The Hillside Clinic in the Toledo District of Southern Belize serves as an international clinical elective site for University of Wisconsin health professional students. Operated by Hillside Health Care International (HHCI), a non-governmental organization based in the United States, Hillside has been providing on-site medical care, mobile clinics, home visits, rehabilitation services, and educational programs through its clinic located in Eldridge since 2000. Hillside relies on a dedicated Belizean staff and international volunteers for its daily operations. HHCI also hosts medical, nursing, physician assistant, pharmacy and public health students and residents from UW and other institutions on 4+ week elective rotations each month. HHCI aims to promote healthy global attitudes through the provision of a culturally-rich educational program and clinical experience for students and residents so that they can better understand their role in the global health arena. Despite the difficult economic times, the Hillside Clinic continues to expand clinical services and educational opportunities for future health care professionals. Highlights from the past year follow:

• Hillside celebrated the opening of a new dormitory facility, Abby’s House, named for a past student volunteer, Abigail Brinkman, MD, offering improved space and facilities for our students and volunteers. Over 100 Belizean dignitaries, board members, community members, patients, and students attended the grand opening ceremony in November, 2008.

• HCCI has partnered with the UW School of Pharmacy, Drake University and the University of Iowa to create a new pharmacy student rotation. They have committed to sending one faculty member and two students each month during the year to make this program a success.

• A UW Masters in Public Health student, Matt Gigot, spent 10 weeks at the clinic performing an analysis of the clinic’s charting system to help defi ne the clinic’s patient population and streamline the process by which patient data is organized and utilized. He also set up an efficient and repeatable template for ongoing recording of patient data which can be performed by the Belizean staff.

• In January, UW physical therapy students and faculty participated in a two-week service learning project in Punta Gorda. Hillside provided housing for this team while they participated in community and elementary schools health talks, body mechanics talks to the local hospital staff, orthopedic clinics to walk-in patients, home visits, and the building of a wheelchair ramp at the Hillside Clinic.

• During March and April 2009, UW medical and PA students performed an assessment of the food security of five Mayan villages through interviews and focus groups. Results were reported to local government officials, non-governmental organizations, and key informants interested in working with Hillside. Programs are now being developed to meet the determined needs to improve the nutritional status of residents in the area.

• In May of 2009, Hillside hosted the second annual Hillside/UW alumni reunion fundraiser, bringing together current and past UW students and affi liates to celebrate the work that has been done and continues to be done in Belize.

Liaisons continued between the SMPH and the growing primary health care movement in the Peoples’ Republic of China. As part of the Department of Family Medicine’s ongoing exchange program with FuXing Hospital/Yuetan Community Health Services Family Medicine program, three DFM faculty members-- Kenneth Kushner, PhD, Michael Ostrov, MD and David North, MD—participated in the Seventh Beijing Symposium on Family Medicine and Community Health Services in August, 2008. They also traveled to Xi’an to participate in a regional conference.

A group of Chinese physicians and health care administrators were scheduled to visit Madison in May of 2009. In addition, two of them intended to stay on for two more weeks to observe our clinical, educational and administrative practices as part of our exchange program. However, they had to postpone their trip due to the H1N1 influenza epidemic. They are now scheduled to arrive in October 2009.

Scholarly ties continued between SMPH faculty and Chinese primary care institutions. Kenneth Kushner, PhD and Jie Wang, MD have become co-editors on a column entitled “Critical Incidents” in the Chinese Journal of General Practice. John Frey, MD, Chair Emeritus, UW Department of Family Medicine, has recently joined the editorial board of the same journal.

Marion Ceraso, Population Health Sciences, and former UW graduate student Dr. Xiadong Kuang published an article in conjunction with American and Chinese co-authors, based on research sponsored by the CGH (Ceraso, M; McElroy, J.; Kuang, X; Vila, P; Du, Lu, L.; Ren, H.; Qian, N; Jorenby, D.;Fiore, M. Smoking, barriers to quitting, and smoking-related knowledge, attitudes, and patient practices among male physicians in China. Prev. Chronic Dis, 2009, 6(1), pp. 1-6.)

The UW SMPH will offer a Traditional Chinese Medicine clinical elective again next year. Three fourth year SMPH students plan to spend a month in Beijing and Tianjin to observe traditional practices incommunity health service centers.

As a result of the Ecuador Field School, the CGH has developed relationships with a number of partners, including health care delivery organizations, non-governmental organizations, universities, and community leaders. These relationships allow us to develop field experiences for students that are mutually beneficial to them and the partner organizations. Furthermore, these partnerships present options for future service learning and applied research. Some of these initiatives follow.

Andean Health and Development - Dr. David Gaus of the UW Department of Family Medicine has worked in Ecuador for over 10 years, building health care service delivery capacity that is both affordable and of high quality. He has organized clinical rotations for medical and pharmacy students and is a contributing faculty member to the Ecuador Field School.

San Luis de Otavalo Hospital – The Otavalo Hospital is a principal public facility that provides care to populations in and around Otavalo, where the field school is based. The hospital has provided tours for UW students and in recent years has arranged for UW students to observe surgeries and births. Specific attention in summer 2009 was focused on the vertical birth pilot project. A primary objective of this project, centered on a birthing room that seeks to reproduce the environment in a traditional indigenous home, is to encourage more women to give birth at the hospital rather than at home. As a related activity, the UW team worked with the hospital’s director of health education (a Quichua-speaking indigenous woman) to bring information about the project, and the country’s law of free maternal health care to women in a poor indigenous community outside Otavalo. Projects at the hospital were supervised by Dr. Alfredo Vela, who expressed interest in future research, particularly in projects related to maternal and infant health.

Ceiba Foundation – The Ceiba Foundation conducts environmental education and preservation and is led by Joe Meisel and Catherine Woodard, who have strong UW affi liations and are involved in the UW Study Abroad Program in Ecuador. During the summer of 2008 they served as advisors to 4 health science students who are conducting MPH fi eld work in their area. We hope this will evolve into an internship open to graduate students from a variety of disciplines in the future.

Comuna de La Calera and Comuna de Yambiro – Dr. Frank Hutchins and the UW global health faculty involved in the Ecuador fi eld school have conducted small-scale service learning projects in rural communities over the past 4 years. Relationships with community leaders have evolved, and these new relationships guide course activities that are responsive to community needs. In addition to group projects, there are excellent opportunities for individual student projects.

Ali Shungu Foundation - The Ali Shungu Foundation conducts small-scale development projects in the area around Otavalo. Foundation head Frank Keifer is a long-term resident of Ecuador. The foundation was a partner in the 2008 water and sanitation project carried out by UW engineering students.

University of San Fransico de Quito (USF) - The Ecuador Field School includes orientation activities at the USF where colleagues have expressed interest in joint education and research projects that could involve students from both institutions. Dr. Fernando Ortega, director of the USF community development department, has worked with interdisciplinary teams in rural Ecuador. He has assisted UW student researchers in environmental health.

Jambi Huasi Medical Clinic – This Otavalo-based clinic, one of the first in Latin American to integrate indigenous and Western medicine, offers an alternative set of treatments to both mestizo and indigenous populations. Its pioneering history and its culturally sensitive approach to health care provision have made this an excellent partner organization for the UW program. Students have volunteered at the clinic, joined clinic staff for health interventions in poor communities, and worked to help clear the clinic’s medicinal plant garden. The director of the clinic has been instrumental in helping the UW program make connections with other organizations and individuals in the Otavalo area.

Ecuador has served as a stable and fruitful site for partnerships and educational programs. The CGH plans to expand opportunities in education, research and community-based service learning in the coming years.

Ethiopia

Background
The American International Health Alliance (AIHA) has established a new partnership through its HIV/AIDS Twinning Center Program that will support the US President’s Emergency Plan for AIDS Relief (PEPFAR) by building critical institutional and human resource capacity in the field of emergency medicine. Established with support from CDC/Ethiopia and in close cooperation with the Ethiopian Ministry of Health, this partnership is the Twinning Center’s seventh in the country.

Partnerships
The University of Wisconsin-Madison (UW) was selected as the lead US partner, joining forces with People to People International (P2P), a nonprofit that harnesses the knowledge and expertise of Diaspora Ethiopians to help combat HIV/AIDS in their home country, a nation of more than 85 million people.  Led by Dr. Girma Tefera of the UW, a team of UW faculty and hospital staff is working with the Addis Ababa University (AAU) Faculty of Medicine and Black Lion Hospital to strengthen their capacity to provide quality care — including ART and treatment for opportunistic infections — to people living with HIV or AIDS. 

The AAU-UW twinning project was launched in July 2009 by a delegation of AAU faculty and AIHA staff that visited Madison to develop a work plan for the first year of the project. Cindy Haq, Frank Graziano, Ryan Wubben and Pete Rankin traveled to Addis Ababa in August 2009 to tour facilities, assess needs, and develop more detailed plans with AAU faculty, Black Lion and AIHA staff. They were joined by Efraim Kramer, consulting physician from South Africa. 

Site Visit to Ethiopia: Fall 2009
 ·    Toured Addis Ababa with Estehiwot (Mamae) Teklemariam, Ethiopia Twinning Project country director; Ellen Caldeira, Public Health Analyst, Global AIDS Program, US Dept of Health and Human Services, Health Resources and Services Administration; Professor Avye, Vice Chancellor and Dean of Social Work; Dr. Milliard, Dean Faculty of Medicine. 

·    Shared dinner with Dr. Jeanie Everson, family physician from Wisconsin, Fred Everson, teacher at Evangelical Theological College, and learned about conditions in Ethiopia from the perspective of expatriate physicians and their families.

 ·    Met with Drs. Milliard, Kramer, Aklilu and colleagues to tour St. Paul Hospital emergency room and new emergency facilities under construction.

 ·    Met with Dr. Milliard and AAU faculty from Internal Medicine, Pediatrics, Surgery, Obstetrics and Gynecology, Anesthesia, Infectious Diseases, Orthopedics, Emergency Nursing, Executive Director of Black Lion Hospital and Dr. Abraham of the Ministry of Health. Dr. Assefu Wtsadik presented an overview of emergency medicine services in Addis Ababa.  Members discussed existing gaps and priorities for the twinning partnership.

 ·    Toured Black Lion Hospital Emergency Department and hospital including critical care units, visited the Surgical Skills Lab and met director Dr. Ronald Lett of the Canadian Network for International Surgery. 

 ·    Presentation by Dr. Sisay on the history of the AAU Emergency Medicine Services and Training Department and recommendations of the Emergency Medicine Task Force. 

 ·    Reviewed HIV/AIDS testing, counseling and treatment programs for adults and children. Met with Dr. Thomas Kenyon, Director of the US Centers for Disease Control programs in Ethiopia to discuss national HIV/AIDS and PEPFAR programs and the rapid scale up of treatment programs for people with HIV/AIDS as well as support for orphans and vulnerable children.

 ·    Toured the new medical school (still under construction) and due to open by January 2010. The group assessed the space that will house the new Emergency Medicine Training Center.  
 ·    Ryan Wubben (UW) and Pete Ranking (UW) taught CPR and CCR to nursing students.

 Next Steps
This trip provided project partnerships the opportunity to meet, reflect and develop a collective action plan for the first year of the Twinning Project. The priorities identified as next steps are:
 1.      Develop and conduct fellowship to prepare AAU physicians and nurses to become leaders of Emergency Medicine in Ethiopia.
 2.      Strengthen the Black Lion Emergency Medicine Department, creating quality improvement research project, to include HIV/AIDS survey screenings and infection control.
 3.      Establish Emergency Medicine Training Center in Addis Ababa

The Center for Global Health works in partnership with the University of Guadalajara to carry out faculty exchanges, field experiences, and credit-based service learning opportunities for graduate and professional students in the areas of medicine, nursing, veterinary medicine, public health, and other health-related fields. This partnership takes place in a context of a sister-state relationship between Wisconsin and Jalisco, Mexico, and is supported by a University Partnership agreement between the University of Guadalajara and the University of Wisconsin System. 

The partnership aims to provide rich and stimulating teaching and learning environments for students and faculty from both schools, while enhancing quality of life for communities.  UW students who participate in the program will develop language skills, cultural skills and professional experience that will allow them to work internationally and to better serve the Hispanic population in Wisconsin.

Priorities for 2009-2010 include achieving excellence in service learning, developing small-scale research projects, continuing to host mutually beneficial faculty exchanges, and identifying additional sources of funding to sustain the partnership. 

 Objectives 2009-2010

• Carry out global health field experiences and interdisciplinary public health service-learning activities jointly with the University of Guadalajara at CUALTOS (Los Altos) and CUCSUR (Costa Sur).
   
• Continue to develop opportunities for clinical clerkships and/or residencies in medicine, veterinary medicine, nursing and pharmacy. 
   
• Continue to sponsor faculty and student exchange visits from the University of Guadalajara to Madison in fields related to Global Health.
   
• Monitor opportunities for mutually beneficial joint research.

Interdisciplinary Public Health Initiative:   A 3-year service-learning program supported by a Baldwin Grant was initiated in Tequililla, a rural town outside of Tepatitlan, in January of 2009. UW students and faculty are working together in areas of health and nutrition, environmental care, youth services and income generation.  The project takes place in the context of an ongoing university partnership with the University of Guadalajara at Los Altos (UDG), which is located in Wisconsin’s Sister-State, Jalisco.  In addition to achieving results at the community level, the partnership aims to enrich and strengthen community outreach and service-learning at both institutions.

The first field visit occurring in January of 2009, when a group of five UW students and two UW faculty worked alongside faculty and students from UDG to do interdisciplinary public health work during a community stay in Tequililla. Activities included the following:

·         An outreach clinic and health post visit where potential improvements to the health post were explored with the local nurse. UW students are now involved in the planning and development of plans to improve the health center to enhance privacy, capacity and quality of care.

·         School-based health education sessions included the local preschool (dental hygiene), elementary school (environmental health and safety)  and middle school (adolescent health issues). 

·         Students also worked with a developing cooperative on income possibilities (jam making). 

·         Students also conducted exploratory meetings and visits to better understand the use of medicinal herbs, the potential for community gardens at schools, the potential to enhance recycling and other aspects of environmental care.

Field Projects for Global Health Certificate and Health Science Students

• Clinical exchanges have been carried out by UW students in medicine (7) and veterinary medicine (1).  These activities have been customized to student interests and have allowed student to learn and shadow local providers in settings ranging from a state-of-the-art urban hospital to working with rural veterinary practitioners at farm sites around rural Guadalajara. (January 2005-present).
   
• In partnership with the Marshfield Clinic, a small-scale project to develop laboratory skills related to food safety is ongoing under the leadership of Dr. Fran Moore, Veterinary Medicine. (November 2006-present).
   
• In partnership with the Marshfield Clinic an exploratory assessment related to child safety and agricultural tasks was carried out in the summer of 2008.  (Medical students Nate and Connie Gundacker)
   
• UW Global Health Certificate candidate Nico Preston and UW-Richland Center faculty member Darby Oldenberg designed and participated in a Service-Learning initiative relating to water quality and environmental health at the CUCSUR campus.

Delegation and Study Tours at UW-Madison

Since the partnership in the health sciences began the UW Center for Global Health has hosted an annual study tour for faculty and students from UDG.  These visits include site visits to areas of professional interest, meetings with colleagues, experiential learning experiences, and a chance to become familiar with UW Madison and the many opportunities it offers.  To date exchange tours have hosted 4 nurses (2006), two visitors from veterinary medicine (2007), 2 lab technicians (2008), and a faculty member with 4 health-oriented students from agricultural sciences (2009).

Lectures and workshops in Mexico

• In March of 2009, Dr. Tom Yuill taught an 80 hour, 4 week intensive graduate-level course at the UDG’s University Center for the South Coast on wildlife diseases.
• Dr. Tom Yuill presented a week long course called “Transforming Agro-Industry: Workshop on Project Design, Planning, and Management.

• Dr. Peter Bosscher presented a workshop entitled “Supply and Treatment of Water and Solid Waste for a Sustainable Future” in January 2007.
• Dr. Peter Bosscher, Dr. Regina Dunst, Dr. Fran Moore, Dr. Tom Yuill, and Lori DiPrete Brown presented a series of lectures  on Rural Health at UDG-CUALTOS in November 2006.
• Lori DiPrete Brown presented lectures on Quality Assurance in Health Care and led various workshops and lectures for faculty on community-based research and service learning between 2005 and 2009.

These activities have been carried out with monetary support from the University of Guadalajara, the Center for Global Health, the Morgridge Center for Public Service, The Marshfield Clinic, the UW Latin America Caribbean and Iberian Studies Program, and the Ira and Ineva Reilly Baldwin Idea Endowment.

For more information contact Lori DiPrete Brown, Faculty Associate, Center for Global Health

Mahidol University
In 2004, Dr. Haq visited Mahidol University with Professor Ken Shapiro and the UW Thai Alumni Association. During this visit the UW established a Memorandum of Understanding (MOU) with Mahidol University. Collaborations between the Center for Global Health and the Faculty of Public Health from Mahidol University continue to evolve as illustrated by the following activities.

• Dr. Arpaporn Powwattana (Mahidol University Faculty of Public Health) was invited by the UW Center for Global Health and UW School of Nursing as a visiting faculty member in the spring of 2009. Dr. Powwattana gave seminars, discussed research opportunities and lectured in the Health and Disease in Thailand course during her two-week visit.

• Dr. Powwattana and Dr. Karen Solheim were awarded a research grant by the UW School of Nursing to compare undergraduate public health nursing curricula in the UW and Mahidol.

• Posters describing the interdisciplinary collaboration between the Center for Global Health and the Faculty of Public Health at Mahidol University have been presented at several venues this past year including:

          o Global Health Education Consortium meeting in Seattle, WA

          o 125th Anniversary Symposium and Rennebohm lecture at the UW School of Pharmacy

          o International meeting of the US-Thai Consortium in Madison, WI, July 2008

Naresuan University and Buddhachinaraj Hospital
The UW School of Pharmacy has signed an MOU with Naresuan University and Buddhachinaraj Hospital to promote cooperation in fi elds of education and academic research through faculty exchanges. Student exchanges have been occurring regularly for the past 3 years.

US-Thai Consortium
During the summer of 2008, the UW School of Pharmacy became one of 15 US Schools of Pharmacy that signed an MOU for 15 years of collaboration with 12 Thai Schools of Pharmacy to foster educational and research collaborations. UW had been an active member of the Consortium for the previous 10 years. An ad hoc committee was established to further defi ne and develop specifi c objectives for these collaborations. Dr. Curtis Johnson (Professor Emeritus, UW School of Pharmacy) chairs the ad hoc committee. Dr. Connie Kraus (UW School of Pharmacy) is also involved with this committee.

The CGH has continued to build partnerships in Uganda through education, research and development projects. Many UW health sciences faculty members are actively engaged in educational and/or research projects in Uganda. Professor Linda Baumann (School of Nursing; Population Health Sciences) and Dory Blobner (Faculty Associate, School of Nursing) are conducting research to train colleagues to improve care for patients with diabetes. Professor Ken Shapiro (CALS) leads training initiatives to improve nutrition and nutritional education for village health workers. Professor James Ntambi (Biochemistry and Nutritional Sciences), is conducting research on nutrition, diabetes and HIV/AIDS in Uganda. Solomy Ntambi, MSW (UW Hospital and Clinics) explored opportunities for social work and other health professional internships that are in development.

A growing number of UW SMPH faculty are contributing to UW-Ugandan partnership activities. Dr. Frank Graziano (Internal Medicine) continued his efforts to enhance the skills of Ugandan health professionals to provide antiretroviral therapy to people living with HIV/AIDS. Dr. Scott Mead (Internal Medicine) returned to Mbarara University in January, 2009 to teach internal medicine residents and faculty. Dr. Cindy Haq (Family Medicine) returned to Uganda in November, 2008 to continue assisting development of family medicine in East Africa with a consortium of European and North American faculty and universities. Dr. David Mann (Orthopedics) served as visiting faculty to Makerere University through Health Volunteers Overseas in October, 2008. Dr. Burr Eichelman (Psychiatry) is assisting with training of psychiatrists in Uganda.

UW-Madison has recruited two new faculty members who bring a strong portfolio of research and development projects in Uganda. Ajay Sethi, PhD, an infectious disease epidemiologist who specializes in HIV, antiretroviral therapy, and substance abuse, joined the Department of Population Health Sciences from Case Western Reserve University. He is engaged in projects to evaluate mobile antiretroviral pharmacy efforts funded by Doris Duke Charitable Foundation, and in HIV/AIDS fellowship training programs supported by the Fogarty International Center. He is supporting UW graduate students to join his research in Uganda.

Tony Goldberg, PhD, DVM, MS, a veterinary epidemiologist from the University of Illinois, joined the UW School of Veterinary Medicine in 2008. Dr. Goldberg has worked in Uganda since 1991, where he directs the Kibale EcoHealth Project, an interdisciplinary project focused on the ecology of infectious diseases transmitted among people, domestic animals, and wild non-human primates in the region of Kibale National Park in western Uganda(http://svmweb.vetmed.wisc.edu/KibaleEcoHealth/). Dr. Goldberg includes UW students and faculty in his projects in Uganda to promote the health of animals, people and the environment.