1. Programs, Collaborations and Sustainability, The Indiana University Honduras Experience Javier F. Sevilla-Mártir, MD AAFP Global Health Workshop, Baltimore, October 10 th,2013

2. 2 Activity Disclaimer ACTIVITY DISCLAIMER It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. Javier F. Sevilla-Mártir, MD, Scott Renshaw, MD and Jennifer Custer, BA, have indicated they have no relevant financial relationships to disclose.

3. Learning Objectives Describe implementation of programs and activities that form the Indiana University Department of Family Medicine Global Health Program in Honduras Describe different types of collaborations and outcomes Discuss model of sustainability to continue to serve the underserved in Honduras Share participants' own experiences and recommendations for successful project implementations and sustainability 3

4. Introduction As student interest in global health experiences and caring for underserved populations around the globe was on the rise Indiana University Department of Family Medicine responded to students’ interest and developed and implemented The ENLACE Project which is now in its 10th year. The ENLACE Project provides innovative curriculum, service learning experiences and administration for the longitudinal Global health program of study at Indiana University School of Medicine throughout all four years of medical school.

5. ENLACE Background Medical Students’ Interest 50% of IU med students with interest in Global Health and international medicine wanted opportunities in Latin America Established platform opportunity to partner with the UNAH medical school and other organizations

6. ENLACE Project ENLACE provides and assists in the development of education, service and research opportunities for medical students, residents, fellows, faculty and community based practicing physicians while at the same time improving access to health care and the quality of services available to the communities we serve.

7. ENLACE Description Three components: Education Research Service

8. Education Introduction to clinical medicine course Spanish integrated curriculum Language and cultural immersion experiences Global Health Elective and Alternative spring break trip comprehensive medical brigades Overseas family medicine clerkship Sponsorship of SIG: GHIG, MSIG, SOL, IUSOC

9. Global Health and International Medicine and other Interest Groups Encourages global health awareness and enhance understanding of the needs of the majority world and of recent immigrants. Plan and organize especial events (Salsa night, Hunger Banquet, Summer Spanish course) campus discussions to showcase of programs and sharing experiences with other students Provide care at IU student outreach clinic with 2 spots for bilingual students each Saturday

10. Spanish Integrated Curriculum Introduction to Clinical medicine (ICM) I&II Innovative program that provides a cultural awareness/competence curriculum with emphasis on the Hispanic/Latino community based on the ICM-I&II content. Students learn Spanish grammar and medical Spanish as part of an integrated language curriculum as we cover the course’s content to help them to achieve an advanced to fluency proficiency level in Spanish in both production and receptive skills (speaking, writing, listening and reading). Special activities are offered to students as opportunities to learn and apply principles of culture, Spanish, grammar and medical Spanish.

11. Family Medicine Clerkship Bilingual students English-Spanish have the opportunity to work at practices or services with significant number of Spanish speaking patients and/or to work with bilingual faculty locally or overseas with objectives and time distribution adjusted to clerkship requirements.

12. Third year Intersession Appropriate Use of Medical Interpreters Through the use of standardized patients, video, lecture/discussion format, students learn the appropriate use of medical interpretation services

13. Care for the Underserved Elective This month-long experience emphasizes high quality care for underserved populations, health disparities, cultural competence and medical Spanish. Students work on full spectrum Family Medicine practice in community health centers in inner city Indianapolis with significant number of recent immigrants from around the world. Selected topics and projects related to underserved communities and health disparities are discussed and presented every Thursday during the course

14. Global Health Elective This 4–8 week elective in Honduras includes practicing medicine in a Spanish speaking country facilitating cross cultural exposure and language immersion. The goals of the program are to enhance students’ understanding of the needs of recent immigrants to the US from Latin America, improve their Spanish and strengthen clinical skills. Bilingual students stay with Honduran medical students and work at the University Hospital. Those with limited Spanish skills stay with Honduran families, attend language school and work at a community hospital

15. SERVICE Closely related to the Research component the service component includes: Clinical services Opportunities to participate in existing activities as well as plan, develop and implement new projects or activities that will improve the quality of life for two targeted at-risk populations: elderly and children under age 5 and the communities in general

16. Service/Health Center Currently, the health center of Las Lajas is in Phase I of two planned phases. Phase I: Construction of ambulatory clinical service area. Clinical building was opened in 2012 Phase II: Construction of living area for visitors. There is not projected completion date set at this point. Completion of Phase II depends on funding.

17. Health Center Health center serves as a referral center for Taulabe County A comprehensive network of epidemiologic surveillance and reporting is run by the local public health system through local health promoters. A communication system between isolated mountain villages and the health center is in place via cell phone communication. Charges cover the cost of services for general medicine daily and specialty visits on scheduled days including donated medicines

18. Research Needs Assessment of the elderly population of Las Lajas, Honduras Needs assessment of the HIV/AIDS population of Trujillo, Honduras Effectiveness of the HIV/AIDS treatment program of Hospital Salvador Paredes in Trujillo, Honduras Pre and post intervention indoor air quality and respiratory symptoms in the village of Savanas, Honduras Assessing the Associated Factors and High Prevalence of Malaria in Trujillo, Honduras

19. Partnerships Honduran communities of Taulabe and Trujillo UNAH CCH ENLACE Honduras foundation NC Church based organization Rivers of the world IUSM Department of Family Medicine IUSM medical students Indianapolis hospitals, businesses /organizations

20. Summary Global health and international medicine programs require innovative curricula. It often take place in areas with no or limited access to health care and scarce resources which at times require building infrastructure. Establishing partnerships is essential for the success of the initiative and to ensure sustainability.

21. Recommendations Identify needs Identify champions Select an area to work Develop partnerships

22. GRACIAS