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Reaching children of the world: As distant as Africa or as close as your neighborhood school‚ the Global Pediatrics Program is working to improve international child health

In the next minute‚ 240 babies will take their first breath; 216 of them will do so in a developing country. By the time the 24 babies born in the world’s wealthiest nations don their bright backpacks and new shoes and head off to kindergarten‚ a third of the others will have suffered from malnutrition. Nineteen will have died‚ most from preventable illnesses such as respiratory infection‚ diarrhea‚ malaria‚ and measles.

The call for help is clear. So is the response being shaped by the Department of Pediatrics.

Chandy John, M.D., reviews a research study with field dream

Last year the department instituted the Global Pediatrics Program—the only one of its kind in the nation—as a resource for educating residents and providing research and clinical service to improve the health of children from developing countries.

“What makes our program special is that we can relate the behavior of a parasite under a microscope to its behavior in a child’s body and teach our students why this matters‚” says program director Chandy John, M.D., M.S. “We think it’s very important to get the whole picture if you really want to make a difference in child health.”

‘An important experience’

The cornerstone of the program is the pediatric residency’s global health track‚ the second of its kind in the country. Of the University’s 24 first-year pediatrics residents this year‚ 22 have chosen to participate.

“All in all‚ between the curriculum we provide‚ the opportunity to go overseas‚ and the opportunity for local global health‚ there’s no other program like this in the country‚” John says.

Residents take a core curriculum covering topics such as disease diagnosis and treatment‚ ethics‚ and disaster management‚ and they also participate in informal educational opportunities. Many take a public health elective at Hennepin County Medical Center‚ which sees large numbers of immigrant and refugee families‚ or work with the University’s International Adoption Clinic.

“I’ve had American patients‚ Hmong patients‚ Liberian patients‚ a great mix of people‚” says second-year fellow Nadia Sam-Agudu, M.D., who did her residency here and hopes eventually to return to her native country of Ghana. “It makes you a better clinician.”

The highlight for many is an overseas elective. Patrick Pederson, M.D., a third-year resident‚ spent six weeks last spring at an urgent care clinic in Uganda‚ where it was not unusual‚ he says‚ to see in a single day two or three children die of very preventable diseases.

“It wasn’t a fun experience. It was an important experience‚” he says. “It confirmed for me that this is pretty much what I would like to do from now on.”

Research and service

Improving understanding of the health issues children face around the world and providing resources to address them are other important facets of the Global Pediatrics Program. In Kenya‚ for example‚ John is studying immune system responses to malaria and how environmental conditions affect transmission. He’s also leading a Uganda study looking at cognitive impairment after cerebral malaria.

On the service side‚ faculty members are developing a 73-chapter manual for physicians dealing with the unique issues of children’s health in the tropics.

Residents get involved as well. Pederson worked with John to assess the impact of cerebral malaria. Troy Lund, M.D., Ph.D., instituted an affordable screening test in Uganda for G6PD deficiency‚ an inherited condition that can cause trouble for children receiving antimalarial medicines. Kate Sutter, M.D., gave lectures on neonatal infections to nurses.

“It sparked an interest in international health that I didn’t know was there‚” Sutter wrote in an online report of her experience. “It has changed my life forever.”

‘Sense of responsibility’

The program’s associate director‚ Cynthia Howard‚ M.D.‚ says she’s encouraged by the growing interest in global children’s health.

Other universities are looking to Minnesota as a model for expanding their own residency programs. Medical students are seeking residencies here because of the opportunity to focus on international pediatrics.

Howard attributes the boom in part to globalization. What were once exotic diseases are now “only a plane ride away‚” she says. “There is a greater sense of responsibility among this generation of medical students‚” Howard says.

The program plans to add another element to its mission in the months ahead: advocacy. New electives will give residents a chance to work with public policy programs‚ lobby lawmakers‚ work with immigrant and refugee health agencies‚ or follow a family through the challenges of settling in a new country.

“We’re taking an interprofessional approach‚” Howard says. “Residents need to know about public policy‚ different health systems around the world‚ poverty‚ the root causes of poverty‚ changing financial environments‚ stakeholders‚ funders. … That kind of information doesn’t emerge from a traditional medical school setting.”

To learn more about the Global Pediatrics Program‚ please visit www.peds.umn.edu/globalpediatrics.

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