S T A N F O R D M E D I C I N E

Volume 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

Short Takes:
Spreading health in Papua New Guinea

A Stanford medical project nurtures a sustainable health care system

by UMA SANGHVI


The 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 group’s 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 health aides.

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.


A view of Ambunti

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 we’re 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.


Medic Speddy Aiwis reports on Oum village's health with Stanford's Kelly Murphy (at left)

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."


To maximize the impact of precious commodities such as penicillin or Amoxicillin capsules: "We undo the capsule and sprinkle a little bit of antibiotic powder on the wound," explains Lu. "So instead of just one dose for a quarter of a day, one capsule can now be stretched out for several people over many days."

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, they’ve been doing this for hundreds upon hundreds of generations."

Successful obsolescence

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.


A checkup for the chief of Oum 2

New frontiers

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.


"We’ve established that this particular series of maneuvers leads to a very inexpensive and very effective medical care system," says Lu. "I think that this could be replicated in other areas." Murphy is considering taking the project to other regions of Papua New Guinea, or other countries altogether. Preliminary plans for a trip to northern Vietnam are in the works for summer 2002 in addition to a seventh, and maybe final, trip to the Sepik. The future may see the project modeled in places far from the banks of the Sepik but "there’s no place on earth like it," admits Myers. "Being able to teach in that environment reminds me why I got into medicine in the first place." SM

For more information about the Stanford Papua New Guinea Medical Project, visit http://www.stanford.edu/group/pngmp/.

 

SM

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