1. Family Medicine Cares International – Improving Healthcare in Haiti AAFP Global Health Workshop September, 2014 Jane A. Weida, MD, FAAFP AAFP Foundation President Medical Director, Reading Hospital Family Medicine Residency Clinical Associate Professor, Penn State College of Medicine Anna Doubeni, MD Associate Professor, Clinical Family Medicine, Director, Global Health Fellowship in Comprehensive Health University of Pennsylvania

2. Dr. Weida has reported no conflicts of interest Dr. Doubeni has reported no conflicts of interest

3. Educational Objectives At the end of this presentation, participants will be able to: 1.Identify opportunities to provide volunteer clinical work in Haiti with Family Medicine Cares International, along with partner Heart to Heart International 2.Discuss the medical education system and the Family Medicine Residency education system in Haiti 3.Describe future opportunities in residency education, faculty education, and faculty development

4. AAFP Foundation Mission Statement The American Academy of Family Physicians Foundation advances the values of Family Medicine by promoting humanitarian, educational, and scientific initiatives that improve the health of all people.

5. The Heart of Family Medicine The AAFP Foundation is a 501(c)3 Supports and/or runs 25 programs. –The work is made possible through the donations of family physicians, corporations and others who provide donations of time and money. Family Medicine Cares International is the Signature International Humanitarian Program of the AAFP Foundation

7. On January 12, 2010… At 4:53 pm, a 7.0 magnitude earthquake struck Haiti, the poorest country in the Western Hemisphere The epicenter was near Leogane, 29 Km (18 miles) west of the capital of Port-au-Prince 100,000 people perished in the first 60 seconds

8. On January 12, 2010… Rescue efforts were hampered by –No electricity –No cell phone reception –No heavy equipment to free survivors –Poor infrastructure, poor roads, the airport was destroyed, etc. Hospitals were quickly overwhelmed by the tremendous need

9. The Devastation At least 220,000 people lost their lives 250,000 residences and 30,000 commercial buildings collapsed or were severely damaged

10. Signature Humanitarian Program That year, the Foundation began making plans for a new Signature International Humanitarian Program, having completed 20 yearly humanitarian trips to former Soviet republics in Asia/Europe Haiti was chosen as the site –Great need –Close to home –Our members expressed interest in providing assistance to the people of Haiti –Partnership with Heart to Heart International on the ground

11. The Need in Haiti Many areas are still coping with the aftermath of the earthquake Its people continue to struggle with a lack of food, education, and basic health care. 11

12. Family Medicine Cares International Announced at the AAFP Annual Assembly in Philadelphia, October, 2012 Components: working to improve the quality of life and health of the people of Haiti –Family Medicine education and promoting Family Medicine in Haiti –Patient care – provides sustainability –Children’s Projects –Medication airlift if possible (customs in Haiti is problematic) –Re-construction/public health project as needed and feasible

13. Family Medicine Cares International Program Components –Patient Care –Medical Education and Training –Children and Youth Projects –Medical Equipment and Supplies – brought in with us Work is Accomplished Through –Annual Delegation –Ongoing Efforts Patient Care Faculty Development

14. Indicates Family Medicine Cares International locations

15. Annual Delegation Trip Delegation: February 15-22, 2014 22 People: –17 Physician members (3 Residents) Three Teams –Patient Care –Medical Education –Service

16. 2014 Delegation Team Members Dr. Jason Marker ………………………………………...Mishawaka, IN Christen Moburg…………………………..…………….Georgetown, IN Dr. Sanket Parikh………………………………………....Sugarland, TX Dr. Jerry Potts………….……………………………….Minneapolis, MN Dr. Alisha Razack………………………………….…………Buffalo, NY Dr. Jacobo Rivero………………………………...……………Zillah, WA Dr. Dave Smith………………………………………….Elkhart Lake, WI Dr. Jane Weida ………………………………………West Reading, PA Dr. Mary Jo Welker ………………………………………Columbus, OH Lloyd Welker………………………………………………Columbus, OH Dr. Gustav Wilde……………………………….……………Franklin, NC Dr. Donald Briscoe…………………………...……………..Houston, TX Dr. Joann Buonamano……………………………………Wofeboro, NH Brenda Cherpitel…………………………...……...…Overland Park, KS Dr. Noemi "Mimi” Doohan…………………………..………..Goleta, CA Dr. Anna Doubeni………………………………………Philadelphia, PA Dr. Anna Goroncy………………………………………...Cincinnati, OH Dr. Elizabeth Green……………………………Steamboat Springs, CO Dr. Kevin Harvey………………………………………….Midlothian, VA Erin Heffernan………………………..………………Overland Park, KS Carrie Johnson………………………...……………..….Taylorsville, UT Dr. Zita Magloire…………………..…………………………Wichita, KS

18. Patient Care Team Divided into 3 groups, included two FM residents Treated More Than 550 Patients –137 well-child visits at a local school

19. Patient Care Team Urban and Rural Locations –Port au Prince –Fondwa and Léogâne –Sud Est Hundreds of families were de- wormed, impacting thousands of people

20. Medical Education Team Leadership “Traveling Squad” Full Day Symposium: Geriatric & Preventative Medicine –Cap Haitien –Port au Prince Faculty Development Met with Key Contacts in Haiti Health Care –Council of Deans (4 med schools) –Cap Haitien & Saint Marc Residencies –MSPP –US Embassy

21. Family Medicine Symposia Topics chosen by Cap Haitien residency director and our symposium planning team Delivered in English, translated into French Attended by 82 Haitian family physicians, residents, and medical professionals Symposium repeated in two locations: –Cap Haitien –Port-au-Prince

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24. Family Medicine Cares International Resident Scholarship One scholarship awarded for a Family Medicine resident to be part of the 2014 delegation – Dr. Zita Magliore –Covered expenses for travel to Haiti & in-country, including housing and food. –Included expenses for Dr. Magliore to present at the 2014 AAFP National Conference. –Will be awarded yearly

25. Medical Training in Haiti Most primary care is delivered by generalists practitioners with no residency training CME is limited and not required There are few trained family physicians Delivery of care is hampered by spotty electrical service, poverty, low physician salaries, rural locations of many patents and physicians, availability of meds, etc.

26. Medical Training in Haiti Primary and Secondary School – 14 years No undergraduate education required Medical school: –Classroom – 2 years –Externship rotations – years 3-5 in public med school(one in Haiti), years 3-6 in private schools (there are three in Haiti) –Internship – 1 year –Mandated social service – 1 year (for nurses too)

27. Residency Training In addition to one-year internship, residency requires: –Family Medicine, pediatrics, IM – 2 more years –Ob-Gyn – 3 more years –General or orthopedic surgery – 4 more years

28. Two Haitian FM Residencies Cap Haitien Family Medicine Residency Program – existence for 13 years Saint Marc Family Medicine Residency Program – existence for 3 years (no graduates yet) Residencies are in need of: –Medical equipment –Books and other training materials –Faculty development

29. NEW This Year – Faculty Development 24 faculty members trained at two Family Medicine Residency Programs: –Cap Haitien Family Medicine Residency Program Teaching/Mentoring Students, Residents, Other Physicians Professionalism –Saint Marc Family Medicine Residency Program Teaching/Mentoring Students, Residents, Other Physicians Professionalism Accessing Medical Information on the Internet Lecture Topic – Research in Family Medicine Precepting with Residents & Faculty 29

30. Ongoing Faculty Development In Haiti Purpose: ongoing faculty development for Saint Marc and Cap Haitien Family Medicine Residencies Core curriculum developed based on identified need Ongoing trips planned for core group teaching the curriculum Allows opportunity to –Review previous material –Introduce new material –Observe and give feedback on faculty precepting Three trips yearly (including the annual delegation trip) 30

31. Faculty Development November, 2014 4 team members 6 days 2 ½ days in Cap Haitien and 2 ½ days in Saint Marc Lectures: –Adult learning –Assessing learners needs –Outpatient precepting –Scholarly activities –Teaching in large groups –Giving constructive feedback –Fair evaluation Precepting inpatient and outpatient 31

32. Faculty Development Workshop: Saint Marc, Haiti Annual Delegation Trip 2014 32

33. Service Team Seeks to improve the quality of life and the health of children in Haiti, as well as provide health and hope to Haiti’s youth. It also allows non-medical delegation members to participate in meaningful volunteer efforts. 500 Children impacted by the Service Team 43 benches varnished/painted 3 schools painted 12 chairs painted 18 soccer balls 18 jump ropes 150 boxes of crayons provided to 3 schools

34. Vo-Tech Scholarships “Agents of Peace” Benefits inner city youth and young adults Provides scholarships to complete vo-tech training in heavy equipment operation, plumbing, electrical, etc. Jobs, hope, change Met the five 2014 scholarship recipients

35. Ongoing Volunteer Opportunities Three to four volunteer physicians are needed each week throughout the year to provide ongoing patient care in community clinics in Haiti.

36. Ongoing Volunteer Opportunities Opportunities for practicing and resident physicians (with physician supervision) Can volunteer for 1 week to months at a time –Costs are reasonable –All details are pre-arranged – translators, transportation, including to and from airport, safe food, housing, training manual for providing care in Haiti, etc. Contact: Brenda Cherpitel Director, Development AAFP Foundation

37. Next Steps/Dreams Support Residencies: Equipment, Resident Training, supplies Faculty Development – several trips per year in addition to delegation trip Exposure to Family Medicine in medical schools Provide continuing medical education

38. Next Steps/Dreams Provide assistance in the development of a third Family Medicine Residency in Les Cayes Develop opportunities with U.S. residency programs for patient care in Haiti Training in Family Medicine research Find opportunities for medical students

39. Brenda Cherpitel AAFP Foundation bcherpitel@aafp.org 800-274-2237, ext. 4452 www.aafpfoundation.org/fmci