{"id":8459,"date":"2016-04-26T11:06:12","date_gmt":"2016-04-26T18:06:12","guid":{"rendered":"https:\/\/familymedicine.uw.edu\/medex\/?post_type=post&#038;p=8459"},"modified":"2022-04-04T16:26:58","modified_gmt":"2022-04-04T16:26:58","slug":"physician-assistants-taking-lead-global-health-education","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/medex\/magazine\/2016\/04\/26\/physician-assistants-taking-lead-global-health-education\/","title":{"rendered":"Physician Assistants Taking the Lead in Global Health &amp; Education"},"content":{"rendered":"<p><span class=\"dropcap\">\u201cI<\/span> <strong><span style=\"font-size: 18pt\">see MEDEX Northwest<\/span><\/strong> being a collaborator with countries that want to start the physician assistant model in their country,\u201d says Alicia Quella, Ph.D., PA-C. Quella, the former site director for MEDEX Northwest in Spokane, who believes that physician assistants are an effective solution in addressing the primary-care needs of low-resource nations across the world.<\/p>\n<p>So do other leaders at MEDEX. In November 2015, Quella and MEDEX global health faculty Reba McIntyre, Ph.D., were awarded a Robert K. Pederson Global Outreach grant from the American Academy of Physician Assistants. With the grant, they took a group of students to Laos to test a pilot project: an elective rotation. One that would provide a valuable experience to the growing number of MEDEX students with an interest in global health, and, more importantly, an additional resource for medical education in Laos.<\/p>\n<div><div id=\"amw_galleria_slideshow_1\" class=\"amw-galleria-slideshow\"><\/div>\n<script type=\"text\/javascript\">jQuery(document).ready(function(){ jQuery(\"#amw_galleria_slideshow_1\").galleria({\"dataSource\":[{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/2-Ellie-and-midwife-teachers-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/2-Ellie-and-midwife-teachers-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/2-Ellie-and-midwife-teachers-150x150.jpg\",\"title\":\"2-Ellie and midwife 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diabetes\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/1-Alicia-Justin-Ellie-Sarah-Portia-Reba-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/1-Alicia-Justin-Ellie-Sarah-Portia-Reba-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/1-Alicia-Justin-Ellie-Sarah-Portia-Reba-150x150.jpg\",\"title\":\"1-Alicia Justin Ellie Sarah Portia Reba\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/5-Ellie-showing-PA-students-ultrasound-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/5-Ellie-showing-PA-students-ultrasound-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/5-Ellie-showing-PA-students-ultrasound-150x150.jpg\",\"title\":\"5-Ellie showing PA students 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1\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/2-Portia-with-students-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/2-Portia-with-students-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/04\\\/2-Portia-with-students-150x150.jpg\",\"title\":\"2-Portia with students\",\"description\":\"\",\"altTag\":\"\"}],\"width\":\"auto\",\"height\":0.76,\"autoplay\":false,\"transition\":\"slide\",\"initialTransition\":\"fade\",\"transitionSpeed\":0,\"_delayTime\":4000,\"_hideControls\":false,\"_thumbnailMode\":\"grid\",\"_captionMode\":\"on_expand\"}); });<\/script><\/div>\n<p>The Vietnam War took an enormous toll on this Southeast Asian country. An estimated 2 million tons of bombs were dropped on Laos, making it one of the most heavily bombed nations in the world. The land remains so contaminated with cluster bombs that it has delayed the development of roads, schools and major industry. Moving forward requires clearing these legacy armaments, a significant task for a resource-constrained nation. Consequently, it\u2019s been difficult for Laos to move forward in areas such as technology and healthcare.<\/p>\n<p>MEDEX Northwest decided to address part of this issue with the Pederson grant, as well as cooperation with Health Leadership International (HLI), a Seattle-based NGO that has worked closely with the Laotian Ministry of Health since 2008 \u2014 and whose president is Laotian-American MEDEX graduate Khampho Ohno, PA-C (Seattle Class 43).<\/p>\n<blockquote><p>\u201cWe have our direction from the ministry,\u201d says McIntyre, the founder and executive director of HIL. \u201cIn our memorandum of understanding, we\u2019ve been asked to do skill-based work. The MEDEX PA students assisted in medical education and skill labs under the direction of Laos physicians and other HLI physicians.\u201d<\/p><\/blockquote>\n<figure id=\"attachment_8474\" aria-describedby=\"caption-attachment-8474\" style=\"width: 1200px\" class=\"wp-caption alignright\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/12-Khampho-Ohno.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-8474 size-full\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/12-Khampho-Ohno.jpg\" alt=\"12-Khampho Ohno\" width=\"1200\" height=\"800\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/12-Khampho-Ohno.jpg 1200w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/12-Khampho-Ohno-300x200.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/12-Khampho-Ohno-1024x683.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/12-Khampho-Ohno-768x512.jpg 768w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/a><figcaption id=\"caption-attachment-8474\" class=\"wp-caption-text\">MEDEX graduate Khampho Ohno, PA-C (Seattle Class 43) is the Laotian-American president of Health Leadership International.<\/figcaption><\/figure>\n<p>As McIntyre indicates, MEDEX students were paired with a Laotian physician. They also helped teach a component of the primary-care curriculum for PA students in Laos. And each of them was required to do intensive research on their assigned health topic as part of their master\u2019s-degree capstone project. Students took care to develop approaches tailored for a low-resource environment, presenting the materials in ways that were sustainable and culturally appropriate.<\/p>\n<p>Justin Shobe, a former critical-care paramedic in the Spokane class, researched and delivered hands-on modules on hypertension and diabetes, growing and significant health concerns in Laos and throughout Southeast Asia. Ellie Andrews, Seattle class, a diagnostic sonographer prior to entering the MEDEX program, helped teach an ultrasound training course, as well as women\u2019s health topics, including miscarriage mismanagement and contraceptives.<\/p>\n<p>Spokane student Portia Kamps focused on the diagnosis and treatment of parasitic infections endemic to the region, and Sarah Kopke, also of Spokane, taught best practices concerning the prevention of diarrhea. In all, MEDEX\u2019s students helped teach 95 Laotian PA students, alongside local physicians and interpreters, at the College of Health Sciences in Luang Prabang.<\/p>\n<p>For McIntyre, the value to the MEDEX students and to Laos is clear. \u201cPA students go into a low-resource country and see firsthand the actual needs of providers. What is appropriate? And what can be low-cost?\u201d she asks. \u201cThe takeaway is how important medical education is \u2014 basically, improving skill levels.\u201d<\/p>\n<p><span style=\"font-size: 18pt\"><strong>Ellie Andrews<br \/>\n<\/strong>MEDEX Seattle Class 48<\/span><\/p>\n<p><span class=\"dropcap\">W<\/span><strong><span style=\"font-size: 18pt\">ith a background in ultrasound<\/span><\/strong> and a passion for women\u2019s health, Ellie Andrews saw that becoming a physician assistant could give her a more diverse role in global health. \u201cWhen I applied to MEDEX it was because they had a Global Health Track for the Master&#8217;s program,\u201d she says. \u201cIt was one of the appeals and I wrote about it in my very first essay that I submitted to CASPA.\u201d<\/p>\n<figure id=\"attachment_8477\" aria-describedby=\"caption-attachment-8477\" style=\"width: 800px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Portrait-Ellie-Andrews.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-8477 size-full\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Ellie-Andrews.jpg\" alt=\"Ellie Andrews of MEDEX Seattle Class 48\" width=\"800\" height=\"800\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Ellie-Andrews.jpg 800w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Ellie-Andrews-300x300.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Ellie-Andrews-150x150.jpg 150w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Ellie-Andrews-768x768.jpg 768w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><\/a><figcaption id=\"caption-attachment-8477\" class=\"wp-caption-text\">Ellie Andrews of MEDEX Seattle Class 48<\/figcaption><\/figure>\n<p>Prior to the elective in Laos with Health Leadership International, Ellie had some exposure to international travel and healthcare. During the summer break of 2015 she and five of her fellow MEDEX Seattle classmates participated with another organization called Guatemala Village Health. \u201cThat was an actual healthcare delivery kind of program.\u201d Ellie pauses, and then clarifies. \u201cIt was more of a mobile health care program that I participated in as a student.\u201d<\/p>\n<p>In the town of Luang Prabang, Ellie took on the role of educator. \u201cI taught some women&#8217;s health topics,\u201d she says. She did miscarriage management, or management of early pregnancy loss, and also taught about contraceptives to the midwifery students. Because her background is in ultrasound, Ellie worked with Dr. Cam McIntyre who directs\u00a0the ultrasound training program. \u201cIt was a beginner&#8217;s ultrasound training course. And so I worked for a week with them in teaching practical skills for ultrasound.\u201d<\/p>\n<p>Of course there was language barrier, something not unfamiliar to Ellie and her previous work in healthcare. \u201cI\u2019ve used interpreters many times in my career. I&#8217;m from San Francisco and I have served a very diverse patient population.\u201d Now on the ground in Laos she was surprised to discover that the individual doing the interpreting were\u00a0the leading Laotian faculty\u00a0in their field.<\/p>\n<blockquote><p>\u201cI\u2019d think, \u2018This person could be teaching this class right now\u2019. But it was <em>my<\/em> job was to assist in teaching the class,\u201d she tells us.<\/p><\/blockquote>\n<p>Teaching about contraceptives in a foreign culture can present all kinds of issues. \u201cDepending on the students, it can be an embarrassing subject,\u201d she says. Apart from having someone teach students in their own language, Ellie believes there must be someone who understands the norms and traditions of the culture.<\/p>\n<figure id=\"attachment_8488\" aria-describedby=\"caption-attachment-8488\" style=\"width: 480px\" class=\"wp-caption alignright\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Lao-Children-frolic-at-the-confluence-of-the-Mekong-Kahn-rivers.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-8488\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Children-frolic-at-the-confluence-of-the-Mekong-Kahn-rivers.jpg\" alt=\"Lao youth at the confluence of the Mekong &amp; Kahn rivers in Luang Prabang.\" width=\"480\" height=\"640\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Children-frolic-at-the-confluence-of-the-Mekong-Kahn-rivers.jpg 480w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Children-frolic-at-the-confluence-of-the-Mekong-Kahn-rivers-225x300.jpg 225w\" sizes=\"auto, (max-width: 480px) 100vw, 480px\" \/><\/a><figcaption id=\"caption-attachment-8488\" class=\"wp-caption-text\">Lao youth at the confluence of the Mekong &amp; Kahn rivers in Luang Prabang.<\/figcaption><\/figure>\n<p>For example, IUD\u2019s are available in Laos, but are not a popular choice. \u201cThey\u2019re a modest culture and having a pelvic procedure is not desirable,\u201d she says. Consequently, Depo-Provera shots and birth control pills\u00a0are very popular.<\/p>\n<p>Then there are issues concerning compliance with oral contraceptives. A husband will leave the community for weeks at a time in pursuit of work. Women taking oral contraceptives might think this is a reason to stop. \u201cAnd then the husband will come back, and the women will start with the contraceptives that day,\u201d Ellie says. \u201cIt takes a week in order to get the hormone levels to the point where they&#8217;re effective for birth control. That would be a common mishap, I would assume.\u201d<\/p>\n<p>\u201cSo we had to talk about that a bit,\u201d she says.<\/p>\n<p>During her month in Laos, Ellie fell in love with the Luang Prabang community, so much so that when it came time to depart she felt like she was leaving home. \u201cThis is a place where I could easily see myself living,\u201d she says. \u201cThe people are so gracious, so patient. Even if there\u2019s a language barrier or a misunderstanding, they will do everything to work it out with you, you know? They really want to understand and have a friendship. They&#8217;re just so kind and quite generous.\u201d<\/p>\n<figure id=\"attachment_8489\" aria-describedby=\"caption-attachment-8489\" style=\"width: 480px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Lao-Crosswalk-and-children-in-downtown-Luang-Prabang.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-8489\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Crosswalk-and-children-in-downtown-Luang-Prabang.jpg\" alt=\"Crosswalk in Luang Prabang\" width=\"480\" height=\"640\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Crosswalk-and-children-in-downtown-Luang-Prabang.jpg 480w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Crosswalk-and-children-in-downtown-Luang-Prabang-225x300.jpg 225w\" sizes=\"auto, (max-width: 480px) 100vw, 480px\" \/><\/a><figcaption id=\"caption-attachment-8489\" class=\"wp-caption-text\">Crosswalk in Luang Prabang<\/figcaption><\/figure>\n<p>Back at MEDEX Ellie occupies the role of clinical year student. \u201cEvery day it\u2019s \u2018Oh my gosh, there\u2019s so much I don\u2019t know\u2019,\u201d she says. \u201cSo to assume the position of authority on a topic, then travel to a remote place and teaching on that subject, there\u2019s definitely something gained and learned.\u201d She believes that there is learning in the process, because she had to research her subject to be able to verbalize it.<\/p>\n<p>\u201cIn that way, I would say that being a student\/co-faculty with HLI challenged us to grow and assume a leadership role. We assumed a level of knowledge and professionalism with regard to these things that you just don&#8217;t get as a student in any other way. I thought it was a great experience to be a teacher. I learned a lot in the process about the material as well. And you don&#8217;t even know how much you know until you try to talk about a topic.\u201d<\/p>\n<p>Like her fellow MEDEX students who traveled to Laos as part of the HLI elective, Ellie graduates in August of this year. We wonder if this experience firmed her resolve towards a future in global health. \u201cI don&#8217;t really know how it&#8217;s going to work out, but without a doubt, I will do global health as part of my work and life, because that is a big part of why I&#8217;m doing all of this.\u201d<\/p>\n<p><span style=\"font-size: 18pt\"><strong>Sarah Kopke<br \/>\n<\/strong>MEDEX Spokane Class 18<\/span><\/p>\n<p><span class=\"dropcap\">I<\/span><strong><span style=\"font-size: 18pt\">nternational travel is not unfamiliar<\/span><\/strong> to Sarah Kopke. After her college years ended she took local buses from Panama to the U.S.-Mexico border. \u201cNot having a lot of money after college, you eat street food and travel cheap,\u201d she says. \u201cYou travel local with chickens stuffed all around your feet. Even as heinous as some of those bus rides were, there&#8217;s no way I would want to take that element out because it&#8217;s not just seeing a place, it&#8217;s about experiencing a place.\u201d<\/p>\n<figure id=\"attachment_8479\" aria-describedby=\"caption-attachment-8479\" style=\"width: 800px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Portrait-Sarah-Kopke.jpg.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-8479\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Sarah-Kopke.jpg.jpg\" alt=\"Sarah Kopke of MEDEX Spokane Class 18\" width=\"800\" height=\"800\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Sarah-Kopke.jpg.jpg 800w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Sarah-Kopke.jpg-300x300.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Sarah-Kopke.jpg-150x150.jpg 150w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Sarah-Kopke.jpg-768x768.jpg 768w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><\/a><figcaption id=\"caption-attachment-8479\" class=\"wp-caption-text\">Sarah Kopke of MEDEX Spokane Class 18<\/figcaption><\/figure>\n<p>It was these early travels that sparked Sarah\u2019s continued desire to see and experience the world. When the opportunity for an elective with Health Leadership International (HLI) arose, the mix of medicine and the opportunity to see a different part of the world reignited that desire.<\/p>\n<p>Sarah had known that she\u2019d work internationally at some point, but hadn&#8217;t found that pathway until this trip with HLI. \u201cEven though it was a very nontraditional rotation for MEDEX, it was a really fortuitous opportunity to include this in my PA education,\u201d she says. \u201cI am proud of this and feel like my education is more complete having had this opportunity. An international opportunity was all that was missing from MEDEX\u2019s curriculum until this point, for me. And teaching is sustainable. It&#8217;s not like you go in and work for two weeks and leave. You leave a little bit more behind if you can teach, or train somebody.\u201d<\/p>\n<p>For seven years Sarah worked as a physical therapist assistant primarily in Western Washington. While volunteering with HLI, in Lao PDR, her teaching focused on the prevention and treatment of diarrhea from non-parasitic causes in the under-five population. \u201cIt was something completely different than what I had done in the past, and that&#8217;s why I picked it. It is also a major cause of preventable childhood death worldwide.\u201d she says.<\/p>\n<p>She taught best practices including hand washing with soap; early rehydration; recognizing early signs of dehydration and various causes of diarrhea; the importance of breastfeeding and nutrition; and decreasing the use of antibiotics as the immediate go-to method to resolve diarrhea.<\/p>\n<blockquote><p>\u201cIt was really about hand washing with soap,\u201d she says. \u201cIt&#8217;s so basic here in the U.S. where there\u2019s soap and hand sanitizers around every corner. But over there, there isn\u2019t even soap in the bathroom at the College of Health Sciences.\u201d \u00a0Reba McIntyre clarifies that soap is expensive and sometimes difficult to provide in a low resource environment.<\/p><\/blockquote>\n<p>For Sarah the focus of her contribution through HLI was a simple concept. \u201cThat\u2019s why I wanted to teach diarrhea prevention and research it more because it\u2019s so simple but so prevalent,\u201d she says. \u201cSecond to pneumonia and respiratory problems, it&#8217;s the most common cause of childhood death under the age of five, worldwide. And yet it&#8217;s so preventable with a small amount of education.&#8221;<\/p>\n<figure id=\"attachment_8492\" aria-describedby=\"caption-attachment-8492\" style=\"width: 640px\" class=\"wp-caption alignright\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Lao-Monks-studying-outside-their-home-temple.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-8492\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Monks-studying-outside-their-home-temple.jpg\" alt=\"Young monks studying outside the temple in Luong Prabang.\" width=\"640\" height=\"480\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Monks-studying-outside-their-home-temple.jpg 640w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Monks-studying-outside-their-home-temple-300x225.jpg 300w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/a><figcaption id=\"caption-attachment-8492\" class=\"wp-caption-text\">Young monks studying outside the temple in Luong Prabang.<\/figcaption><\/figure>\n<p>Sarah references the efforts in this area of the Bangladesh Rural Advancement Committee, or BRAC. In 1972 the BRAC non-governmental organization launched an initiative to educate the local population of Bangladesh in an effort to decrease the mortality rate from diarrhea. Mothers were instructed how to prevent diarrhea through hand washing, washing foods and breast-feeding to six months of age. Over 15 years BRAC assessed the effectiveness of this public health effort, and found a significant decrease in diarrhea and mortality. Teenagers who were babies at the time of the initial educational efforts 15 years earlier were observed teaching the younger children to wash their hands and food.<\/p>\n<p>\u201cThis is not a one day fix,\u201d emphasizes Sarah. \u201cIt\u2019s not that people around the world are not intelligent. It&#8217;s really a lack of education and funding. There are cultural affects to be considered, and whether they&#8217;ll even want your medicine or not.\u201d<\/p>\n<p>When asked if she has plans to work in global health upon graduation from MEDEX, Sarah says, \u201cThoughts are forming, definitely. First of all, I have a strong desire to learn Spanish fluently. That I feel in my heart. So I want to follow that and blend it with clinical experience in Central America. I would like to continue to teach with HLI. So I&#8217;m not sure yet whether the future holds teaching or clinical work, or a combo of the two.\u201d<\/p>\n<p>Looking back, Sarah viewed this most unusual elective in Laos PDR with Health Leadership International as an opportunity. \u201cIt was eye-opening and an honor to teach fellow students, and it was a really imperative part of my education. I hope this opportunity exists for future MEDEX students.\u201d<\/p>\n<p><span style=\"font-size: 18pt\"><strong>Justin Shobe<br \/>\n<\/strong>MEDEX Spokane Class 18<\/span><\/p>\n<p><span class=\"dropcap\">P<\/span><strong><span style=\"font-size: 18pt\">rior to MEDEX and his path<\/span><\/strong> to becoming a physician assistant, Justin Shobe was a critical care paramedic and paramedic field supervisor. His work involved a lot of training. \u201cI would train new people and test them in the field and in the classroom as well,\u201d he says. \u201cThat involved a lot of cardiac monitoring, training, IV pump skills, and basic patient management.\u201d<\/p>\n<p>All this made Justin very comfortable in the teaching role, which was good preparation for the HLI elective working with the students at the College of Health Sciences in Laos.<\/p>\n<figure id=\"attachment_8478\" aria-describedby=\"caption-attachment-8478\" style=\"width: 800px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Portrait-Justin-Shobe.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-8478\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Justin-Shobe.jpg\" alt=\"Justin Shobe of MEDEX Spokane Class 18\" width=\"800\" height=\"800\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Justin-Shobe.jpg 800w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Justin-Shobe-300x300.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Justin-Shobe-150x150.jpg 150w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portrait-Justin-Shobe-768x768.jpg 768w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><\/a><figcaption id=\"caption-attachment-8478\" class=\"wp-caption-text\">Justin Shobe of MEDEX Spokane Class 18<\/figcaption><\/figure>\n<p>Admittedly, Justin hadn\u2019t traveled internationally before. During his didactic year curriculum, Justin worked on an underserved project with his Spokane 18 classmates, the target population involving refugee immigrants. \u201cI\u2019ve always been pretty interested in learning about other populations, and that project really set that off. Everybody really got into it, and we all had to present on our population.\u201d<\/p>\n<p>This earlier project inspired Justin to gain that broader vision. \u201cMy wife and I were already planning our own trip to go work, in some sort of medical capacity, in Central America,\u201d he says. Then this trip to Laos came up as a Global Health elective with MEDEX and HLI. Justin responded to HLI&#8217;s\u00a0mission and the sustainability of the project. \u201cIt&#8217;s really about working with the local people, finding out what they need, and meeting them where they&#8217;re at, educationally and culturally.\u201d<\/p>\n<figure style=\"width: 640px\" class=\"wp-caption alignright\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Lao-Luang-Prabang-style-temple-roofs-are-notable-for-multiple-layers.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-8491 size-full\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Luang-Prabang-style-temple-roofs-are-notable-for-multiple-layers.jpg\" alt=\"An ornate buddhist wat or temple in Luang Prabang. \" width=\"640\" height=\"480\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Luang-Prabang-style-temple-roofs-are-notable-for-multiple-layers.jpg 640w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Luang-Prabang-style-temple-roofs-are-notable-for-multiple-layers-300x225.jpg 300w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/a><figcaption class=\"wp-caption-text\">An ornate buddhist wat or temple in Luang Prabang.<\/figcaption><\/figure>\n<p>As part of the HLI team, Justin co-taught skills development in CPR, neonatal resuscitation, IV, and intraosseous access. He was also assigned the hypertension and diabetes module. \u201cThose were two things that weren&#8217;t necessarily overlapping with my paramedic role, but I&#8217;ve become more confident since coming to MEDEX.\u201d<\/p>\n<p>Justin\u2019s wife, Julie, became part of the team that traveled from Seattle to Laos. \u201cShe helped teach the diabetes portion as well because she is a certified diabetes educator here in the states.\u201d<\/p>\n<p>The prevalence of type 2 diabetes in the Southeast Asian region came as a surprise to Justin. \u201cThe problem is growing because there is increasing urbanization of the populations,\u201d he says. \u201cThere&#8217;s more westernization of the diet, lower quality of foods, higher calories, and lower nutritional content. On top of all of this is the predisposition of the Asian populations to develop type 2 diabetes.\u201d All of these factors are contributing to a rapid increase in cases of diabetes.<\/p>\n<blockquote><p>\u201cIt&#8217;s hard to educate people on a disease that doesn&#8217;t cause any symptoms early on, same as hypertension. It&#8217;s hard to get people over there to take medication. It\u2019s hard to even get people here in the states to take medication. The problems are not totally dissimilar.\u201d<\/p><\/blockquote>\n<p>Justin and Julie developed a nutritional education handout based on the \u201cChoose My Plate\u201d graphic for use by the Laos health science students with their patients out in the field. \u201cMostly it has to do with portion sizes but, even before that, you need to know what foods go into which food groups,\u201d Justin says. The class worked with the handout, and Justin had the students create plates with food models so they could use that same exact exercise with the patients in their practice. \u201cThat approach is where we need to start because it&#8217;s free, and it doesn&#8217;t involve a financial obligation or the huge culture shift of taking medication. It&#8217;s really the best starting place, and can help minimize the effects of a lot of diseases at once, rather than just targeting one disease.\u201d<\/p>\n<figure id=\"attachment_8470\" aria-describedby=\"caption-attachment-8470\" style=\"width: 1200px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/8-Julie_justins-wife_-Justin-and-sarah-with-students.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-8470 size-full\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/8-Julie_justins-wife_-Justin-and-sarah-with-students.jpg\" alt=\"8-Julie_justins wife_ Justin and sarah with students\" width=\"1200\" height=\"800\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/8-Julie_justins-wife_-Justin-and-sarah-with-students.jpg 1200w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/8-Julie_justins-wife_-Justin-and-sarah-with-students-300x200.jpg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/8-Julie_justins-wife_-Justin-and-sarah-with-students-1024x683.jpg 1024w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/8-Julie_justins-wife_-Justin-and-sarah-with-students-768x512.jpg 768w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/a><figcaption id=\"caption-attachment-8470\" class=\"wp-caption-text\">Julie Shobe, Justin Shobe and Sarah Kopke surrounded by their new friends from the College of Health Sciences in Laos.<\/figcaption><\/figure>\n<p>During his time teaching at College of Health Sciences, Justin made an effort to learn many small phrases and numbers in the Laotian language. Otherwise, his lectures were all delivered side-by-side with co-trainer, an internal medicine\u00a0physician from the capital city of Vientiane. \u201cSome of the hands-on stuff was a little bit more interactive, without necessitating an interpreter standing right there the whole time,\u201d says Justin. By using direct eye contact he found a closer relationship could develop between the Lao students and the MEDEX\/HLI team.<\/p>\n<p>Working with up to 90 students at a time, Justin and his MEDEX cohorts taught\u00a0in a large classroom facility at the College of Health Sciences\u00a0outside Luang Prabang. The classroom itself was open window, not air-conditioned, so in a tropical setting it got rather warm in the afternoon. \u201cOften times we were sweating while they were putting on sweatshirts,\u201d he says. \u201cFor them it was a little chilly.\u201d<\/p>\n<figure id=\"attachment_8495\" aria-describedby=\"caption-attachment-8495\" style=\"width: 480px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Lao-Flower-Seller.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-8495 size-full\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Flower-Seller.jpg\" alt=\"Flower seller in the Luang Prabang market.\" width=\"480\" height=\"640\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Flower-Seller.jpg 480w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Lao-Flower-Seller-225x300.jpg 225w\" sizes=\"auto, (max-width: 480px) 100vw, 480px\" \/><\/a><figcaption id=\"caption-attachment-8495\" class=\"wp-caption-text\">Flower seller in the Luang Prabang market.<\/figcaption><\/figure>\n<p>Justin found the students to be very disciplined. \u201cIt was my understanding that about two-thirds of them were fairly new students at the College, and one-third of them were providers from the District hospitals in the extended learning program,\u201d he says. These returning students had some hands-on skills from\u00a0the field already.<\/p>\n<p>A peak experience was graduation on the final day. \u201cWe had a ceremony for the students to get their certificates, and that was exciting to watch,\u201d Justin says. \u201cThey would come by and everybody wanted to take pictures with their cell phones\u2014with their friends, with their groups, and with us teachers. That was really exciting and fun.\u201d<\/p>\n<p>Later in the week Justin and Julie were walking about in Luang Prabang prior to flying home when they ran into several of the students. \u201cWe were so excited to see each other,\u201d he says. \u201cIt was like long lost friends.\u201d Just one week ago they were together every single day for the entirety of the course. \u201cIt was a really fun reunion, and of course they wanted to take pictures and hang out again. None of them could speak English so we just hung out and said the little bit that we could in each other&#8217;s language, and then went our separate ways.\u201d<\/p>\n<p>At the start, when Justin first heard of the elective for the Global Health Track with MEDEX and Health Leadership International, he suspected this was a natural fit for his physician assistant education. At the end of the experience, after he and his wife got to teach together on one of those days in Laos, they assessed the experience. \u201cWe kind of looked at each other,\u201d he says. \u201cWe both realized this is definitely something that we want to continue to do in the future.\u201d<\/p>\n<p><span style=\"font-size: 18pt\"><strong>Portia Kamps<br \/>\n<\/strong>MEDEX Spokane Class 18<\/span><\/p>\n<p><span class=\"dropcap\">F<\/span><strong><span style=\"font-size: 18pt\">or Portia Kamps the main draw<\/span><\/strong> to MEDEX and physician assistant training was her interest in global health. Growing up, she visited Mexico several times, and later traveled to Guatemala and India prior to entering MEDEX. These experiences gave her a sense of how things are in other parts of the world, especially in terms of living conditions and access to healthcare.<\/p>\n<figure id=\"attachment_8476\" aria-describedby=\"caption-attachment-8476\" style=\"width: 800px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Portia-Kamps.JPG.jpeg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-8476\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portia-Kamps.JPG.jpeg\" alt=\"Portia Kamps of MEDEX Spokane Class 18\" width=\"800\" height=\"800\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portia-Kamps.JPG.jpeg 800w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portia-Kamps.JPG-300x300.jpeg 300w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portia-Kamps.JPG-150x150.jpeg 150w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/Portia-Kamps.JPG-768x768.jpeg 768w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><\/a><figcaption id=\"caption-attachment-8476\" class=\"wp-caption-text\">Portia Kamps of MEDEX Spokane Class 18<\/figcaption><\/figure>\n<p>\u201cIt\u2019s very eye-opening to see what medicine is like in a low resource\u00a0country,\u201d she says. This was especially true of her time in Lao PDR with Health Leadership International (HLI) where she served as a student faculty member. Her emphasis was on parasites within the region, specifically intestinal and worm parasites. \u201cWe focused primarily on what was endemic to that region of Lao, and some of the critical aspects of parasite infections that the students would find helpful in their practices in the future.\u201d<\/p>\n<p>As with the three other MEDEX students, Portia\u2019s lectures were delivered with a U.S. or Lao physician\u00a0to sex segregated groups. \u201cOne of the groups was all of the male students, and the other was all of the female students,\u201d she says. \u201cThe other group at the time of the lecture was doing their lab.\u201d<\/p>\n<p>When Portia initially learned of the HLI elective rotation she thought, \u201cThis is something I want to be involved in.\u201d The idea of training others was exciting. \u201cHere is a different aspect of global health. Not the clinical aspect, but the educational aspect and how that can impact the region. We were able to help with their education, and also see the training that they have, and the training that they are asking for.\u201d<\/p>\n<p>During her visit to Lao, Portia and the other MEDEX students were able to tour some of the medical facilities in Luang Prabang and other districts.<\/p>\n<blockquote><p>\u201cThe resources there are very different than here,\u201d she says. \u201cAt the hospital we saw equipment that we had ten, twenty years ago in use every day, and how much they would utilize that equipment until it literally broke and couldn&#8217;t be used.\u201d<\/p><\/blockquote>\n<p>In speaking about this with the Laotian faculty,\u00a0Portia learned how much better equipped district hospitals are now than five or ten years ago. \u201cThe district clinics have really started to have an impact on their regions,\u201d she says.<\/p>\n<p>Portia\u2019s background is in sports medicine, primarily in high schools. \u201cI was an athletic trainer,\u201d she says. \u201cI worked in small towns in Colorado, and then I moved up to Spokane and worked at North Central through Rockwood Clinic. I enjoyed the athletics, as well as the healthcare aspects and getting to follow the athletes and care for their injuries daily.\u201d<\/p>\n<figure id=\"attachment_8475\" aria-describedby=\"caption-attachment-8475\" style=\"width: 400px\" class=\"wp-caption alignright\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/13-Portia-helping-in-splinting-workshop.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-8475 size-medium\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/13-Portia-helping-in-splinting-workshop.jpg\" alt=\"Portia helps with the splinting workshop.\" width=\"400\" height=\"600\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/13-Portia-helping-in-splinting-workshop.jpg 800w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/13-Portia-helping-in-splinting-workshop-200x300.jpg 200w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/13-Portia-helping-in-splinting-workshop-683x1024.jpg 683w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/04\/13-Portia-helping-in-splinting-workshop-768x1152.jpg 768w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><figcaption id=\"caption-attachment-8475\" class=\"wp-caption-text\">Portia Kamps and Bill Affolter demonstrate techniques in a casting and slinging workshop.<\/figcaption><\/figure>\n<p>It was high school youth trips south of the border that initially fueled her international interests. \u201cYou get used to your normal, your routine, where you live and what you have access to,\u201d she says. \u201cTo see how it&#8217;s so different in other places really piqued my interest and expanded my perspective of the world. I thought, wow, the world is a whole lot bigger than what I know.&#8221;<\/p>\n<p>As an adult Portia volunteered with a team that traveled into Guatemala. \u201cWe went up to remote mountain villages outside one of the towns,\u201d she says. She participated with the dental team that cleaned, extracted and repaired teeth. \u201cI held a lot of flashlights. That was my first major exposure to medicine abroad.\u201d<\/p>\n<p>Her trip to southern India was for a children\u2019s home, where she also served as part of a dental team. \u201cWe did dental hygiene work there, and some basic medical if the kids had something they needed,\u201d she says. There were two nurses on the team, and that sparked Portia\u2019s initial interest in advancing her medical career beyond sports medicine.<\/p>\n<p>\u201cThat&#8217;s one of the main reasons I became a physician assistant\u2014 to be more involved in global health,\u201d Portia says. What that looks like going forward she cannot say. Ultimately, it will include health education. \u201cI know the educational component is a part of what we do in global health, regardless if you&#8217;re working clinically or not. The opportunities are just so vast within the world. I don&#8217;t have a specific country or region or people or disease type that I want to focus on.\u201d<\/p>\n<p>As a westerner and an American, Portia appreciates that she has access to medical training. \u201cI am privileged to have the capacity but also the opportunity to pursue and to learn medicine,\u201d she says. \u201cThat&#8217;s something that can be so unique compared to most of the world.\u201d<\/p>\n<p>Looking back, Portia views her experience with Health Leadership International as invaluable. \u201cI really enjoyed interacting with the students and people there,\u201d she says. \u201cI found everyone very helpful, very polite, engaging and just very interested in learning.\u201d Her ongoing education as a physician assistant with MEDEX becomes the foundation with which to contribute globally. \u201cI can go and share what I have learned and help better the world.\u201d<\/p>\n<p><em>A portion of this story appeared in the Spring 2016 edition of UW Medicine Alumni Magazine.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>At the start of their clinical year four MEDEX physician assistant students participated in a global health pilot project and traveled to the Southeast nation of Laos. There, under the sponsorship of the NGO Health Leadership International, they assisted in training their Laotian counterparts, PA students at the College of Health Sciences in Luang Prabang. Months later they reflect on what they gained from this experience, and their growing personal commitment to global health.     <\/p>\n","protected":false},"author":1,"featured_media":8462,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20],"tags":[],"class_list":["post-8459","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medex-stories"],"cp_meta_data":{"student_name":["MEDEX & Global Health"],"_edit_last":["1"],"_webdados_fb_open_graph_specific_image":[""],"_yoast_wpseo_primary_category":["48"],"_thumbnail_id":["8462"],"_yoast_wpseo_primary_post":[""]},"_links":{"self":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/8459","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/comments?post=8459"}],"version-history":[{"count":13,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/8459\/revisions"}],"predecessor-version":[{"id":16923,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/8459\/revisions\/16923"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/media\/8462"}],"wp:attachment":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/media?parent=8459"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/categories?post=8459"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/tags?post=8459"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}