ims 4-12 issue on global health

8/2/2019 IMS 4-12 Issue on Global Health

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insideMount Sinai

Providing Medical Care to the Masses

CONTINUED ON PAGE 2

The world is more densely populated, urbanized, and

interconnected than ever before. In understaffed city

hospitals and rural clinics throughout Africa, Asia, and

Latin America, health care workers are encountering

increasing rates of obesity, diabetes, lung cancer,

and heart disease in their patient populations. Theseconditions once affected mostly people in industrialized

countries. Now they are more prevalent in developing

nations that are also battling infectious diseases such as

AIDS, malaria, pneumonia, and tuberculosis.

Mount Sinai Global Health, which unies The Mount

Sinai Medical Center’s many international missions

and programs—as well as efforts in underserved U.S.

communities—is addressing these challenges through

research, training, and clinical practice. With Mount

Sinai’s innovative thinking and intellectual rigor, we are

maximizing human and technological resources, and

giving equal weight to the demands of the present and

the predicted needs of the future.

— Philip J. Landrigan, MD, MSc

Promoting cardiovascular health throughout the world is a priority for

physicians at Mount Sinai Heart, led by Valentin Fuster, MD, PhD, Physician-

in-Chief of The Mount Sinai Medical Center. They see the expanding

spectrum of cardiovascular diseases increasingly affect low-and-middle-

income countries.

“How do we reach the millions of people in remote areas of the world who

are as likely to be affected by cardiovascular disease as those in high-income

countries?” Jagat Narula, MD, PhD, Associate Dean for Global Health, and

Editor-in-Chief of Global Heart , the journal of the World Heart Federation,

asks rhetorically. “How do we reach the masses?”

For one day in January, Dr. Narula, the Philip J. and Harriet L. Goodhart

Professor of Medicine (Cardiology), and Director of the Cardiovascular

Imaging Program at Mount Sinai Heart, was able to do so. Through a

program he co-founded, known as HAPPY (Heart Attack Prevention

Program for You), Dr. Narula reached out to thousands of individuals who

had converged in Sirsa, a remote area of India, for a one-week meditation

A Commitment to Global Hea

Bringing Safe,

Sustainable Health Care

to Women in Guatemala

In Colombia, Children

Learn about Heart Health

Improving Quality of

Life on the Spirit Lake

Tribe Reservation

Building a Strong Health

Care System in Haiti

Mount Sinai’s

Global Reach

Lookinside

THE

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15,2012

These women were among millions of people who gathered

recently in Sirsa, India, for a one-week celebration and

meditation camp. Mount Sinai physicians performed thousands

of cardiovascular screenings at the event (see story below).

Dr. Landrigan is Dean for Global Health, Ethel H. Wise Professor an

Chairman, Department of Preventive Medicine, Professor of Pediat

Director, Children’s Environmental Health Center, Mount Sinai Scho

of Medicine.

Mount Sinai’s Partho P. Sengu

MBBS, MD, DM, screens a pat

in Sirsa, India.



camp. The Reverend Gurmeet Ram Rahim

Singh Ji Insan, a spiritual leader whom they

had come to hear, relayed a message from

Dr. Narula on the importance of eating well,

exercising, and not smoking.

Over a 24-hour period, Dr. Narula led a

health care team that screened 4,684

patients for blood pressure, glucose,

and cholesterol, and performed carotid

ultrasounds for more than 650 at-risk

patients. The record-breaking feat wasrecognized by editors at Guinness

World Records.

The event also included an initiative

led by Partho P. Sengupta, MBBS, MD,

DM, Associate Professor of Medicine

(Cardiology), and Director of Ultrasound

Research at Mount Sinai Heart. Dr. Sengupta

mobilized 75 cardiologists and sonographers

from medical institutions around the world,

including the United States, Australia,

and Bulgaria, who volunteered to read

echocardiograms that were sent via cloud

computing to their homelands on behalf of

the American Society of Echocardiography.

Using new handheld ultrasound devices,

Mount Sinai investigators and their team

performed scans on 1,030 patients over two

days, also earning a Guinness World Records

certicate. Joining Dr. Sengupta onsite was

a second cardiologist and nine sonographers

from the United States, including Mount

Sinai’s Ingrid Altamar, and local cardiologists

and health care workers.“We saw really sick patients who had

severe valve disease and undiagnosed

congenital defects,” says Dr. Sengupta. Five

people were sent directly to the hospital.

“Ultimately, we connected 1,030 hearts with

75 experts from around the world,” he adds.

Dr. Narula says global initiatives like the

one in Sirsa, help Mount Sinai by providing

investigators with an opportunity to analyze

and understand the disease process using

modern technology.

Tourism is robust in the Lake Atitlán region in

the Guatemala Highlands, an area known for

its winding mountains, and beautiful volcanic

lake. But in the outlying villages, far from the

busy hotels, residents live without running

water and electricity. Here, the maternal

death rate is the highest in Central America.

Mount Sinai’s Global Health Program

is making strides toward sustainable

women’s health care here and in other

indigenous societies throughout Central

America. Taraneh Shirazian, MD, Director of

Global Health, Department of Obstetrics,

Gynecology and Reproductive Science

at Mount Sinai School of Medicine, has

spearheaded initiatives that provide onsite

clinical care, and teach best practices in

pre- and post-delivery protocol to local

health care workers.

Prior to being deployed to communities

throughout Guatemala, El Salvador, and

Honduras, Mount Sinai residents are trainedto understand the local cultures. They are

taught how to address global health issues

such as women’s rights, and access to

family planning, along with cultural beliefs

surrounding delivery and pregnancy.

“We focus on understanding, educating, and

empowering women in the context of their

local perspective,” says Dr. Shirazian.

Approximately one Mount Sinai resident goes

on each of the six or so annual missions to

the Lake Atitlán region, which are conducted

in cooperation with a nongovernmental

organization (NGO) called Saving Mothers.

Local birth attendants have no formal

training; they’re unequipped for life-

threatening complications such as post-partum hemorrhage and eclampsia, a

convulsive condition that often follows

pregnancy-induced hypertension. The Mount

Sinai teams train birth attendants in critical

practices such as clean and safe delivery,

shoulder dystocia, and appropriate and

timely referral in cases of emergency. The

local hospital staff also receives training in

appropriate administration of medications

through a best-practices protocol manual.

When Mount Sinai’s teams noticed the

absence of even the most basic resources

for a clean, safe delivery, they began

distributing birth kits with soap, gloves, clea

sheets, blankets, and baby hats, along with

simple, pictorial instructions for delivery.

In May, they will begin distributinghemorrhage kits to the Guatemalan birth

attendants to stem post-partum hemorrhag

the leading cause of maternal death.

“Mount Sinai prepares its physicians for

responsible global citizenship,” says Dr.

Shirazian. “They become better physicians

when they can educate women from diverse

backgrounds. Only through culturally

sensitive collaboration can we hope to

make any sustainable impact on global

women’s health.”

Providing Medical Care to the Masses (continued from page 1)

Bringing Safe, Sustainable Health Care to Women in Guatemala

Mount Sinai residents provided Guatemalan birth attendants with birth kits that contain necessities

such as soap, gloves, clean sheets, and pictorial instructions for delivery.

At the celebration in Sirsa, India, men lined up

to receive echocardiograms.



Mount Sinai Heart researchers, in collaboration with Sesame

Workshop, have shown that children ages four through six are eager

to learn the importance of exercising and maintaining a healthy diet.

With proper intervention, and support from parents and teachers,

they can develop healthy habits that last a lifetime. These key ndings

were reported recently in a three-year study of thousands of pre-

school children in Bogotá, Colombia that was led by Valentin Fuster,

MD, PhD, Physician-in-Chief of The Mount Sinai Medical Center and

Director of Mount Sinai Heart.

Dr. Fuster and his team have been examining ways to prevent the

spread of cardiovascular disease (CVD) in both developed and

developing countries as lifestyles become more sedentary, and

high-fat, high-carbohydrate diets become the norm. In Bogotá, CVD

has become the leading cause of death, according to an assessment

of seven Latin American cities that appeared in The American Journal

of Medicine.

The Mount Sinai team says their encouraging results in Bogotá,

using popular characters from Sesame Workshop, can be replicated

across cultures. They say prevention programs like this will save lives

and enormous amounts of money that governments now spend to

treat CVD.

“We have to promote health and stop talking about disease,” says

Dr. Fuster, who is also Director of the Zena and Michael A. Wiener

Cardiovascular Institute and the Marie-Josée and Henry R. Kravis

Center for Cardiovascular Health at The Mount Sinai Medical Center.

“Young children learn what you teach them. And children impact the

behavior of their parents.”

The Spirit Lake Tribe Indian Reservation

covers about 405 square miles in the East-

Central part of North Dakota, an area in theremote Northern Plains bounded by lakes

and at terrain that gives way to rolling

hills. This branch of the Dakotah tribe, with

approximately 6,600 members, has lived on

the reservation since the tumultuous days

of 1867, when Native Americans fought to

preserve their way of life.

Today, Mount Sinai School of Medicine—

under the leadership of Jonathan Ripp, MD,

MPH, Assistant Professor, Division of General

Internal Medicine, Department of Medicine,

and Associate Director, Global Health Training

Center—is working with the Spirit Lake Tribe

to improve their quality of life. Almost 60

percent of the community is unemployed,

and about 50 percent live at or below thepoverty level. Rates of obesity, diabetes,

and alcoholism among Native Americans, in

general, far exceeds that of the rest of the U.S.

population, and members of the Spirit Lake

Tribe are no exception.

For three years, Mount Sinai has partnered

with the tribe’s Cankdeska Cikana Community

College (CCCC) to help educate and promote

healthy behaviors among tribe members, and

to encourage tribal youth to pursue careers in

health care.

Mount Sinai’s students helped the community

conduct an elder health needs assessmen

in 2010. The data collected was used to

help fulll grant requirements for fundingto support services for the tribe’s elderly

population. For the past three years, CCC

has offered a health care course that is ta

by Mount Sinai’s medical and public heal

students, residents, and faculty.

In June 2012, approximately six of Mount

Sinai’s medical and public health student

residents, and faculty will visit the reserv

for a fourth summer to teach the course

CCCC, and help run a day camp for midd

school children that exposes them to diff

health professions, and encourages healt

habits. The camp’s activities include visit

from Emergency Medical Service worker

nurses, and assistance in producing video

public health announcements.

“The people of Spirit Lake honored and

welcomed us into their lives with unexpe

openness,” says Dr. Ripp. “Each experienc

we shared—the elder interviews, tradition

ceremonies, and family ceremonies—gav

us a new appreciation of their complex

community.”

Improving Quality of Life on the Spirit Lake Tribe Reservation

In Colombia, Children Learn About Heart Health

We have to promote health and stop talking

about disease. Young children learn what you

teach them. And children impact the behavior

of their parents. — VALENTIN FUSTER, MD, PHD

Pre-schoolers in Colombia perform for their peers, singing and dancing abou

the importance of exercising and maintaining a healthy diet.

PHOTOS, FROM LEFT TO RIGHT: Cankdeska

Cikana Community College students march

at the Spirit Lake Tribe’s annual celebration,

which culminates with a traditional pow wow

CONTINUED ON PAGE 4



Haiti’s catastrophic

earthquake in 2010 quickly

drew physicians, nurses and

other health care workers

from The Mount Sinai

Medical Center and around

the world. As expected,

National Hospital, Haiti’s

large hospital in the capitalof Port-au-Prince, was in a

shambles. What the outside

world did not realize, however, was how inadequate and fractured

Haiti’s health care system had been long before the earthquake hit.

“The earthquake was a catalyst that opened people’s eyes to how

bad things were, and what we could do to make it better,” says Ernest

Benjamin, MD, Professor of Surgery and Anesthesiology, Chief, Division

of Surgical Critical Care Medicine, and Director of the Surgical Intensive

Care Unit at The Mount Sinai Medical Center. Dr. Benjamin, arrived

at National Hospital three days after the earthquake, and led Mount

Sinai’s medical relief efforts there.

Now, Dr. Benjamin is galvanizing Mount Sinai’s physicians, residents,

and medical students, and members of other U.S. medical centers to

help establish a strong health care infrastructure in Haiti. Their multip

efforts include the following initiatives:

Building a Strong Health Care System in Haiti

Mount Sinai’s Global Reach

Inside Mount Sinai2012 Marketing & Communications

Carrie Gottlieb, Editor

Marilyn Balamaci, Editor

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Ernest Benjamin, MD, demonstrates

critical care procedures for Haitian

medical students.

• Twice a year, Dr. Benjamin and Adel M. Bassily-Marcus, MD,

Assistant Professor of Surgery, at The Mount Sinai Medical Cente

travel to Haiti to teach fth-year Haitian medical students an

intensive, four-day course in critical care medicine.

• Dr. Benjamin and François Lacour-Gayet, MD, Chief of the Divisio

of Pediatric Cardiothoracic Surgery at Monteore Medical

Center in New York, are planning four missions to Haiti in 2012, in

which they will perform heart surgery on a total of 60 children.

Ultimately, Dr. Benjamin would like to help create a Heart Institute

of Haiti to treat adults and children, and develop an advanced

cardiac care program that includes cardiac surgery.

• A group of third-year medical students at Mount Sinai are

conducting research on the prevalence of neurological problems

Haiti, under the supervision of Isabelle M. Germano, MD, Professo

of Neurosurgery, Neurology, and Oncological Sciences.

In Colombia, Children Learn About Heart Health (continued from page 3)

The study in Bogotá, started with 1,000 children

in 2009, and has grown to more than 25,000.

Research supervisors spend 40 hours over

a ve-month period with the children, using

specially designed Sesame Workshop characters

that promote healthy habits in books, posters,

videos, games, and songs. Their teachers attend

training sessions, and their parents participate in

workshops, and receive weekly notes containing

positive health messages about nutrition and

active lifestyles to share with their children. The

changes in knowledge, attitudes, and habits weremeasured using a standardized tool. Children

in the intervened group exercised regularly and

maintained their weight over six months.

The children provide the impetus for families to

change their lifestyles, says Michael E. Farkouh,

MD, MSc, Associate Clinical Professor of Medicine

(Cardiology), and a co-author of the study. “We

are promoting good health and we can do this

across countries,” says Dr. Farkouh. “Our program

opens up a whole new area for cardiovascular

public health.”

A larger effort in Spain that is modeled after the

program in Bogotá currently involves 100,000

children. In Spain, Dr. Fuster plans to add a second

level of educational intervention for when the

children turn seven. The project also examines

whether the control of emotions can help prevent

drug addiction after the age of 10.

Argentina

Bangladesh

Belize

Brazil

Cameroon

Chile

China

Colombia

Costa Rica

Dominican

Republic

Ethiopia

Grenada

Guatemala

Haiti

Honduras

India

Iran

Ireland

Italy

Kenya

Liberia

Malawi

Mexico

Mongolia

Mozambique

Paraguay

Peru

Rwanda

St. Vincent and

the Grenadines

South Africa

Spain

Tanzania

Thailand

Uganda

United States

Uruguay

Vietnam

A SNAPSHOT OF INITIATIVES AROUND THE WORLD:

ims 4-12 issue on global health

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