This week our Global Health pathway held another joint simulation with our colleagues from OB/GYN, EM, and surgery. This time, our interdisciplinary teams triaged the care of a 19-year-old pregnant woman who presented with fever, HA, vomiting and fatigue for the past several days. Fleeing violence in her native Sudan, the patient had recently arrived in a Ugandan refugee camp (in a malaria-endemic region). The patient was critically ill and altered but astute investigations by our teams discovered the cause: malaria. Shortly thereafter, the patient suffered a tonic-clonic seizure and coded (sequela of cerebral malaria). The team performed a resuscitative hysterotomy and delivered a live infant.
Following the simulation, we discussed the epidemiology, pathophysiology, diagnosis, and treatment of malaria. We also discussed the multiorgan failure that accompanies the most severe malaria cases, including cerebral malaria, the most severe consequence of Plasmodium falciparum. Finally, we discussed the role of resuscitative hysterotomy (aka “perimortem c-section”) and why removal of the fetus from a gravid uterus is potentially lifesaving for both mother and neonate (if viable). Cardiopulmonary resuscitation is less effective in the third trimester because of aortocaval compression, and the procedure should be done regardless of viability of infant for maternal benefit.
Kudos to Ian Drobish for representing Internal Medicine and using his training to make an early diagnosis of malaria!
We are excited to announce that the applications for all our pathways are open!
This includes the following pathways:
– Global Medicine Pathway
– Hospital Medicine Pathway
– Integrative Medicine Pathway.
– Primary Care Pathway
– RACE (Residents As Clinician Educators) Track
The deadline is November 20th at 11:59pm PST. You may apply to as many of them as you would like, and we will work with you to match into one of them based on competitiveness, interest, and fit. Please note that you may do the Integrative Medicine Pathway concurrently with another pathway.
Please read the application requirements carefully (listed at the bottom of each google form) to ensure that you submit the required documents before the application deadline!
Thank you to everyone who joined us last night for the Pathway Interest Meeting! I have attached a link to the 30 minute introduction video as well as documents that were presented during the meeting for those of you who were not able to attend.
Applications are being finalized as we speak! We will send a consolidated email in the next 1-2 weeks containing all pathway application forms and final application details.
If you have any questions regarding specific pathways, please reach out to the chief in charge of your pathway!
Mandy Mohindra and Ian Drobish, our inaugural Global Health Pathway residents, participated in an interdepartmental simulation with fellow Emergency, Surgery, and OB/GYN residents. The simulation centered on a patient presenting with profound dehydration from a diarrheal illness. The resident teams had to manage the resuscitation while figuring out the underlying etiology (cholera!) and overcoming a twist – the patient was also pregnant.
The teams then participated in a socially distanced debrief and dinner while discussing the realities of providing medical care in under-resourced settings. The session ended with skills stations which taught trainees how to establish intraosseous access (without an EZ-IO device!), calculate fluid drip rates for IV medications, and mix-up homemade oral rehydration solution. Thank you, Ian and Mandy, for representing our program and bringing your A game!
Today our amazing Med/Peds PGY3, Jack Strutner, led us through a case he saw in Mozambique at his time at Maputo General Hospital. His patient was a young man with HIV who came in with subacute diarrhea with profuse bloody bowel movements and a fever. He was found to be severely volume depleted and with an AKI on exam. We worked through our diagnostic schema and work-up of diarrhea in an HIV patient, focusing on infectious etiologies. Our expert discussant from Infectious Diseases, Dr. Stephen Rawlings, helped further flesh out our differential for these patients and discussed ARV side effects. We then discussed the differences in work-up approaches for patients in resource poor settings vs here in the US, with the main difference being more focus on stabilization and resuscitation with empiric antibiotics and less so on diagnostic tests. The patient unfortunately passed which we discovered is sadly a common scenario on a global scale, highlighting the importance of ongoing global efforts to improve water supply and sanitation in disease prevention.
Take away points:
1) Remember to take a thorough history regarding diarrhea onset, characteristics (volume, content, frequency) and associated symptoms
2) ARVs, particularly protease inhibitors, integrase inhibitors and Zidovudine (causing acute pancreatitis) may be the cause of diarrhea in some HIV patients
3) Diarrheal illness is still a leading cause of death worldwide, particularly in resource poor nations
Thank you again to Dr. Strutner for a thought provoking case, and to Dr. Rawlings for always providing great teaching! We hope to hear from our colleagues in Maputo sometime again soon!
The International Health Collective is looking for residents to volunteer at their monthly clinic in Tijuana on Saturday, March 7th. Providers meet in Otay Mesa at 8am, and are back on this side of the border by 4pm. This is an amazing global health opportunity to deliver primary care to an underserved community in a low-resource setting. You will have a lot of autonomy, but also plenty of support from Dr. Jia Shen (cardiology) and Dr. Weena Joshi (pediatrics). Interpreters are available, so no Spanish is required. Please email Janet (email@example.com) if you are interested!