S T A N F O R D M E D I C I N E
19 Number 1 Winter 2002
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Carloyn Chen, a member of Stanford's undergraduate class of 2001, makes the eight-hour boat trip from Ambunti to Oum
wobbly Twin Otter airplane landed on a patch of grass in the Papua New
Guinea village of Nagri. As Stanford undergraduate Anh Bui emerged, she
saw hundreds of villagers lined up along the runway waiting for her groups
arrival. The crowd was chanting and singing. Men clutched spears and women
waved fans made from feathers and leaves. Bodies were painted with letters
that read "PNG" and "Stanford."
"Old women were dancing all around us in circles," Bui recalls.
"We were overwhelmed by their energy."
Bui, now a graduate, was part of a 14-member Stanford team two
doctors, four medical students and eight undergraduates that trekked
to the rainforest of the East Sepik Province in Papua New Guinea in June
2001 to see patients and lead medical lectures and workshops for local
Since 1996, for two weeks every summer (save one) a team from Stanford
has made its home in this remote place where hundreds of miles
of dense, mosquito-infested tropical forest are interrupted only by the
tortuous Sepik River and the occasional village. By now the program has
trained over 200 medics from more than 80 villages to care for their communities,
representing a combined patient population of at least 50,000.
In 1996, Stanford dermatologist Peter Lu, MD, led the first team into
Papua New Guinea with then-medical student Julie Hopkins (MD, 1998). From
the start, the goal was to develop a sustainable health care system in
the Sepik by training village medics to care for their own people.
"This project is different from other international medical trips
because were not here to swoop in and bring our meds, treat a couple
of people and leave," explains medical student Clement Yeh. "The
idea is to make ourselves obsolete."
Lu and other team members have pieced together the support needed to
make the project possible. Stanford pediatrician Janelle Aby, MD, a member
of the first team, helped obtain medications from drug companies
which donate about $100,000 in drugs each year. Other supplies are contributed
by Stanford Hospital and the Papua New Guinea-based Pacific Island Ministries.
Funds for the project come from the Stanford Medical Student Association,
the Christian Medical Dental Society, the Flora Foundation and the Peninsula
Foundation. In addition, the School of Medicine gives students academic
credit for their efforts.
Before the project began, villagers had poor access to basic health care.
"Every kid had malaria, acute and chronic. We saw tropical skin ulcers
all over: silver-dollar-sized holes covered with flies. Kids were dying
from dehydration," recalls assistant professor of surgery Kelly Murphy,
MD, a member of the first team. "There were kids with tinea imbricata
infections so superinfected that if they were back at Stanford, they would
have been put in the ICU."
As a result of the training received through the project, the medics
have improved the health of their villages sometimes dramatically.
"After just one year, in the village of Oum, there were no more ulcers,"
recalls Lu. "And dehydration had disappeared."
Simple preventive care and hygiene practices have been the most powerful
tools in improving the health of the Sepik, says Murphy. For example,
the disappearance of tropical ulcers can be attributed to basic first
aid, he says.
Malaria is another success story. By using mosquito nets, staying indoors between 10 p.m. and 2 a.m. (when the malaria-carrying female Anopheles mosquito is on the prowl) and correctly diagnosing and treating infected patients early, Oum villagers saw the incidence of malaria drop in two years from almost 100 percent to nonexistent.
Students become teachers
The turning point for the Stanford Papua New Guinea project came in 1999
when Lu invited the top medics to teach the training course. "They
wrote the lectures, they wrote the final exam," recalls Lu. "And
they did a beautiful job." So in 2000 the team stayed home. Reports
that the course went smoothly told the team that Sepik medic education
had come of age. "We set up a school," says Lu. "Now our
job is to teach the teachers."
Curiosity among the advanced medics about the causes of disease prompted the Stanford teachers to create a new course this year one that transcends basic patient care and focuses on scientific principles underlying the human body.
"We wanted to give them a larger context to think about transmission and prevention, in addition to specific disease treatment," explains Robert Siegel, MD, a Stanford associate professor of microbiology and immunology who co-taught a lecture on infectious disease this summer. In workshops held after each lecture, medic students participated in hands-on activities to reinforce new concepts. For example, the cell biology lecture was followed by a microscope workshop, where students had their first peek at the cellular world.
The Papua New Guinea project has given more than 50 Stanford students the opportunity to learn and teach medicine in a challenging and inspiring environment.
Limited resources push students to be creative. "It hones your skills to a certain extent since you have no CT scan, no laboratory," says medical student Ward Myers, who has been to the Sepik twice. "It forces you to get by with a lot less."
Second-year medical student Brenda Czaban says she felt honored to become the first Stanford student to be present for the traditionally private ritual of childbirth. By the light of a window in a dark Sepik dwelling, Czaban watched a woman give birth attended only by her own mother who vigorously kneaded her belly to expedite delivery and her sister, who cut the cord after the placenta had been delivered.
Although Czaban observed many potentially dangerous practices
for example the baby was delivered directly onto an unclean bark floor,
splashed with cold water and then lay untouched for half an hour
Czaban said she found the experience humbling. "After all, theyve
been doing this for hundreds upon hundreds of generations."
After a six-year run, the Stanford Papua New Guinea Medical Project is nearing its end. This summer, 2001, was just "a checkup," says Lu. A core of dedicated Papua New Guinea medics has taken over the training of new medic students.
These advanced medics, many of whom have attended the Stanford course
since 1996, have been instrumental in improving the health of their own
villages. While running clinics in these regions this summer, Murphy was
astounded at the dramatic gains in health made in just two years since
the team had last been there. In one village, not a single person had
health complaints in need of examination, so the Stanford students resorted
to doing well-child checks on schoolchildren.
As the local medics become more skilled and the Stanford presence becomes less crucial, sending an entire team back to the Sepik may soon no longer be necessary. Murphy is hoping to start a one-month Sepik rotation for interested Stanford Hospital medical residents at the newly constructed Oum clinic, which will provide access to health care for 20 surrounding villages. Visiting doctors would work with and continue the education of local medics.
For more information about the Stanford Papua New Guinea Medical Project, visit http://www.stanford.edu/group/pngmp/.
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