SyllabusforMEDS554,Page2of5

TableofContents

1.0 ForWhomIsThisCourse?

2.0CourseOverview

3.0Itinerary

4.0LearningObjectives 4.1Uponcompletionofthecourse,studentswill: 4.2CourseNotes 4.3Prerequisite(s) 4.4RecommendedPreparation5.0 5.1GradingBreakdown 5.2Class&FieldParticipation 5.3JournalEntries 5.4CommunityHealthEducationProject 5.5ReadingAssignments&Questions 5.6GlobalCitizenshipRoundtablePresentation 5.7SocialMediaBlogReflection&Pictures 5.8TelemedicinePatientCaseWrite-Up6.0AccommodationsinPanama 6.1Housing7.0Appendix 7.1LectureTopicSummaries 7.2RequiredReadingAssignments(DocumentTitleList) 7.3RequiredReadingAssignmentQuestions 7.4SupplementalReading(DocumentTitles) 7.5VaccinationRequirements 7.6WhattoTake 7.7Health&SafetyIssuesAbroad

Administering Antipyretic To Febrile Child

Emergency Extraction for Appendicitis

Dental Exam In Remote Jungle Village

Departing for Multiday Clinic in Dugout Canoe

1.0ForWhomIsThisCourse?• GlobalHealthStudents&Faculty• UndergraduateStudents• Graduatestudents• MedicalStudents• Physicians• Nurses• PhysicianAssistants• NursePractitioners• Pharmacists• PublicHealthWorkers• AidWorkers• Epidemiologists• Occupational&Physiotherapy• Dentists&DentalStudents

Thisexperienceisvaluabletoanyonewithaninterestinimprovingtheircontextualunderstandingoftypicalchallengesandvarioussolutionstohealthcaredeliveryinrurregions.Participantsfromawidevarietyofdisciplineswillgainvaluableinsightintoremoteruralhealthcareindevelopingworldsettings.**AlthoughtheprimaryfocusofthiscourseGlobalHealth,thecoursesmaybemodifiedfordifferentspecialties

2.0CourseDescriptionThis course will provide students with first-hand experience in the delivery of remote ruralhealthcareandcommunitydevelopmentastheygainexposuretothevarioussocio-economicfactorspresent inunderservedremoteregionsaroundBocasdelToro,Panama.Thestudentsandfacultyadvisor(s) travel toPanamaandstayattheFloatingDoctorsheadquarters,wherethelecture&fieldcomponentsofthecoursearebased.Thecoursewillintegratebothlecture-based instructionswith field-based practice. Instructionwill be conducted primarily in BocasdelToro,Panama.

AfterarrivinginBocasdelToroonSundayandattendingNewVolunteerOrientationandalectureinCulturalCompetency,studentswillparticipateinseveralhoursoftrainingandclinicalorientationthefollowingMondaymorning,spendingtheafternoonworkingin

the government convalescent home that Floating Doctors supports. On Tuesday, the students willdeploywith the Floating Doctorsmedical team on a 4-daymission to a remote island community.They will sleep in hammocks strung up in the community, living and working in the village untilreturningtobaseonFridayafternoon.FullclinicdayswillbeconductedonTuesday,WednesdayandThursdaywithadditionalfollow-uponFridaymorningbeforetravellingbacktobase.The students also have several lectures pertaining toGlobal Health, aswell as patient case rounds

while in the field,aswellaspre-readingandreflective journalingaimedatgaining insight intohowtheirexperiencehasaffectedthemaswellashowtocreateeffectiveandethicalcontentforreportingandsocialmediadriversofhealthcaredelivery.During clinical days, students will be placed at multiple stations including ultrasound,doctor/provider stations, intake stations, administration stations, or sent to accompany housecalls or emergency responses. Depending on language ability and background (i.e. medicalstudentsvs.graduatepublichealthstudentvs.pre-medicalstudent),participantsmayscribeortranslate in clinic, assist providers in consults, ultrasounds, house calls or procedures, ormaystaff thepharmacystation,administrationstation,or clinic intakestations tocheckvitals, takebasichistoriesandconducthealthscreeningforanemia,diabetesorotherconditions.Participantswill gain invaluable empiric experience learning about several unusual disease presentations and advanced cases ofconditionsthataretreatedatearlierstagesinthedevelopedworld,aswellaslearningthecontextualapproachtosolutionsthatarepracticaltothesurroundingresourcelimitations.OnFridayafterreturningtobase,studentswillreturntoAsilointheafternoon.

Theyarealsoexpectedtoprepareacommunitydevelopmentoreducationprojectbefore theirarrival (often a poster or other enduringhealth educationmaterial), to implementduring theirvisittothecommunity.The course provides students with a unique, mentored clinicalexposurecoupledwithdidactic lectures.ThecourseencompassesawidevarietyofGlobalHealthtopicsincluding:economic,social,andpolitical health issues in Panama, region-specific diseases, the

practice of emergency medicine in rural developing regions. cultural competency, legal and ethicalissues,andthefundamentalapproachtointerventionsinresource-limitedsettings.

3.0Itinerary

Day1(Sunday):ARRIVALDAY• 6:00–7:00PM:NewVolunteerOrientation• 7:30–8:30PM:Dinner• 8:30–9:30PM:Lecture1:“CulturalCompetency”

Day2(Monday):• 7:30–8:30AM:Breakfast• 8:30–9:30AM:Lecture:“Geriatrics&End-of-LifeCareinResource-LimitedSettings”• 10:30–11:00AMBreak• 11:00AM–12:00PM:Lecture“MentalHealthinDevelopingWorldSettings”• 12:00–1:00PM:Lunch• 1:00–2:00PMNewVolunteertrainingbyFloatingDoctorsleadership• 2:00PMTraveltoIslaColon• 2:30–5:00PM:Workatthe‘Asilo’• 5:00PMReturntoBase• 6:30PM:Dinner

Day3(Tuesday):• 7:30–8:30AM:Breakfast• 8:30AM:Departformultidayclinicdeployment• 12:00PM:Arriveatclinicdestinationandunload• 1:00–2:00PM:Lunch• 2:00–4:00PM:Setupcampandarrangeprepareclinicalgear• 4:00–6:00PM:Freetime• 6:00–7:30PMDinner

Day4(Wednesday)&Day5(Thursday):• 7:30–8:30AM:Breakfast• 8:30AM–5:30PM:Conductclinicalwork• 6:00–8:00PMDinner&PatientCaseDiscussion

Day6(Friday):• 7:30–8:30AM:Breakfast• 8:30AM–11:00AM:Last-DayPatientFollow-Up• 11:00AM–2:30PM:TravelbacktoFloatingDoctorsHeadquarters• 2:30–4:00PM:Freetime• 4:00PM–5:00PM:Lecture:“Medico-LegalAspectsofAidWork”• 6:00–7:30PMDinner

Day7(Saturday):DEPARTUREDAY

**Studentsmayarrangeseparatelytostaylongerandparticipateinadditionalweeksofvolunteerworkbyadvancearrangement

4.0LearningObjectives4.1Uponcompletionofthecourse,studentswill:

• UnderstandthecriticalissuesimpactingthedeliveryofhealthcareinPanamaandotherresource-limitedsettings• Describethesocial,political,andeconomicbarrierstohealthcareinPanama• Explainvariousregion-specificdiseases/conditionsprevalentinPanama• Developskillstoimplementcommunityprojectswithanemphasisonculturalcompetence• Learncontextualapproachestoglobalhealthsolutions• Demonstratecapabilityinemergencymedicineinaruralsetting• Understandhowtoeffectivelyutilizesocialmediatodriveglobalhealthcaredelivery.

4.2CourseNotesPreparatorymaterials such as Floating Doctors’ Volunteer Handbook and Treatment Guidelineswill be sharedwith everyone byemailpriortodepartureduringtheapplicationprocess.4.3Prerequisite(s):N/A4.4RecommendedPreparation:*Notrequiredbutwilladdgreatlytoparticipantexperience:

• ConversationalSpanish• CheckingBloodGlucosewithstandardglucometer• BasicphysicalexamtechniquessuchacheckingBloodPressure,heightandweight

Studentsareexpectedtoattendandbeontimeforallscheduledevents,includingorientation,lectures,discussion,sitevisits,andculturalactivities.Studentsmustcompleteallreadingsandassignmentspriortotheclasssessionandbereadytoparticipateinallcourse-relatedactivitieswithanopenmindandpositiveattitude.4.5TechnologicalProficiencyandHardware/SoftwareRequiredBasic4.6RequiredReadingsPleaseseethereadinglistprovidedbelow

5.0CourseRequirementsandEvaluationComponentsDuringlecturesordiscussions,studentsmustbepreparedtoexplainimportantpointsandengageinathoughtfuldiscussion.Participationinclassesisstudent-determinedandthoseexpectingtoexcelinthecoursewilltaketimetobothreadandanalyzeanyassignedreadingmaterial.Studentsareexpectedtoattendallscheduledevents,includingorientation,lectures,discussions,sitevisits,andculturalactivities.Studentsshouldcompletereadings/assignmentspriortoeachevent/classsession,andshouldbepreparedtoactivelyparticipateinallcourse-relatedactivities.PUNCTUALITYISIMPORTANT!Pleasedonotbelate.Ifyouarelate,wewillproceedtotheday’seventswithoutyou,whichwillnegativelyimpactyourgradeinthecourse.

5.1GradingBreakdown

Assignment Points %ofGradeClass&FieldParticipation 10 10JournalEntries 10 10CommunityHealthEducationProject 10 10ReadingAssignments&Questions 15 15GlobalCitizenshipRoundtablePresentation 25 25SocialMediaBlogReflection&Pics 25 25PatientCaseWrite-Up 5 5TOTAL 100 100

5.2Class&FieldParticipationFullcreditforthisrequiresactiveparticipationinlecturesandfieldvisits.Thisincludes:completingreadingassignmentsinatimelyfashion,attendingalloftheclinicsandcommunityeventspreparedanddressedinappropriatemanner,contributingtogroupdiscussions,anddemonstrationofculturalcompetencetolocalcommunity.

5.3JournalEntriesThesewillberequiredfromallstudents.Theseentriesshoulddetailtheexperiencesofthestudentsbothatthemobileclinicsandinthecommunity.Theyshouldincludeobservationsofthephysicalsetting,eachday’sactivities,andpersonalinsightofthevariousinteractionsstudentsengagein.Entriesmustbemadedaily(includingthearrivaldayanddepartureday,foratotalof7entries),shouldbeaboutaparagraphinlengthandmustbeemailedtoDr.LaBrotnomorethan3daysafterthelastdayofthetrip.

5.4CommunityHealthEducationProjectTheeducationprojectincludesdeveloping,withinagroupofnomorethan3participants,aneducationalposterthatcanbeusedtoteachonaspecifictopicattheclinics.TopicsinthepasthaveincludedWoundCare,Nutrition,Hygiene,HandWashing,DentalHygieneandDiabetesCare.Thestudentswillbeexpectedtopresenttheirpostertomembersofthecommunityduringclinicaldeploymentandtoleavetheirposterbehindwithlocalschoolteacherstouseintheirclassrooms.

5.5ReadingAssignments&Questions

ThesewillbebasedonrequiredreadingsandareduebeforeyouleaveforPanama.Therewillbeabout15questions(see‘Appendix’)thatwillrequirealongparagraphortwotoanswersuccinctlyandthoughtfully.Readingquestionsaremeanttoensureyouhavecompletedtheassignedreadingandthatyouarethinkingcriticallyaboutthetopicsinthecourseandthequestionshavebeendesignedtorequireintegrativeknowledgefrommultiplereadingstoanswer.However,thereadingshaveallbeenchosennotonlytoimproveyourunderstandingofGlobalHealthgenerally,butalsobecausethesereadingsaredirectlyapplicabletothehealthcarelandscapeinwhichyouwillbeworkingduringyourtimeinPanama.Muchoftheinformationiscriticalinordertoavoidmakingserious

practiceerrorsandtokeepyourselvesandFloatingDoctors’patientssafe.Youarewelcometoreadaheadandcompletethereadingsquestionsinadvance,andyouarestronglyrecommendedtoalsoreadtheSupplementalReadingMaterialonthelistprovided.

5.6GlobalCitizenshipRoundtablePresentationEachhealtheducationprojectgroupwillbeexpectedtogiveabrief10-to15-minutepresentationaboutyourcommunityhealtheducationproject.ThispresentationmustincludeadiscussionaboutyourposterandanoverviewofthechallengesfacedinPanamaregardingyourtopic,andareviewofwhatwentwell&whatneededimprovement,andyourrecommendationsforfuturework.GradeevaluationswillbearrangedbetweentheFloatingDoctorsprogramcoordinatorandyourinstitution’sprogramcoordinator,butisnormallybasedonfaculty,coursecoordinator,andpeerassessments.Professionalattireisrequired.

5.7SocialMediaBlogReflection&PicturesMuchglobalhealthisnowdrivenbysocialmedia,whetheritisgeneratingfundingforaproject,launchingapublichealtheducationcampaign,orrecruitingpeopletoparticipateinglobalhealthactivities.InnomatterwhatfieldofGlobalHealthyoumayeventuallychoose,onecommonthemewillbethatsocialmediawillbeacomponent.Intheincreasinglygiganticcollectionofcontentoutthere,contentwithaspecificagendaneedstoreallystandouttogeneratewideengagement.FloatingDoctorsencouragesvolunteerstowritereflectiveblogsandprovidesomepicturesbothtoencouragepersonalreflectionontheirmissionexperience,andalsoasapotentialsourceofcandid,thoughtfulsocialmediacontent.Sometimesstudentcontentisoflittlevalueandmayjustbearchived,butoftenmaybeanhonest,insightful,orfunnypieceofhighlyengagingwritingwithstunningphotosthatareextremelyhelpful.Toappreciatewhatisinvolvedinthecreationofeffectivecontent,andtounderstandhowtotranslateyourpersonal,subjectiveexperiencetoadvancethedeliveryofhealthcare,eachstudentwillberequiredtosubmitafinalsocialmediapaperapproximately5-6pagesinlength,double-spaced(referencesifuseddonotcounttowardsthepaperlength).Thispapershouldbeintheformatofapersonal-experience,first-personblogaimedatutilizingaparticipants’subjectiveexperiencetoengageadditionalsupportfortheFloatingDoctors(morevolunteersormorefunding)andshouldinclude8edited,captionedphotosthatmeettheSocialMediaContentGuidelines(oneoftherequiredreadingsforthiscourse)requirements.ThesepapersandphotosmaybeusedbyFloatingDoctorsintheirsocialmediacampaigns,butthisisnotrequiredandstudentsareabsolutelywelcometorequestthattheirsubmissionnotbeeditedandsubmittedforuseinsocialmedia.Studentsshouldfocusontheirexpectationsorpreconceivedideaspriortocoming,theirexperienceonsite,andanydetailsabouthowtheexperiencemayormaynothavechangedthemandinfluencedtheirfutureGlobalHealththinkingandpractice.Somehelpfulitemstoincludeare:

• Whatwassomethingthatpushedyououtofyourcomfortzone,andwhatwasthatlike?• Whatwasthemostdifficultthingyouencountered(physically,emotionally,clinically,orhowever)?• Whatwasthesaddestthingyouencountered?• Whatwasthefunniestthingyouencountered?• Whatwasyourfavoriteexperience?• Isthereaparticularpatientwhostandsoutinyourmind?

5.8TelemedicinePatientCaseWrite-UpInresource-limitedsettings,telemedicineisoftentheidealsolutionforbringingspecialistcaretoremoteregions.Eachparticipantmustselectonepatient’scaseandwriteitupasamedicalcaseforsubmissiontothetelemedicineserviceutilizedbyFloatingDoctors(www.sermo.com).Thismaybeeitherenexotictropicalconditionoragarden-varietyproblem,butanycaseshouldbediscussedwithanemphasisontheapproachinresource-limitedsettings.Acasemayeitherbewrittenupasforeducationalandinformativepurposes,orforsolicitingspecialistadviceforapatient.

6.0AccommodationsinPanamaTheprogramalwaysstartsonaSunday,sinceFloatingDoctorsallowsparticipantstoarriveonlyonSundays.AllstudentsarerequestedtoarriveinBocasdelToro,PanamaontheSundaybefore5:30PMwhentheywillmeetwithFloatingDoctorsleadershipatapre-arrangedlocationinBocasandbetakentotheFloatingDoctorsheadquartersforroomassignments,dinnerandorientation.StudentsmayarriveinPanamacityandcontinuetoBocasdelTorothesameday,butoftenanovernightstayinPanamaCityisneeded,sopleaseutilizethetraveladvicegiveninFloatingDoctorsvolunteermaterialsandplanaccordingly.

6.1Housing

StudentswillstayattheFloatingDoctorsbaseonIslaSanCristobal,a10-minuteboatridefromthetownofBocasdelToroonIslaColon.Lecturesaswellaspreparationforthemulti-dayclinicsandAsilovisitswilltakeplaceattheFloatingDoctorsprovidedhousingorourpharmacywarehouseonIslaColon.Threemealsperdaywillbeprovided.TherewillbeaccesstoWi-Fiandotherbasicamenities.Allprogram-relatedtransportationandtransporttoandregularlyscheduledwatershuttleservicetwicedailybetweenBocastownonIslaColon,andtheFloatingDoctorsheadquarters.

Headquarters & Dormitory

Dinner at Headquarters

View From FD Observation Tower

Deepening Jungle Night

Returning From House Call

Off to Health Education Session

7.0Appendix:7.1LectureTopicSummaries:1.CulturalCompetencyReviewcommonbutoften-unexpectedculturalissuesthatariseduringconsultsacrosswidereligious,ethnic,geographic,language,andsocio-economicgulfs.Learnskillstocommunicatemoreeffectivelywithpatients,utilizetranslators,andreducemedicalerrorrelatedtomiscommunication.Participantsshouldgainconfidencewhenapproachingconsultsinunfamiliarculturalsettingsandusingculturalcompetencyskillstoimproveclinicaloutcomes.2.GeriatricsandEnd-of-LifeCareTheburdenofgeriatricconditionsindevelopingregionsisreviewed,andaresource-limitedapproachtogeriatricandend-of-lifecareisdiscussed.Non-pharmaceuticalstrategies,especiallyforpalliativecare,areemphasized.Handlingofpatientdeathsindifferentculturalcontextsisincluded.Participantsshouldgaingreaterawarenessofthescopeofapproachestogeriatricandend-of-lifeissuesinmissionsettings.3.MentalHealthintheDevelopingWorldAsummaryofmentalhealthinmissionsettings.Burdensofmentalillnessinthedevelopingworldarehighlighted,aswellascommonbarrierstoeffectivecare.Specificmentalhealthconditionscommontomissionsettingsarereviewed,aswellasconditionsthatrequiredifferentapproachesinresource-limitedsettings.Participantsshouldgainincreasedconfidenceandcompetenceapproachingmentalhealthissuesintropicalanddevelopingsettings.3.Medico-LegalAspectsofAidWorkExplorethecomplexmedico-legalconsiderationssurroundingmissionworkindevelopingregions.Learnhowtoavoidplacingyouoryourteaminlegaltroublewhilefarfromhome,howtolicenseandensurethesecurityofyourteam,andhowtomakebest-practicedecisionsinresourcelimitedsettings.Alsoreviewtheethicalconsiderationsformissionworkandhandlingmedicalerrors.Participantsshoulddevelopanappropriateethicalframeworktoguidetheirbehaviorduringmedicalaidwork,reducetheirliabilityonmissions,ensurebetterinformedconsent,andworkmoresmoothlywithlocalservices.

7.2RequiredReadingAssignments(DocumentTitleList):1. AdolescentHealthProblemsandInjuries2. AdolescentHealthRisksandSolutions3. AllergensofRelevance(Ascaris)inTropicalRegions:4. BestPracticesforShort-TermMedicalMissions5. BreastCancerinDevelopingCountries6. CenterforDiseaseControlDiarrhealDiseaseBrief7. CommonInfant&NewbornProblems8. CreatingaFundraisingPlatform9. CulturalCompetenceandDisparities10. DevelopingCulturalCompetence11. EffectsofBreastfeeding12. EradicatingTuberculosis:TheNextWHOMission13. EthicalBehaviorinMissions14. FeverintheTropics15. HIV/AIDSintheCaribbeanandLatinAmerica16. Legal&EthicalAspectsofFirstMedicalResponse17. LeishmaniasisPanama18. MajorCardiovascularDiseaseIssues19. MedicalLiabilityinHumanitarianAssistance20. MedicalTourism

21. NeglectedDiseasesofNeglectedPopulations22. ObesityandDiabetes23. WHO:AdolescentPregnancy24. WHO:MaternalMortality25. WHO:PreventingEarlyPregnancy26. WHO:PreventingUnsafeAbortion27. WHO:TheMidwifeintheCommunity28. PulmonaryManifestationsofTropicalParasites29. SocialMediaContentGuidelinesPhotoTutorial30. TheInsulinDilemmainResource-LimitedCountries31. 32. TransmissionofTBinResource-LimitedSettings33. BarrierstoEmergencyCareinLowIncomeCountries34. TheUseofPhsyicianAssistantsinPanama35. WHO:PrimaryHealthCareinLowIncomeCountries36. WHO:HealthProfileforPanama37. WHO:PanamaProfileAt-A-Glance38. WHO:EmergencyCareinDevelopingCountries

7.3RequiredReadingAssignmentQuestions:1.Whydoyouthinkthereiscurrentlynosafer,higher-compliance,lesssideeffect-riddentreatmentforcutaneousLeishmaniasiswidelyavailableinLatinAmericaexceptfordailyinjectionswithAntimony,aheavymetal?2.Describeanysituationinyourlifethatrequired(orWOULDhaverequiredifitwasnotdone,ordoneinadequately)demonstratingculturalcompetencetoachieveasuccessfuloutcome.3.ShouldthefocusofGlobalHealthbemoredirectedtoCommunicableDiseases(HIV,Zika,DiarrhealDisease,etc.)orNon-CommunicableDiseases(Diabetes,HeartDisease,Asthma,etc.)?Why?4.Describetheidealsocialmediapictureyoucanimagine:apictureyouenvisionashavingthegreatestpossibleengagementvalue,andatwhattargetdemographic(s)thispicturewouldbeaimed?Whatarethespecificgoal(s)youhaveforthispicture:Morevolunteers?Morepartnerships?Morefoundationsupport?Moreonlinegiving?Somespecificproductdonation?Explainwhyyouridealpictureisexpectedtosuccessfullyengageyourtargetaudienceandwhy.5.Whyarepatientsinthedevelopingworldatgreaterriskfornon-communicablediseases?List4examplesanddescribetheparticularpatientpopulationatincreasedrisk,whytheyareatincreasedrisk,andtheextraburdenofthispopulation'sincreasedrisk.6.ThereisanongoingGlobalHealthdebateoverwhichhealthproblemsshouldbeprioritized.Globalapproachesoftenhavegreaterresourcesandcommitmentsbymultiplegovernmentalandnon-governmentalgroups,butmaynotmatchparticularlocalhealthlandscapepeculiaritiesinmanyregions.Localapproachesoftencanbebettertailoredbutareusuallylessresources,andthelackofimpactoutsidethelocalareamightnegatethebenefitsoftheintervention(i.e.,avectorcontrolprograminoneareathatissuccessful,butimmediatelyreturnstopre-interventionbaselinebydiseaseimmigrationfromsurroundingareaswhereinterventionswerenotundertaken.Inyouropinion,whatisthesinglemostimportantGlobalHealthissuethatneedstobeaddressed,andwhatdoyouthinkwouldbethebestgeneralstrategyforaddressingit?Why?7.Inyouropinion,whatdoyouthinkarethetopthreemajormaternalhealthissueglobally,andbrieflydescribetheburdenoftheseconditionsgloballyanddescribehowyoufeeltheyshouldbeaddressed.8.WhichdoyouthinkismoreimportantinthecontextofGlobalHealth?MaternalHealthorChildHealth?Why?9.Tropicalconditionsoftenhavesymptomsthatmimicconditionsfoundoutsidethetropics.Forexample,weeksofgeneralstomachupsetandoccasionalcrampingandmilddiarrheaandrectalitchingpresentinginNewYorkmightmakethedoctorthinkfirstofsomekindofsubclinicalgastroenteritisandperi-analitchingfromdiarrhea,whereasthesamesymptomspresentinginatropicalsettingmightmakethedoctorimmediatelyreachforabottleofde-wormingtablets.Pick4conditionsfoundalmostexclusivelyorexclusivelyintropical,developingworldsettings,butthateachhaveverysimilarsymptomstodifferent,commonconditionsinthehealthcareenvironmentinyourhomecountry.Foreach,giveanexampleofhowthistropicalconditioncouldbemistakenassomethingelse?10.Continuingfromquestion#9:HowisthisrelevanttoanAmericandoctorfromanurbansettingwhentheyparticipateinashort-termmedicalmissiontoatropicalsetting?Whatisitscurrentandfuturerelevancetodoctorswhomayneverpracticeoutsideoftheirwell-resources,non-tropicalsettingathome?11.Yourmedicalteamisonasingle-dayvisittoacommunitydeepinthemountains.A4-yearoldchildwithavirallowerrespiratorytractinfectionisbroughtinbyhisparents.Hehad3daysoffeverwithcoughandafewepisodesofvomiting,andfor2dayshehashadnofeverbuthiscoughisprettybothersome,especiallyatnight.Thedoctorscanhearcomescatteredmucousthroughoutbothlungfields.Heisproducingsomeclearphlegmwhencoughing.Heiseatinganddrinkingbutlookslikehecouldstandtodrinkalotmorefluid.Yourdoctorsthinkhehasavirallowerrespiratorytractinfectionthatisresolving.Theysayhedoesnotneedantibioticsnow,andthathewillprobablyrecoverfromtheviralLRTIwinafewdays.Youarepleased,becauseantibioticsstillworkinthisanti-bioticsensitiveenvironment,andyouwanttoavoidgivingantibioticsunnecessarilyandcreatingresistance.However,theysaythatifitDOESprogresstoabacterialpneumonia,thechildwillbeingreatdanger.Theteamisleavingthatdayandwillnotbebackfor3months.Thereisabsolutelynootherhealthcareorcommunicationcapabilityformanyhourswalk

throughmuddy,thinkmountainjungle.So...doyougivetheantibioticsornot?Howwouldyouapproachthis--pleasebespecific;it'snotenoughtosay,"Iwouldlookattheoverallhealthetc."ThisisaVERYtypicalexampleofadecisionthatismadeattheindividualpatientlevelandthegloballevelconstantly,andthefundamentalapproachtodecidingwhattodoisthesameatalllevels--andthedecisionisfrequentlynotaneasyone.Bespecificandthinkascontextuallyaspossible.12.Whichisabetterapproachtomalaria?EliminationorControl?Why?13.Ifmosquitoscouldbeexterminated(asmaynowbewithintherealmofpossibility)toeliminatethespreadofmosquito-borneillness,shouldtheybe?Whyorwhynot?Giveatleastthreeargumentsforandagainst.14.Giveyouropinionofwhatarethetop5healthissuesforPanama,withasentenceortwotodescribetheburdenoftheseconditionsinPanamacomparedtoglobally.15.Disparitiesinhealthaccessarecommoninallcountries.Mostcountrieshaveatleastsomeversionofa"Two-Tiered"systemandthereisalotofethicaldebateabouthaving2-tieredaccess.Giveadescriptionofthisasitappliestoyourhomecountry,andtheprosandconsofthesocialethicaldebatesurroundingtheexistenceofmultiple-tiersofhealthaccess. 7.4SupplementalReading(DocumentTitles):1. DengueFever2. EmergencyMedicalServicesinRuralAreas3. BloodPressure4. BurdenofMajorMusculoskeletalConditions5. Chagas6. ChagasinCentralAmerica7. Dengue-RiskToDeveloping&Developed8. DengueFever9. DengueFevers10. Dengue-EmergenceofGlobalProblem11. DiseasesofChildrenintheSubtropicsandTropics12. EliminatingMalariainPanama13. EmergencyMedicalServicesinRuralAreas14. GenitourinaryHistoryFEMALE15. GeophagyinPanama16. GlobalBurdenofTyphoid

17. HealthDisparitiesinLatinAmerica18. HepatitisPanama19. ImpactofChagasinLatinAmerica20. Incidence&MortalityofCervicalCancer21. MajorTrendsinCaribbean22. ObesitytrendsinLatinAmerica23. PanamaPAHO24. PerceptionsofHealthcareQuality25. RockyMountainSpotterFever26. RockyMountainSpotterFeverPanama27. TropicalAbdominalPain28. TropicalFevers29. TropicalSprue30. ViralHemorrhagicFevers31. WHOPanamaProfileSocioeconomic32. YellowFeverC

7.5VaccinationRequirementsToparticipateinthiscourse,studentswillneedvaccinationcoverageforPanama.Foruptodateinformationonyourrequirements,pleaseseetheCenterforDiseaseControl’swebsiteat:http://wwwnc.cdc.gov/travel/destinations/panama.htmTypically,thefollowingvaccines(whichmanypeoplehavehadduringchildhood)arerequiredtobecurrent:

• Chickenpox• Polio• MMR(Measles/Mumps/Rubella)• DPT(Diphtheria/Pertussis/Tetanus)

ThefollowingvaccinesareusuallyrecommendedbytheCDCforPanama:

• HepatitisA• HepatitisB(FloatingDoctorsrequiresthattheseriesbestartedpriortoarrival)• Typhoid• YellowFever• Rabies

Lastly,thereismalariainPanama.Fortunately,Bocasisnotahigh-riskregionandthereforemalariaprophylaxisisnotrequired.MostvolunteerschoosenottotakeMalariaprophylaxishereandalthoughitisconfirmedtoexistintheprovinceofBocasdelToro,in5yearswehavenotseenonecase.However,Chikungunya,Dengue,andothermosquito-bornediseasesmaybepresentandvigilantself-protectionagainstmosquitosisrecommended.Toallowampletimeforyourvaccinationstotakeeffect,andtobeginaroundofanti-malarialmedication(ifyousochoose),plantoseehealthcareprovideratleastsixtoeightweekspriortodeparture.Studentsareadvisedtovisittheirhealthcareprovider,evenintheeventthatinoculationcannotbeobtainedwithinfourweeksofdeparture,asvaccinesandmedicationcanstillbeadministered.

• Immunizationrequirements• Healthrisks• Climate• EmbassylocationsPolitical/socialenvironments

7.6WhattoTakeFollowingisalistofsuggesteditemstopack.Duetosharedlivingspace,packinglightlyisencouraged.Pleaselimityourselftonomorethantwosmallduffelbagsoronetravelbackpackforclothingandpersonalitems,andonesmalldaypack(schoolbackpack)forclinicdays.PleaseconfirmwiththeFloatingDoctorsVolunteerCoordinator(volunteerinfo@floatingdocrors.com)toverifyifthereareanychangesorspecialrequirementsforyourtrip.Clothing(packclothingthatcan,andprobablywillgetdirty)

• hotweatherclothing(T-shirts,tanks,shorts,lightweightjeans/cargopants,undergarments,pajamas)• swimsuit(forswimmingandbathingonmulti-dayclinics)• lightweight,full-coverageclothingforsun/bugprotection• hat• sunglasses(nodesignerglasses)• sandalsthatareeasytowash• sturdyshoesgoodforhiking• rainponcho/jacket• watchwithasecondhand(forclinics)• scrubsforclinics(notrequired)

ImportantDocuments

• Validpassport(besureyouhaveATLEAST6monthsbeforeexpirationasmanycountriesdonotallowentryofpassportswithlessthan6monthsofvalidity)

• TravelInsurance• ImmunizationRecord• Colorphotocopiesofpersonaldocuments:Passport,Driver’sLicense,BankCards,Prescriptions• Money:PanamausesUSdollarsthereforemoneyiseasilywithdrawnfrombanksindowntownBocaso Youwillberesponsibleforthefollowingcosts:! Airfare/transportationto/fromBocasdelToro! Dailymealswhennotonmulti-dayclinicsandifstayingoff-base• *MealsonbaseareprovidedMonday-Friday,withnomealserviceallSaturdayandonlydinnerprovidedonSunday.! Nonclinic-relatedtransportationortravelbetweenF.D.baseandtownoutsideofregularshuttletimes! TravelInsurance! Laundry(hand-laundryequipmentavailable,coinlaundryordrop-off/pickuplaundryservicesinBocasTown($-3-$5perloadto

washanddry).! Extracurricularactivities! PhoneService(Pay-as-you-gophoneavailablethroughoutPanama)• Pertinentcourseinformation:readings,notebookforjournalentries,etc.

Toiletries(ifneedbe,canbepurchasedinBocas)

• BugSpray(withDEET)• CalamineLotiontoSootheItchyBugBites• Sunscreen• Shampoo/conditioner• Soap• Deodorant• Brush/hairties• Shavinggear• Prescribedmedications• Towel• AloeVera/aftersunlotion

ClinicItems

• anypersonalmedicalequipmentyoumightprefertouse(stethscope,penlight,otoscope)

• waterbottle(waterinBocasisdrinkable)• smalldaypack• Waterproofbag(notrequiredbutusefulonboatsduringheavyrains)

Multi-dayClinicGear

• hammock&bugnet(maybesoldseparately;werecommendahammockwithintegratedbugnet)• twopiecesofrope15feetlong(suitablefortyingeachendofyourhammockandsupportingyourbodyweight)• sleepingsack,sheetorverylightblanket• Traveltowel

DONOTBring

• hardsuitcasesortrunks• weaponsofanykind(pocketknives,fieldtoolsareok)• illegalorrecreationaldrugs• valuablejewelry• unnecessarycreditcards

7.7HealthandSafetyIssuesAbroadHealthInsuranceInternationalMedicalInsuranceCoverageismandatorybeforedeparture.Ifyouhavemedicalinsurance,youshouldcheckyourpolicytoseeifitincludesmedicalcoverageduringinternationaltravelandthescopeofcoverage,especiallyemergencymedicalevacuation.SafetyinPanamaStudentswillberequiredtoregistertheirtripwiththeStateDepartment/AmericanInstituteinPanamabeforedeparture.Studentsshouldrefertotheinformationbelowwhenpreparingfortheirtrip.StudentsarealsoencouragedtoreviewtheStateDepartment’sConsularInformationSheetonPanama,availablehere:http://travel.state.gov/content/passports/english/country/panama.html.TravelSafetyTips,excerptedfromtheStateDepartmentwebsite:(http://travel.state.gov/travel/tips/safety/safety_1747.html)WhattoTake

**PLEASEreviewtheFloatingDoctors’listof‘ThingstoBring’andotherinformationalresourcesbeforeyourtrip!Therearesomeveryspecificitemsyoumayneed,especiallyifyouaredeployedovernighttothecommunities.IfyouhaveregisteredwithFloatingDoctorsalreadybuthavenotreceivedtheVolunteerinformationdocuments,please

contactvolunteerinfo@floatingdoctors.comtofollowup.Safetybeginswhenyoupack.Tohelpavoidbecomingatarget,donotdressinawaythatcouldmarkyouasanaffluenttourist.Expensive-lookingjewelry,forinstance,candrawthewrongattention.Alwaystrytotravellight.Youcanmovemorequicklyandwillbemorelikelytohaveafreehand.Youwillalsobelesstiredandlesslikelytosetyourluggagedown,leavingitunattended.Carrytheminimumnumberofvaluables,andplanplacestoconcealthem.Yourpassport,cashandcreditcardsaremostsecurewhenlockedinahotelsafe.Whenyouhavetocarrythemonyourperson,youmaywishtoputthemeachinadifferentplaceratherthanallinonewalletorpouch.Avoidhandbags,fannypacksandoutsidepocketsthatareeasytargetsforthieves.Insidepocketsandasturdyshoulderbagwiththestrapwornacrossyourchestaresomewhatsafer.Oneofthesafestplacestocarryvaluablesisinapouchormoneybeltwornunderyourclothing.Ifyouwearglasses,packanextrapair.Packthemandanymedicinesyouneedinyourcarry-onluggage.Toavoidproblemswhenpassingthroughcustoms,keepmedicinesintheiroriginal,labeledcontainers.Bringcopiesofyourprescriptionsandthegenericnamesforthedrugs.Ifamedicationisunusualorcontainsnarcotics,carryaletterfromyourdoctorattestingtoyourneedtotake

thedrug.Ifyouhaveanydoubtaboutthelegalityofcarryingacertaindrugintoacountry,consulttheembassyorconsulateofthatcountrybeforeyoutravel.Bringtravelers’checksand/oroneortwomajorcreditcardsinsteadofcash.ATMcardsgenerallyworkatthelocalbankinBocasdelTorobutadditionalfeesfromyourbankmayapply.Creditcardsarealsoacceptedatmanyvendors.Packanextrasetofpassportphotosalongwithaphotocopyofyourpassport’sinformationpagetomakereplacementofyourpassporteasierintheeventitislostorstolen.Putyourname,addressandtelephonenumbersinsideandoutsideofeachpieceofluggage.Usecoveredluggagetagstoavoidcasualobservationofyouridentityornationality.Ifpossible,lockyourluggage.WhattoLeaveBehindDon'tbringanythingyouwouldhatetolose.Leaveathome:

• Valuableorexpensive-lookingjewelry• Irreplaceablefamilyobjects• Allunnecessarycreditcards• YourSocialSecuritycard,librarycard,andsimilaritemsyoumayroutinelycarryinyourwallet.

Leaveacopyofyouritinerarywithfamilyorfriendsathomeincasetheyneedtocontactyouinanemergency.Maketwophotocopiesofyourpassportidentificationpage,airlinetickets,driver'slicenseandthecreditcardsthatyouplantobringwithyou.Leaveonephotocopyofthisdatawithfamilyorfriendsathome;packtheotherinaplaceseparatefromwhereyoucarrytheoriginals.Leaveacopyoftheserialnumbersofyourtravelers'checkswithafriendorrelativeathome.Carryyourcopywithyouinaseparateplaceand,asyoucashthechecks,crossthemoffthelist.WhattoLearnAboutBeforeYouGoLocalLawsandCustomsWhenyouleavetheUnitedStates,youaresubjecttothelawsofthecountryyouarevisiting.Therefore,beforeyougo,learnasmuchasyoucanaboutthelocallawsandcustomsoftheplacesyouplantovisit.Inaddition,keeptrackofwhatisbeingreportedinthemediaaboutrecentdevelopmentsinthosecountries.ThingstoArrangeBeforeYouGoRegisteryourtravelItisagoodideatoregisteryourtravel--thinkofitascheckingin--withtheStateDepartmentsothatyoumaybecontactedifneedbe,whetherbecauseofafamilyemergencyintheU.S.,orbecauseofacrisisintheareainwhichyouaretraveling.TravelregistrationisafreeserviceprovidedbytheStateDepartment,andiseasilyaccomplishedonlineathttps://travelregistration.state.gov.(InaccordancewiththePrivacyAct,theDepartmentofStatemaynotreleaseinformationonyourwelfareorwhereaboutstoinquirerswithoutyourexpresswrittenauthorization.)CreditMakeanoteofthecreditlimitoneachcreditcardthatyoubring,andavoidchargingoverthatlimitwhiletraveling.Americanshavebeenarrestedforinnocentlyexceedingtheircreditlimit.Askyourcreditcardcompanyhowtoreportthelossofyourcardfromabroad.1-800numbersdonotworkfromabroad,butyourcompanyshouldhaveanumberthatyoucancallwhileyouareoverseas.InsuranceFindoutifyourpersonalpropertyinsurancecoversyouforlossortheftabroad.Also,checkonwhetheryourhealthinsurancecoversyouabroad.MedicareandMedicaiddonotprovidepaymentformedicalcareoutsidetheUnitedStates.Evenifyourhealthinsurancewillreimburseyouformedicalcarethatyoupayforabroad,healthinsuranceusuallydoesnotpayformedicalevacuationfromaremoteareaorfromacountrywheremedicalfacilitiesareinadequate.Considerpurchasingapolicydesignedfortravelers,andcoveringshort-termhealthandemergencyassistance,aswellasmedicalevacuationintheeventofanaccidentorseriousillness.

PrecautionstoTakeWhileTravelingSafetyontheStreetUsethesamecommonsensetravelingoverseasthatyouwouldathome.Beespeciallycautiousin(oravoid)areaswhereyoumaybemoreeasilyvictimized.Theseincludecrowdedsubways,trainstations,elevators,touristsites,marketplaces,festivalsandcrime-riddenneighborhoods.

• Don'tuseshortcuts,narrowalleysorpoorlylitstreets.• Trynottotravelaloneatnight.• Avoidpublicdemonstrationsandothercivildisturbances.• Keepalowprofileandavoidloudconversationsorarguments.• Donotdiscusstravelplansorotherpersonalmatterswithstrangers.• Avoidscamartistsbybeingwaryofstrangerswhoapproachyouandoffertobeyourguideorsellyousomethingatbargainprices.• Bewareofpickpockets.Theyoftenhaveanaccomplicewhowill:

! Jostleyou,! askyoufordirectionsorthetime,! pointtosomethingspilledonyourclothing,! ordistractyoubycreatingadisturbance.

• Bewareofgroupsofvagrantchildrenwhocouldcreateadistractiontopickyourpocket.• Weartheshoulderstrapofyourbagacrossyourchestandwalkwiththebagawayfromthecurbtoavoiddrive-bypurse-snatchers.• Trytoseempurposefulwhenyoumoveabout.Evenifyouarelost,actasifyouknowwhereyouaregoing.Trytoaskfordirections

onlyfromindividualsinauthority.• Knowhowtouseapaytelephoneandhavetheproperchangeortokenonhand.• Learnafewphrasesinthelocallanguageorhavethemhandyinwrittenformsothatyoucansignalyourneedforpoliceormedical

help.• Makeanoteofemergencytelephonenumbersyoumayneed:police,fire,yourhotel,andthenearestU.S.embassyorconsulate.• Ifyouareconfronted,don'tfightback--giveupyourvaluables.

SafetyinYourHotel

• Keepyourhoteldoorlockedatalltimes.Meetvisitorsinthelobby.• Donotleavemoneyandothervaluablesinyourhotelroomwhileyouareout.Usethehotelsafe.• Ifyouareoutlateatnight,letsomeoneknowwhenyouexpecttoreturn.• Ifyouarealone,donotgetonanelevatorifthereisasuspicious-lookingpersoninside.• Readthefiresafetyinstructionsinyourhotelroom.Knowhowtoreportafire,andbesureyouknowwherethenearestfireexits

andalternateexitsarelocated.(Countthedoorsbetweenyourroomandthenearestexit;thiscouldbealifesaverifyouhavetocrawlthroughasmoke-filledcorridor.)SafetyonPublicTransportationIfacountryhasapatternoftouristsbeingtargetedbycriminalsonpublictransport,thatinformationismentionedineachcountry’sUSTravelPageinthesectionaboutcrime.TaxisOnlytaketaxisclearlyidentifiedwithofficialmarkings.Bewareofunmarkedcabs.TrainsWell-organized,systematicrobberyofpassengersontrainsalongpopulartouristroutesisaproblem.Itismorecommonatnightandespeciallyonovernighttrains.Ifyouseeyourwaybeingblockedbyastrangerandanotherpersonisveryclosetoyoufrombehind,moveaway.Thiscanhappeninthecorridorofthetrainorontheplatformorstation.Donotacceptfoodordrinkfromstrangers.Criminalshavebeenknowntodrugfoodordrinkofferedtopassengers.Criminalsmayalsospraysleepinggasintraincompartments.Wherepossible,lockyourcompartment.Ifitcannotbelockedsecurely,taketurnssleepinginshiftswithyourtravelingcompanions.Ifthatisnotpossible,stayawake.Ifyoumustsleepunprotected,tiedownyourluggageandsecureyourvaluablestotheextentpossible.

Donotbeafraidtoalertauthoritiesifyoufeelthreatenedinanyway.Extrapoliceareoftenassignedtoridetrainsonrouteswherecrimeisaseriousproblem.BusesThesametypeofcriminalactivityfoundontrainscanbefoundonpublicbusesonpopulartouristroutes.Forexample,touristshavebeendruggedandrobbedwhilesleepingonbusesorinbusstations.Insomecountries,wholebusloadsofpassengershavebeenheldupandrobbedbygangsofbandits.HowtoHandleMoneySafely:

• Toavoidcarryinglargeamountsofcash,changeyourtravelers’checksonlyasyouneedcurrency.Countersigntravelers’checksonlyinfrontofthepersonwhowillcashthem.

• Donotflashlargeamountsofmoneywhenpayingabill.Makesureyourcreditcardisreturnedtoyouaftereachtransaction.• Dealonlywithauthorizedagentswhenyouexchangemoney,buyairlineticketsorpurchasesouvenirs.Donotchangemoneyonthe

blackmarket.Ifyourpossessionsarelostorstolen,reportthelossimmediatelytothelocalpolice.Keepacopyofthepolicereportforinsuranceclaimsandasanexplanationofwhathappened.Afterreportingmissingitemstothepolice,reportthelossortheftof:

• Travelers'checkstothenearestagentoftheissuingcompany• Creditcardstotheissuingcompany• Airlineticketstotheairlineortravelagent• PassporttothenearestU.S.embassyorconsulate

HowtoAvoidLegalDifficultiesWhenyouareinaforeigncountry,youaresubjecttoitslawsandareunderitsjurisdiction.YoucanbearrestedoverseasforactionsthatmaybeeitherlegalorconsideredminorinfractionsintheUnitedStates.Familiarizeyourselfwithlegalexpectationsinthecountriesyouwillvisit.TheUSTravelPageforPanamaincludesinformationonunusualpatternsofarrestsinparticularcountries,asappropriate.DrugViolationsMorethanone-thirdofU.S.citizensincarceratedabroadareheldondrugcharges.Somecountriesdonotdistinguishbetweenpossessionandtrafficking,andmanyhavemandatorysentences–evenforpossessionofasmallamountofmarijuanaorcocaine.AnumberofAmericanshavebeenarrestedforpossessingprescriptiondrugs,particularlytranquilizersandamphetamines,thattheypurchasedlegallyelsewhere.OtherU.S.citizenshavebeenarrestedforpurchasingprescriptiondrugsabroadinquantitiesthatlocalauthoritiessuspectedwereforcommercialuse.Ifindoubtaboutforeigndruglaws,asklocalauthoritiesorthenearestU.S.embassyorconsulate.PossessionofFirearmsTheplaceswhereU.S.citizensmostoftenexperiencedifficultiesforillegalpossessionoffirearmsarenearby–Mexico,CanadaandtheCaribbean.SentencesforpossessionoffirearmsinMexicocanbeupto30years.Ingeneral,firearms,eventhoselegallyregisteredintheU.S.,cannotbebroughtintoacountryunlessapermitisobtainedinadvancefromtheembassyoraconsulateofthatcountryandthefirearmisregisteredwithforeignauthoritiesonarrival.(NOTE:TherearealsostrictrulesaboutbringingfirearmsorammunitionintotheU.S;checkwithU.S.Customsbeforeyourtrip.PhotographyInmanycountriesyoucanbedetainedforphotographingsecurity-relatedinstitutions,suchaspoliceandmilitaryinstallations,governmentbuildings,borderareasandtransportationfacilities.Ifyouareindoubt,askpermissionbeforetakingphotographs.