1. The Gambia Rafik Hanna St. Luke’s Roosevelt Hospital Center Global Health Division May 16, 2012

2. Goals of the Trip, March 2012 To gain more exposure to tropical medicine, particularly TB. To help provide medical care at the Medical Research Council Unit (MRC). To provide some teaching and oversight in the emergency department at Royal Victoria Teaching Hospital. To consider fostering a longer term relationship with Royal Victoria Teaching Hospital (RVTH).

3. Where in the world is Gambia?

4. Map of Gambia

6. Gambia Data Population: 1.729 million Size: 4,008 sq. miles (smaller than Connecticut) Total GDP 2010: $807 million ($430 per capita) Ranked 160/179 in poverty (HDI) Literacy: 46.5% (Age 15 and above)

8. Health Statistics Life expectancy is 57.8 years. Infant Mortality (57/1000) Under-5 Mortality (98/1000) HIV prevalence (2% of those age 15-49) TB Prevalence is 460/100,000 (about 100 times that of the U.S.) Physicians per 1000 people (0.0 – 0.1)

9. HIV in Gambia 2% of the population age 15-49. Adds to the TB Burden. President first denied that there was HIV in Gambia. HIV is called “LVD.” The president claims he can cure HIV.

10. MRC Gambia It is the UK’s single largest investment in medical research in a developing country. The MRC Unit is primarily involved in lab research, clinical research, epidemiology studies, and clinical services. Youtube: “MRC Gambia” Participated in patient care in the clinical services and took an observatory/educational role in the clinical research aspects.

11. MRC Gambia

12. Tuberculosis in the Gambia

13. TB Field Work in the Gambia

14. Royal Victoria Teaching Hospital

17. Emergency Medicine in New York and Banjul Recognition of need for emergency services as essential to health of population. Education of public to recognize symptoms of fatal common illnesses. Training of first-level health workers in basic triage and assessment. Implementation of ETAT at all levels, including the outpatient clinics. Establish communication on a community level for volunteer cooperation for transport. Extra nursing at receiving hospitals. Establishment of strong team work at receiving hospitals to quickly be involved in resuscitation. Supervising physician needs to be physically present in emergency department at all times. Cooperation with well-resourced countries and other African nations in greater establishment of emergency medicine training.

18. Summary Very good experience Tale of Two Cities Goals of TB, Clinical Work, Lecturing Accomplished Further Work with RVTH to be determined Join the Global Health Team!

19. World’s Greatest Cities