 2004, the Office of International Medicine Programs (IMP) at the GW School of Medicine and Health Sciences (SMHS) has been sending medical, health sciences, public health, and nursing students to participate in Project Medishare in Haiti. In the spring of 2016, IMP decided to “cross-pollinate” its programs, and it opened the Haiti Mission, as it is known, to applicants from the Medical Research Fellowship Program (MRFP), a 12-month research program for international medical graduates. The result: an enhancement of both IMP programs through an additional layer of the exchange of knowledge, culture, and capacity.
“This is a great example of multiple programs intersecting and bringing together SMHS faculty, U.S.-based medical students, and international students,” says Rachael Fellabaum, program manager and international liaison for the IMP office. “The main purpose of our office is to facilitate international activities that support the SMHS mission of improving the health of our local, national, and global communities.”
Alabbas was one of 23 fellows in the most recent cohort of the MRFP. The 12-month program is designed to serve as an enhancement for international medical graduates planning to apply to residency training programs in the United States. Fellows are familiarized with the U.S. medical system and practice, aided in developing the research skills and activities that may lead to publication in peer-reviewed journals, offered one-on-one mentorships and career guidance, and through workshops aimed at meeting the unique needs of foreign medical graduates, taught how to augment their personal and leadership skills.
The Saudi government asked GW to create a program for its medical school graduates “to increase their research skills and increase their chances of matching for residency,” says IMP Program Manager Rodrigo Castillo. IMP launched the fellowship program in 2012. In April, 20 of the 23 fellows in the program matched in the United States or Canada, he notes. The overall program success matching rate is 85 percent compared to 50 percent for all international medical graduates in the U.S. (NRMP 2015 Annual Report).
“Our goals are for the fellows to learn about the American health care system, to really explore what it’s like to work with other researchers in a clinical setting, and to do research,” says Castillo.
In 2016, Castillo says, IMP decided to open the Haiti Mission to the MRFP fellows. “We have this mission every year, and we wondered, why haven’t we opened it to our fellows?” he recalls. Project Medishare for Haiti was founded in 1995 by doctors at the University of Miami School of Medicine. SMHS has been sending groups of medical, health sciences, public health, and nursing students, supervised by SMHS and School of Nursing faculty, on medical missions to Thomonde, Haiti, for a dozen years. The one- or two-week missions are generally staged in spring and summer, with students working in rural Haiti and treating nearly 200 patients a day with supervising physicians.
Sending citizens of one of the richest countries on earth to one of the poorest was carefully considered. To compare, the Gross Domestic Product (GDP) in Saudi Arabia was worth 746.25 billion US dollars in 2014 and represents 1.20 percent of the world economy. The GDP in Haiti was worth 8.71 billion US dollars and represents 0.01 percent of the world economy.
Thus, it was a trial year for the program, as Castillo explains, and that fact was reflected in the application process. Part of the application was designed to assess candidates’ level of motivation, whether they had previously done community service, and if they had any engagement in the third world.
“Our goals for them on the mission are to improve their skills and conduct clinical work in a difficult setting in a third-world environment, which could be life-changing,” says Castillo.
They succeeded. Each of the three fellows who participated in the mission was profoundly moved by the abject poverty they saw and the lack of food and clean water, and each came away with the desire to commit some portion of time to similar missions or community service.
“The mission made me aware that this was something I’d like to do again,” says Ahmed Alsaiari, 29, of Jeddah. “Even though what I did was very small, it was really appreciated by the people, who waited in line two or three hours to see us.”
Alsaiari, who began his residency at Ochsner Foundation Clinic in New Orleans in June, is married and has a 4-year-old son, and he found the experience enlightening. “I come from a different culture in Saudi Arabia,” he says, “and I appreciated talking to others, especially the attending [physician], about medical practices and advances elsewhere.”
The six-day program includes four days in a mobile clinic, with teams assigned to triage, adults, pediatric, and women’s health. A fifth day of community service involved home visits where fellows could gain further understanding of the severity of health problems in Haiti. The fellows said they learned to think creatively, make quick diagnoses, and provide care with scant resources.
The fellows, co-supervised by a team of GW physicians, treated problems such as malnutrition and respiratory issues in children as well as adult diabetes, arthritis, and hypertension. The multidisciplinary team also performed examinations and administered much-needed medications. They also left behind desperately needed medicine and health care information for conditions ranging from malnutrition to tuberculosis, and from untreated pediatric cancer to AIDS.
“I cannot imagine having applied for residency without [the GW Medical Research and Fellowship] program,” says Alabbas. “It’s difficult for a foreigner, so this prepared me and helped me a lot to be a strong candidate.”
Hanan Alkhaldi, 28, who recently started her residency at the University of Maryland, says she feels motivated “to do more of these missions, whenever I get the chance. It was one of the best things I’ve done in my life.”
She adds, “I knew [Haiti] was poor but I was surprised by the level of poverty. Everybody [we met] is malnourished and looks younger than their age. I know we couldn’t spend as much time as we wanted with any patients, but still I tried to slow down and spend a little more time. I felt the people we saw were thankful for small things.”
The March 2016 Medical Mission also included students from SHMS, the School of Nursing, the Milken Institute School of Public Health, and faculty leaders. Liqi Shu, a first-year medical student from Hangzhou, China, was a mission participant and says he benefited from his interaction with Alsaiari, who told him about MRFP, and from medical faculty who were attending. “It was a great experience,” says Shu, the son of two doctors.
“Global health is a shared responsibility,” explains Huda M. Ayas, Ed.D. ’06, M.B.A. ’98, M.H.S.A. ’93, associate dean for international medicine and executive director of IMP. “When the question was asked about the possibility of our medical research fellows participating in the Haiti mission, it was a natural yes. Thanks to Project Medishare and the people of Haiti, our three medical research fellows had a transformational learning experience that they otherwise would not have had in their home country of Saudi Arabia. Our plan is to continue thinking of ways where we can leverage our 57 partnerships in 25 countries to benefit GW as well as the international community.”
Adds Fellabaum: “I think the expectation for the fellows is that, long-term, they will expand their understanding of what it means to be a medical doctor.”
Following Hurricane Matthew in the fall of 2016, the GW medical community is building on its long history of providing aid to Haiti; with the partnership now in its 12th year, the university and Project Medishare, led by Jack Summer, M.D. ’81, clinical associate professor of medicine at SMHS, continues to send students on medical missions, particularly to the country’s Central Plateau. A university-wide working group is also developing a plan to support Haiti after the devastating effects of the hurricane.