School of Medicine

Wayne State University School of Medicine
Blogging Around the World: Christopher Sy in Nicaragua
In Headlines on March 4, 2015
The volunteers take a much-needed break.

The volunteers take a much-needed break.

The clinic site in Tadazna.

The clinic site in Tadazna.

Local residents greet visitors.

Local residents greet visitors.

Christopher Sy, M.A., a fourth-year medical student, is in Nicaragua the week of Feb. 21-28 for a medical mission trip organized by the Wayne State University School of Medicine’s World Health Student Organization. The Village of Siuna, Nicaragua, will host a clinic staffed by students and WSU physicians. The group also will conduct public health workshops and work on a community project to gain a better understanding of the patients they will see.

This is part two of two. Click here for part one.

Dia Cuatro – Clinic Too!

This is our second full day of clinic and our second full day in one of Nicaragua's most remote areas (Tadazna and neighboring villages).

I have to echo past sentiments and say again that we have an amazing group of people with us. Everyone is ever an optimist. I have not heard anyone complain unless it was about Karl's smelly armpits (just jokingly.....? haha) or Hieu's lack of exotic meats (supposedly he has armadillo and boa constrictor in the works).

Camaraderie and trust has been instant and strong, and will undoubtedly be lasting.

I wasn't too surprised to learn that we all slept exponentially better this second night compared to the first. Doing our bathroom business in deep dark pits (latrines) is no big deal. I mean, we never forget to put the toilet seat down now, so that's a plus. In more than one conversation I've had with my colleagues, the sentiment has been expressed that this place already feels like “home.” Coming back from clinic for lunch or dinner has us all giddy with excitement, especially since there is always the prospect of a heated Euchre game at the table – a Michigan card game in which I and my fellow Californians are at a huge disadvantage. For now. Something else we've noticed? The food seems to be getting better and better – the next meal seemingly more tasty than the last yet still remaining healthy and fresh. Delicioso.

Just a little bit about our organizational layout for any interested readers: We have six teams — one triage team, one pharmacy team and four care teams. The triage team is led by a fourth-year student and two to four first-year students, and is in charge of eliciting a chief complaint and obtaining vital signs. Additionally, triage can obtain blood sugars and urine dipsticks as needed. Each care team consists of either a fourth-year or a resident physician acting as a senior and a first-year acting as the junior. We have the first-year students practice and hone their patient-interviewing skills while the fourth-years and residents assist with the physical exam while chiming in with timely teaching points depending on the patient’s specific presentation. After interviewing patients, the care teams then present, or staff, the case with an attending physician, of which we have two: one family medicine and one obstetrician and gynecologist, which is great, because many patients are either pregnant or have female-specific concerns. The pharmacy team is manned entirely by first-years, who are doing an outstanding job counting pills and making sure patients understand how to take the medications we’ve prescribed. Some might call us a well-oiled machine. Well, if perspiration counts as oil I might agree. We run clinic until the sun goes down, taking a break only for lunch. It feels good to put in a day’s work knowing you’ve made a tangible difference.

The official patient count for today? 50. Success.

The clinic continues to run smoothly. Being the flexible, resilient group that we are, we've made improvements in the workflow of our triage and pharmacy units. Everyone is working as a team. Everyone is looking for ways to improve for the betterment of our patients. Everyone is still looking for an excuse to snag a lollipop or two from the pharmacy to keep our blood sugars at an optimal level (a requirement, obviously).

Unfortunately we continue to be accosted by those darn roosters in the wee hours of the morning, but it’s a moot point in the bigger picture of things. Every single one of us on this trip is up for the grit and the challenge.

We wouldn’t have it any other way. Por supuesto. 

Dia Cinco – Clinic Three Spree

We had our last full day of clinic today. Tomorrow we will do a half day, as we are traveling back to Siuna.

I think it's safe to say we are getting the hang of this. Here are our daily patient totals plus or minus two patients:

Clinic Day 1: 48
Clinic Day 2: 50
Clinic Day 3: 72

Did someone say exponential increase?
How about the top three diagnoses?

1. Dehydration
2. Gastric Esophageal Reflux Disease
3. Urinary Tract Infection/Sexually Transmitted Disease

I'm sure the order of the above can be debated but in counsel with my colleagues these appear to be the popular choices. Dehydration is interesting since our patients never come in declaring that their intracellular volumes are low. They don't even admit that they're thirsty. Patients will instead say they have a headache or fatigue or weakness or dizziness or cracked lips or loss of appetite or recurring kidney stones, to name a few. GERD is also interesting. And as a preface to this, I’ll add that No. 4 on the list is probably arthritis. The reason I bring this up is that a leading cause for GERD from many of our experiences is overuse of ibuprofen or other NSAIDs as a result of coping with arthritis and other musculoskeletal pains. Education is big in this regard, and it is huge with No. 3 UTIs/STDs, as those are imminently preventable. Sometimes the best medicine is no medicine.

All in all, a much different demographic and set of circumstances than we are used to in the Motor City, but one that affords a priceless learning experience.

Not only are we learning a lot about this region’s public health needs, we are learning just as much, if not more, about the cultural richness of Nicaragua. As previously alluded to, we aren’t simply treating our patients, we are literally living with and among them – sleeping, eating, bathing, singing, laughing and yes, even pooping, exactly as they do. This allows us a level of patient understanding that, in my opinion, is unparalleled. Additionally, Bridges to Community not only allows medical brigades such as ours to perform clinic work, it also has opportunities for service and community projects. Two first-year students have been going out daily into the community to help build new latrines, stoves and other infrastructure-type buildings to benefit the villages as a whole. The stories they bring back are always inspiring and humorous. Apparently blue Oreos exist out here? Who knew this trip was all-inclusive?

One half-day of clinic left tomorrow. Although we all look forward to our homes with our families and friends (and Instagrams), we can’t deny that leaving this place will be at least a little bit bittersweet. On the brighter side (to some) rumor has it iguana is on the menu for tonight.

Stay tuned. We’re off to take our cold showers before the sun sets and we can’t see a thing. Of course, we all start sweating immediately after the shower but we at least feel psychologically cleaner. After that, euchre anyone? Stories? Pillow talk by candlelight?

How about all of the above?

Dia Seis — Farewell, sweet, sweet rooster ... you will be missed (not)

By now I think it is clear what creature has been the bane of our existence here.

Every night, rooster? Seriously?

Anyway, today is the most bittersweet of days: We start our journey home while leaving our newfound home behind. We had one more half-day of clinic scheduled, which sounds nothing but routine by now, except that we somehow had to see 40 patients in exactly half the time. Our first two days of clinic we saw about 50 patients in a full day. Is 40 even possible?

Oh yes. Yes it is. With this group, yes.

With three full days of experience in the trenches and morale sky high from nights of bonding, euchre and inside jokes, we were able to see all 40 patients before lunch. If you looked up teamwork in a dictionary there would have to be a group photo of us. We. Were. Pooped. After that whirlwind of a clinic, we cleaned up and had our final meal in Tadazna.

We had a very nice and ceremonious sendoff after eating, but before we got on our bus back to Siuna. We were able to thank our hosts, cooks and translators, and the countless individuals who make a medical trip like ours possible. There is no way we could have done this on our own.

I forgot to mention that we had “reflection” sessions every night in which we had been doing similar things: sharing thoughts, feelings and offering gratitude where it was rightly deserved. After our goodbyes and the taking of endless photos, we set out on the bumpy road back to Siuna.

Our transition back to first-world amenities was warmly welcomed, to say the least. Siuna meant the return of reliable electricity, hot water, supermarkets, mattresses and NO ROOSTERS, but sadly, no more cute baby chicks. Our Bridges to Community guide gave us a tour of Siuna's hospital, which had gained running water in the past year. Afterward, she took us to the best restaurant in Siuna to celebrate a week of hard work. It was beyond delicious. The best part of that restaurant was the dance floor and the blaring salsa music.

Tomorrow we fly on our little propeller planes back to Managua to stay one night before flying back to the United States.

 In a weird way, I think we'll miss that silly rooster.

 

MPAC featured in AAMC's The Reporter
In Headlines on March 2, 2015
Doug Skrzyniarz

Doug Skrzyniarz

An article in the February 2015 edition of the Association of American Medical College’s Reporter highlights the Wayne State University School of Medicine’s Medicine and Political Action in the Community organization.

“Medical Students Step into Advocacy Roles” details a number of ways medical students across the nation are making their voices heard on issues ranging from protesting deaths at the hands of police in Ferguson, Mo., and New York with white coat “die-ins” to meeting with state and federal lawmakers to discuss health care legislation.

"When our students go to Lansing or Washington, and have their white coats on, they have a voice with legislators that other professionals, quite frankly, just don’t have,” Doug Skrzyniarz, associate vice president of Government Affairs for the School of Medicine and MPAC director told The Reporter. “You’ll be treating thousands of people in your community, and in that role, people will look to you. Legislators know that.”

MPAC is designed to support the involvement of WSU medical students interested in political issues and action. Through a series of lectures and activities like State Capitol Day, students develop an understanding of how the medical profession interacts with public affairs.

During the annual State Capitol Day events, WSU medical students meet in Lansing with key office holders and directors who oversee health care and determine how it is funded in Michigan. Students have met with the director of the Michigan Department of Community Health, state senators and representatives, and the chairs of Senate and House subcommittees dealing with health issues.

The events, Skrzyniarz said, educates medical students about how to advocate and lobby legislators when they become physicians. The Lansing visits also demonstrate to the Legislature that the WSU School of Medicine is a leader in health care policy, and has medical students engaged in advocacy.

When a student dons the white coat symbolic of the profession, “You’re a leader whether you know it or not or want it or not,” Skrzyniarz told The Reporter.

Read the full article at https://www.aamc.org/newsroom/reporter/february2015/426086/advocacy.html.

Lycopene may ward off kidney cancer in older women
In Headlines on February 27, 2015
Cathryn Bock, Ph.D., M.P.H.

Cathryn Bock, Ph.D., M.P.H.

A higher intake by postmenopausal women of the natural antioxidant lycopene, found in foods like tomatoes, watermelon and papaya, may lower the risk of renal cell carcinoma, a type of kidney cancer.

A team led by Wayne State University School of Medicine and Karmanos Cancer Institute Associate Professor of Oncology Cathryn Bock, Ph.D., M.P.H., made the conclusion after analyzing data from 96,196 women nationwide and in Detroit who enrolled in the Women’s Health Initiative from 1993 to 1998 and were followed through July 2013 by participating initiative sites, including Wayne State University.

“We were surprised to observe a protective effect of lycopene, as several previous studies in other populations did not detect a similar relationship,” Dr. Bock said.

The results are explained in “Antioxidant micronutrients and the risk of renal cell carcinoma in the Women's Health Initiative cohort,” featured in the Feb. 15 issue of Cancer. WSU’s current Women’s Health Initiative site principal investigator and Professor of Internal Medicine and Oncology Michael Simon, M.D., M.P.H.; Associate Professor of Pathology Ikuko Kato, Ph.D.; and Associate Professor of Oncology Jennifer Beebe-Dimmer, Ph.D., M.P.H., contributed to the paper. First-author Won Jin Ho, M.D., a 2013 School of Medicine graduate, started on the project as a medical student and is now a second-year Internal Medicine resident at Case Western Reserve University in Cleveland.

The investigators analyzed the risks for kidney cancer associated with intake of lycopene and other micronutrients that have antioxidant properties, including lutein and vitamins C and E. During follow-up, 240 women were diagnosed with kidney cancer. Compared with women who reported a lower intake of lycopene, those who ingested more had a 39 percent lower risk. No other micronutrient was significantly associated with the same risk.

The 63,920 estimated new cases of kidney and renal pelvis cancer in 2014 made up 3.8 percent of all new cancer cases, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. In 2011, there were an estimated 358,603 people living with the cancer in the United States.

It is the eighth-leading cancer among women and is commonly diagnosed at a more advance stage.

“Kidney cancer is a relatively rare cancer, and so focusing only on reducing risk of this disease would be short-sighted,” Dr. Bock said. “Rather, a diet focused on one’s own personal risk factors, such as family history, would be more beneficial.”

A low-salt diet is recommended for women with a risk of hypertension, a major risk factor for kidney cancer. There are other steps women can take now for their health, including eating more foods and fruits with naturally-occurring lycopene.

“Lycopene from food sources has also been associated with decreased risk of breast and prostate cancers, and a diet high in vegetables and fruits are generally well-accepted for promoting good health,” she said.

Good sources of lycopene include tomatoes and tomato-based products, watermelon, pink grapefruit, guava and papaya. Dr. Bock suggests consulting a doctor before taking a lycopene supplement.

The team is now examining whether there is a relationship between antioxidant nutrient intake and kidney cancer risk in a National Cancer Institute-funded case-control study primarily conducted with participants from the metropolitan Detroit area.

“This study included a broader population, including both men and women, and with greater representation of African-Americans, and therefore may help describe the associations in populations beyond post-menopausal women who are primarily of European descent,” Dr. Bock said.

The Women's Health Initiative program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.
African-American history exhibit in final days
In Headlines on February 26, 2015
From left, students Adam Milam, Ph.D., and Osamuede Iyoha, with Audrey and Jack Sobel, M.D.

From left, students Adam Milam, Ph.D., and Osamuede Iyoha, with Audrey and Jack Sobel, M.D.

The group discusses a display board featuring various past and present African-American School of Medicine deans.

The group discusses a display board featuring various past and present African-American School of Medicine deans.

Wayne State University School of Medicine Interim Dean Jack Sobel, M.D., took a tour guided by two medical students Tuesday of “Celebrating Diversity,” the exhibit and lecture series on the history of African-Americans at the school. The exhibit is on display through the end of this month in the Shiffman Medical Library, 320 E. Canfield St., Detroit.

The final lecture in the series will be held at 2 p.m. Saturday at the library.

“History is very important because it gives you your roots. You can’t understand modern affairs without understanding the history,” Dr. Sobel said. “This should be a permanent exhibit.”

Third-year medical student Adam Milam, Ph.D., and fourth-year medical student Osamuede Iyoha led Dr. Sobel and his wife Audrey through the collection of histories and related photos that celebrate February’s Black History Month. Topics and photos included African-Americans who have held assistant, associate and vice dean positions at the school; a history and overview of the school’s Post Baccalaureate Program; an overview of the School of Medicine’s Black Medical Association student organization’s history; and more.

The quartet also spoke about past and present diversity issues and Dr. Sobel’s own experiences while attending medical school in South Africa during the era of apartheid, a system of racial segregation.

“I very much appreciate the presence of the two medical students, who provided soul to the presentation,” Dr. Sobel said.

The exhibit was installed in late January and included guest speakers each Saturday who shared histories of their personal and family experiences.

The exhibit was designed to inform the School of Medicine family about the important role the school played – and still plays – in educating African-American physicians. “Over time, African-Americans who have made major contributions to the School of Medicine are being forgotten. This exhibit will remind those of us who knew some of them and will introduce others just coming along to them,” said Anita Moncrease, M.D., clinical associate professor of Pediatrics and a Class of 1984 graduate, before the exhibit opened.

“It’s important to highlight the impact African-Americans have made in Detroit and in the health of the people of Detroit,” Milam said. “It’s important to spotlight those who have stuck around and have brought in students to train in disadvantaged communities.”
March 21 Lampoon benefits Sit On It Detroit
In Headlines on February 24, 2015

The Aesculapians, the honor society of the Wayne State University School of Medicine, will let off a little steam with some good-natured ribbing while raising much-needed funding for a Detroit organization at the annual Lampoon.

“Scott Hall on Call – Late, Late Late Night With Wayne State Aesculapians” will take place March 21 at Saint Andrew’s Hall, 431 East Congress, Detroit. Doors open at 6 p.m. and the show starts at 7 p.m. Tickets are $15 online at http://www.aesculapians.org/buy-tickets.html or $20 at the door. VIP tickets are $35 on the website or $45 at the door.

Lampoon consists of tongue-in-cheek skits and videos produced by members of the four medical classes. Each class produces about 20 minutes of material parodying medical school life for the evening’s entertainment. And while fun is the event’s watchword, Lampoon has its serious side, raising about $10,000 annually for a roster of Detroit charitable organizations.

This year Lampoon will benefit Sit On It Detroit, which builds handcrafted benches using reclaimed wood from abandoned houses and businesses throughout the city of Detroit. The benches are installed along bus stops that lack seating. The benches also serve as meeting spots and libraries because they have built-in book shelves.

Launched in 2013 by two Wayne State University urban planning majors, Sit On It Detroit has since built, installed and maintained dozens of benches throughout the city and has been commissioned to create tables, benches and artwork for other city projects.

“Sit On It Detroit believes in the principles of community, service, volunteering and improving Detroit, the basic pillars upon which Aesculapians was founded nearly 56 years ago, and still upholds to this day,” said Patrick Nolan, vice president of the WSU School of Medicine’s Class of 2016 and coordinator of this year’s Lampoon. “The organization’s enthusiasm and vision appealed to and aligned with the Aesculapians, whose members dedicate their time volunteering to better our greater Detroit community and city. The dedication and strength of our volunteers, and funds generated from the Lampoon show can only help take Sit On It Detroit to the next level and showcase it on an even larger stage within the great city of Detroit.”

Blogging Around the World: Christopher Sy in Nicaragua
In Headlines on February 23, 2015
Christopher Sy, a fourth-year medical student, is in Nicaragua this week with the World Health Student Organization.

Christopher Sy, a fourth-year medical student, is in Nicaragua this week with the World Health Student Organization.

The group gathers at the airport.

The group gathers at the airport.

Two students get in some computer time before flying.

Two students get in some computer time before flying.

Christopher Sy, M.A., a fourth-year medical student, is in Nicaragua the week of Feb. 21-28 for a medical mission trip organized by the Wayne State University School of Medicine’s World Health Student Organization. The Village of Siuna, Nicaragua, will host a clinic staffed by students and WSU physicians. The group also will conduct public health workshops and work on a community project to gain a better understanding of the patients they will see.

This is part one of two. Click here for part two.


Dia Uno - The Departure

Hola!

My name is Chris Sy. I'm a fourth-year medical student at the fabled Wayne State University School of Medicine applying for neurosurgery. For better or worse I'll be the student blogger for a medical relief trip to Nicaragua organized by the World Health Student Organization on campus.

I'll tell all of you right now ... it's exciting to just get away from the bitter cold and hug that equator a little more. What was it in Detroit? Minus 10 degrees? Ugh. So yes, the improvement in climate is appealing (80 degrees and sunny in Managua, yeah I rubbed it in) but what is more enticing is what we are all going down there to do: bring medications, supplies and primary medical care to communities that are having a much harder time than even the Motor City. Those are just the tangible things. In doing so we also hope to impart smiles, inside jokes and hilarious dance moves. In short, our goal is not only to improve physical health but to foster an exchange of culture for emotional and mental health.

After all, medicine is an art as well as a science, is it not? Oh definitely.

All right, what's the lowdown on the trip? There are 19 of us in the group: 12 first-year medical students, three fourth-year medical students and four physicians -- three from Family Medicine and one from Obstetrics and Gynecology. As I type this, we are actually 38,000 feet in the air on the way to our layover in Atlanta. From there, we will be hopping over to Managua, the capital of Nicaragua, and then to a town called Siuna, and finally, a smaller town called Tadazna. We are linking up with a non-governmental organization there called Bridges to Community once we land.

We will be there for about seven days, of which we will hold at least five days of clinic. Word on the street is that Wi-Fi and many other amenities are not available outside of the capital, so I'm planning to send this first entry from Atlanta. I will be collecting photos and stories and other deep dark secrets (just kidding ... or am I?) daily for blog entries despite the supposed lack of Internet. Worst case scenario is our entire epic journey will be posted all at once when we return rather than day by day, but at least this one will get through.

We're all excited. We've left our scarves and jackets behind in exchange for sunglasses and mosquito nets. We've got a great group of individuals who aren't shy about being uncomfortable and stepping out of our Motown bubble. I hope I'll be able to accurately convey to all of you what we're up to, who we've met and what we've eaten (supposedly iguana is a thing down there). I'm also planning to collect shout-outs, so stay tuned. So far so good!

Dia Dos – The Journey to Don Gavino's (he is as legit as that sounds)

Today was full of 180s. Where to start?

Our goal today was to leave the capital Managua and eventually make it to the remote village of Tadazna. We spent the night at the Hotel Camino Real (which was nice and a stark contrast to the conditions in which I now type, but more on that later). I wouldn't be surprised if it was one of the top hotels in the country, and the subsequent breakfast buffet didn't disappoint. Side note: Starfruit juice is delicious.

After breakfast we made our way to the airport as our first stop, Siuna, was a one-hour flight. So more peanuts and in-flight movies, am I right? That's a negative. We ended up taking two propeller planes because all 19 of us couldn't fit in one. Although the turbulence was mildly upsetting for some, the flight afforded some amazing views – pictures/videos of which I hope will end up accompanying this post.

Once in Siuna, I think it's fair to say the hot, humid climate we've all been expecting/excited for hit us full blast in all its sweat-inducing glory. It was hot. Caliente, some might say. Our amazing guide from Bridges to Community is actually a native of Siuna so she was able to give us a formal introduction/orientation over lunch (consisting of chicken, salad, rice and beans.)

We hopped into a school bus and got ready for another one-hour journey to Tadazna on mostly unpaved roads. If you've ever ridden the neck-jerking Indiana Jones ride at Disneyland that's pretty much what it felt like, multiplied by 100,000. After passing innumerable potholes, stray dogs, cattle, bison, cornfields, pigs and roadside dwellings with red Claro brand satellite dishes, we finally made it to Tadazna.

We are staying at Don Gavino's house and all 19 of us are staying in a single concrete-wood room filled with bunk beds, dorm style. No running water and no warm water, which is not too much of a big deal as it’s probably something like 90 degrees. Naturally there is no WiFi and there are electric lights only sporadically. We have latrines and a new kitten friend we call Buttercup. Again, I'm hoping the numerous pictures/videos we are taking will be posted with this.

Supposedly there are tarantulas and scorpions and snakes and miscellaneous giant rodents/insects. I don't think any of us expected exactly this, but after talking with my colleagues it seems none of us would have it any other way. We know this is an experience that will give us perspective and personal insight into so many things. In addition to personal growth (and quite frankly the experience of a lifetime), we hope to help people in the small, honest ways that we can.

We went from freezing snow to humid, scalding heat. From hotel with a pool to farmlands and barrel showers. From Woodward Avenue in Detroit to the unpaved "calle" in Tadazna littered with roosters, horses and swine.

Oh Tadazna.

All in all, we're excited to finally set up this clinic and start seeing patients. Let's do this.

P.S. – Tanu would like to say “hi” to her Mom and Dad.

Dia Tres – Clinic Day 1 and Done

Tired.

We finally had our first day of clinic and it was a hefty one. We ended up seeing 48 patients, including men, women and children who were bused in from even more remote villages. It being the first day, we had to start early to set up the pharmacy, triage and patient care areas. This meant waking up at 5 a.m., before the sun rises, but not before the dozens of neighboring roosters crowed us all awake at 1 a.m. and  every hour thereafter (no, they don't just call out once at sunrise as in cartoons).

Not sure why but we are always so hungry. Luckily we have a dedicated group of workers from Bridges to Community who cook us huge family-style meals that are as healthy as they are tasty. Most every meal consists of rice, beans, numerous vegetables and at least one kind of fruit. Meat is a rare treat here, but that does not stop us from eating like ravenous beasts despite our American/carnivorous nature.

So what did we see out here?

From my own experience there were a good amount of respiratory infections and respiratory problems due to environmental exposures. The burning of garbage is common in rural Nicaragua, with many households doing their own burning in their own yards. This allows potentially toxic pollutants to freely waft into homes. This, on top of a tropical climate, makes dehydration an additional issue here. I would say other common issues are parasitic infections, sexually transmitted diseases, gastric reflux and musculoskeletal problems secondary to lifelong manual labor. A big change for us is that, unlike our patients at home, most individuals here are rather thin and hypertension/diabetes is scarce.

The day was long. At times it was hectic. At any given time the sun could be bearing mercilessly down and the next sheets of heavy rain would cascade down. Throughout all of this, however, we still found time to laugh and smile and squabble over our limited supply of lollipops and Life Savers candy. We doused each other in gallons of DEET repellant while firing sarcastic jokes/comments that we all somehow (thankfully) find incredibly humorous. In short, I don't think we could have put together a better, more cohesive or more resilient group.

We're hoping to continue representing Detroit well and we're looking forward to what comes next. Bring it.

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