Global Health MPH Program Enters Next Phase

More than 30 students, including a half-dozen dual Doctor of Osteopathic Medicine-Master of Public Health candidates, arrived in February to serve internationally in Bolivia, Cambodia, India, Nepal, and Zambia, and domestically in Puerto Rico and at the U.S.-Mexico border.

Another of this year's dual College of Osteopathic Medicine-MPH candidates served this past fall with the nonprofit International Rescue Committee in Oakland.

The Global Health program is currently in the process of phasing out field study opportunities at the U.S.-Mexico border and in Puerto Rico to focus on international locales.

Alumna Recalls International Experiences

Samira Hameed, MSPAS/MPH 2019, did field study work in Cambodia the spring before graduating. The trip included six weeks of intensive work followed by two weeks during which program participants were allowed to explore the country.

Hameed is from Chicago and came to California for school, working for two years after graduation in the Emergency Department at Kaweah Delta District Hospital in Visalia before returning to Chicago to continue her work emergency room care.

She found she had an unexpected month between jobs in October 2022 and took the opportunity to take part in a second international program, this time through Loma Linda University at Béré Adventist Hospital in Béré, Chad. The hospital is affiliated with Loma Linda, which focuses on clinical work.

The two field experiences could not have been more different.

Her time in Cambodia focused solely on Public Heath, which focuses on research rather than clinical work. Her time in Chad included a great deal of clinical work. “I got to do things I normally don’t get to do in America, like deliveries,” she says. Hameed describes one mother who gave birth to a child who weighed less than 2 kilograms. She helped care for the child, who required a nasal feeding tube to survive after birth.

Diagnostic tools were limited at the hospital in Béré. There was no lab testing, no CT scanning equipment, and only one ultrasound machine that was used primarily for pregnancies, Hameed says. One surgeon would come to the hospital and perform what Hameed describes as open-close procedures to diagnose patients – a process she characterizes as the most invasive diagnostic technique available.

Hameed’s time working with an AIDS/HIV organization in Cambodia was buoyed by the fact that Cambodia has been highly successful in diagnosing and treating those who have HIV or AIDS. Cambodia is one of the few counties to achieve the Joint United Nations Programme on HIV/AIDS – known as UNAIDS – goal of 90-90-90 by 2020 to end the AIDS epidemic: 90% of people living with HIV know their status; 90% of those diagnosed with HIV infection receive antiviral treatments; and 90% of all people receiving those treatments have viral suppression.

“The U.S. still hasn’t done that,” she says.

Chad, by comparison, is rife with meningitis and malaria. Hameed says just about everyone, of all ages, contracts malaria, oftentimes multiple times. She treated numerous people with malaria and related cases of anemia and hoped she would not contract the disease herself from the bites of mosquitoes she says were “everywhere,” even though she took prophylactic medication before she arrived in Chad.

She never contracted the disease.

Chad also has a high infant mortality rate, with approximately 66 deaths for every 1,000 live births, the UN Inter-agency Group for Child Mortality Estimation reports. That’s about 12 times the infant mortality rate in the United States. Another 25 per 1,000 total births end in stillbirth in Chad, compared to fewer than three per 1,000 total births in the U.S.

Hameed says the mother of the infant who weighed less than 2 kilograms at birth would not cuddle her child while it had a nasal feeding tube in place, to avoid making a connection with the infant, who the mother feared would die. That was despite being told the baby would only have the feeding tube until it was strong enough to nurse on its own. But once the feeding tube was removed, the mother began to hold and cuddle her child.

Touro University California students in Cambodia lived in what Hameed describes as a “boutique hotel.” By way of comparison, she slept on a hospital bed while in Chad, with bathrooms and showers outdoors. “It’s essentially like you’re camping for a month,” she says.

Hameed lost about 10 pounds during her stay in Chad due to a diet that consisted primarily of beans and rice. She says any child who came to the hospital with any amount of fat on their bodies was described by medical staff as coming from a wealthy family – because they could afford to buy food.

Hameed’s time in Cambodia was structured and she always felt she was safe. Tribal conflicts in Chad sometimes led to the abduction of hospital medical staff, she says, although that did not happen during her time there. But a spate of civil unrest complicated her departure from the country as she tried to get to the capital N’Djamena – an approximate 15-hour bus ride – and to the airport before a mandatory daily government-imposed curfew.

She credits her field study experience in Cambodia with giving her the desire to seek another Public Health experience abroad.

Hameed says the field study trip to Cambodia was “truly the best Public Health experience I could ask for.” That’s primarily because it’s such an established program and is safe for students. She says her experience in Cambodia, combined with two years as a Physician Assistant in a hospital Emergency Department, helped prepare her for the rigors of her time in Chad.

The international field study locations used by Touro University California – Bolivia, Cambodia, India, Nepal, Zambia – are all wonderful options for students taking part in their first Public Health field study, Hameed says, because they are established, structured, and safe.

“I think that’s the best way to do the first Public Health trip,” she says, mentioning the ability to visit Victoria Falls in Zambia and to practice her Spanish in Bolivia, were she to go to either country. “I wish I went to all of them.”

Alum Gains ‘Comprehensive Perspective’

Dr. Aaron Wang, a dual MPH-DO graduate of the Class of 2021, served in Cambodia from December 2019 through January 2020. While there, he wrote about the Complementary Nighttime Mobile Services Approach to provide sustained HIV testing and counseling to entertainment workers, men who have sex with men, and transgender women in Phnom Penh.

Wang says one of his takeaways from the experience is that public health is a field to meet a diverse group of professionals from different places.

“My colleagues were from Texas, the United Kingdom, Malaysia, and Singapore,” Wang says. “They had many interesting paths that brought them to Cambodia. It felt like a truly international experience sharing our diverse backgrounds and stories.”

Public health in Cambodia requires partnering with different groups: local health departments, establishment owners/managers, outreach workers, and target populations.

“Each group has their own interests and needs. It was important to learn how to educate entertainment establishment owners and managers and work around their hours, how to reduce turnovers of outreach workers despite low wages, how to gain trust of the target population, and how to maintain follow-up with the target population that may be from out of town or changing jobs,” Wang says. “This experience provided me with a comprehensive perspective of how to investigate and promote public health intervention.”

Wang is currently completing a Family Medicine Residency at Good Samaritan Regional Medical Center in Corvallis, Oregon. He plans to begin a Geriatric Fellowship in July at UCLA in Los Angeles.

Field Study an ‘Eye-Opening Experience’

Dr. Ella Severson, a dual MPH-DO graduate of the Class of 2019, was in Cambodia the spring prior to graduation. She was struck by what she saw while there.

“I was surprised to see so much beauty and modern living in a developing country,” Severson says. “While Cambodia is still developing its infrastructure, the people there are very forward-thinking and there are so many beautiful places to visit.”

Severson recommends that those traveling to Cambodia for a field study learn about the country’s recent history, especially the history of the Khmer Rouge, before arriving in-country. She also recommends learning some basic Khmer to help with such things as getting around and ordering food.

“Being able to work abroad for my field study [project was a truly eye-opening experience,” Severson says. “I felt that I got a chance to completely immerse myself in another culture and apply the concepts I learned in my Public Health courses in a novel way. Working closely with the team in Cambodia gave me an opportunity to better understand and connect to the people involved in our study.”

Severson finished a Psychiatry Residence at UCSF Fresno in June 2023 and has since been working for a prison in Stockton as an inpatient psychiatrist.