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Hanni Stoklosa is a 3rd year medical student at Tufts University School of Medicine in Boston, Massachusetts. She spent the last year as the University Coalitions for Global Health Fellow at the Global Health Council where she catalyzed coalitions among global health organizations with a university presence. Hanni has extensive experience fighting disparities abroad in Egypt, Guatemala, the Philippines, Thailand, Australia, China, and Taiwan. Conversant in Mandarin, she has conducted gender violence HIV/AIDS research and served as a prevention educator in Hubei Province of China and Taipei, Taiwan. She is also serving in on American Medical Student Association’s AIDS Advocacy Steering Committee and Global Health Education Consortium’s board.

TM: What is IFMSA and what is IFMSA about?

Hanni: The International Federation of Medical Students’ Associations is the intersection among medical student associations across the globe. Internationally, they collaborate on advocacy campaigns, service projects, and research & clinical exchanges.

IFMSA-USA offers future US physicians a comprehensive introduction to global health issues. Through our programming and opportunities, we develop culturally sensitive students of medicine, intent on influencing the transnational inequalities that shape the health of our planet. Specifically, we provide US medical students with international experiences as well as opportunities to share book and medical equipment excesses with the world. www.ifmsa-usa.org

TM: How did you get involved in this organization? What are your responsibilities as president?

Hanni: My passion is for abolishing global health inequalities. After attending a National Convention, I was drawn in by the world-changing work of other IFMSA-USA members. I’ve been hooked ever since!

As president I:

Chair and lead the National Executive Board,
Represent IFMSA-USA to IFMSA internationally and to the other National Presidents
Represent the NMO to the IFMSA-USA Board of Trustees.
Represent the NMO to the external organizations including the media.

TM: What are the benefits of IFMSA-USA membership? www.ifmsa-usa.org/join.htm

Hanni: Exchanges: clinical or research experiences abroad in IFMSA member countries www.ifmsa-usa.org/priorities/scope.htm & www.ifmsa-usa.org/priorities/score.htm

IFMSA internationally: international medical student peer collaborators in any area: global health, community and public health, medical education…..the sky’s the limit!

Information: our listserv provides global health updates; our interactive online forum offers global health discussion opportunities www.ifmsa-usa.org/forum/

Book-AID: donate your used books to those in need overseas nome@ifmsa-usa.org

Equip: collect excess medical supplies at your school and get them to clinics abroad

npo@ifmsa-usa.org

TM: Is IFMSA a political organization? What is your stance on global health and what changes would you like to see in the world.

Hanni: IFMSA-USA is not a political organization, but we encourage our members to get involved in advocacy through the American Medical Student Association’s Global Health Action Committee. It is vital for us to leverage our powerful voices to sway policy makers to prioritize global health. www.amsa.org/global

TM: What in your eyes is the most pressing issue in world health today?

Hanni: Human resources for health. Africa has 25% of the world’s disease burden, 13.8% of the world’s population, but only 3% of the world’s health workforce. The Joint Learning Initiative estimates that we’ll need 600,000 doctors, nurses, and midwives now; 1 million more are needed to achieve Millennium Development Goals.

TM: What are your plans after you graduate Medical School? Do you plan to go abroad?

Hanni: I would like to return to Wuhan, China in some capacity- perhaps establishing a twinning program with my university, to train more doctors and nurses.

TM: Can you talk about IFMSA’s Village Concept Projects?

Hanni: IFMSA-USA has 4 associated Village Concept Projects in Tanzania, Uganda, Ghana, and Kenya. Their overall objectives are to provide sustainable improvement of the living conditions in underprivileged communities as well as to develop the capabilities of students. http://www.ifmsa-usa.org/village.htm

TM: What was your most memorable experience with IFMSA-USA?

Hanni: The IFMSA General Assembly in Serbia- imagine the globe-changing potential of 25 medical students from 25 different countries strategizing about HIV/AIDS Campaigns. Enough said.

TM: Are there any IFMSA-USA upcoming events?

Hanni: Yes-our National Global Health Convention will be coming up in January 2008. Stay tuned.

TM: Who are some of your heroes and why?

Hanni: Dr. Gui is an unbelievably courageous doctor who risked his life by exposing HIV spread in rural China. He perseveres day and night on behalf of his patients. I only hope that I can be half as gutsy and dedicated.

Canadian Dean Giustini has been a medical librarian for more than twenty years, and is currently the biomedical branch librarian at the University of British Columbia. He has presented workshops and lectures on Web 2.0 and written editorials for the British Medical Journal. He’s been a blogger since 2005, and has experimented with wikis and podcasting. He is the 2007 Canadian Hospital Librarian of the Year. He also started blogging with Open Medicine in April 2007, a blog that highlights research at the Open Medicine journal. His official MedLib blog is http://weblogs.elearning.ubc.ca/googlescholar

TM: For those unfamiliar with your blog, please provide us an overview of your blog, who your target audience is, and what role your blog fulfills.

DEAN: The UBC Google scholar blog tracks developments in information technologies in medicine and higher education, with a specific focus on expert searching and information retrieval. My readers are mostly physicians, librarians and those working in health care but I get academic librarians interested in Google scholar coming to the blog. I believe that my blog is the only one tracking Google trends for physicians.

TM: In your blog you talk a lot about Google Scholar. What is Google Scholar and what do you think is the future of Google Scholar?

DEAN: Google scholar is a search tool designed by Google Inc. It crawls content from across the web with a focus on scholarly content. It recently announced that it would crawl all of Elsevier Science’s journals which might put the total number of citations near one billion, according to my estimates. That makes it the largest index to the scholarly literature, ever. Google scholar is now a much-relied upon search tool and its future is assured.

TM: Some blogs are author-centric, some are topic-centric, some read almost like journalistic publications. Are there sub-categories within blogs? What types of blog styles do you find most compelling and why?

DEAN: I enjoy a range of blog styles and blog types. I like reading blogs for opinions, for interesting perspectives and views on current events and to keep up with what is happening in health care around the world. I read librarian, physician, nursing, educational technology blogs the most. I enjoy quirky blogs too like intueri.org (a psychiatric resident blog) or aphophenia (written by academic danah boyd) for her take on social networking. I like checking out rosie.com from time to time, and even the Huffington Post.

TM: Specifically, what recent advances in technology and/or tech companies have contributed to new resources and ways to access medical information for medical students and physicians? For the public?

DEAN: The ‘gold standard’ in searching is still PubMed, but there are a number of proprietary tools like ACP PIER, DynaMed, UptoDate and the Cochrane Library which are also important additions to any online library. The National Library of Medicine has some of the best sites for physicians and consumers; I’ve mentioned PubMed, but there is also MEDLINEplus, and what I call meta-search tools like the NLM Gateway and the NLM Entrez system. I have used all kinds of interfaces and search tools and I still believe that OVID’s search interface is the best on the market - but it is expensive.

TM: Looking forward, what changes do you anticipate seeing in the way that physicians and student doctors access and use medical information during and after their training?

DEAN: Digital, open, free and accessible will be the information mantra for the next few years. Physicians will continue to share information and build their own information tools and databases using wiki technologies, I believe. More open access journals like Open Medicine will be created and there will be new publishing paradigms that will allow greater control as well as access. AskDrWiki is an example of residents sharing information with each other after their training.

TM: If a student doctor or young physician has an idea about generating a popular blog, what suggestions can you make that might help them move forward and succeed in their endeavor?

DEAN: That’s a tough one. I think blogging is about the ‘love of sharing’. You have to want to tell people a story or share your knowledge. You might also want to enjoy writing. Although it might make little sense to give away expertise, I have found that blogging has opened up my contacts around the world and helped me to promote the work of health librarians.

TM: Do you have any other insights that you can add in closing?

DEAN: In closing, let me say that all of us should start to get ready for Web 3.0. I’ll be writing about that soon on the blog, so come and visit.

Jessica Otte is a medical student at The University of British Columbia in Vancouver, Canada. In 2006, she worked with a mobile clinic in northern India and at a small health center in rural Nepal, learning about cross-cultural care and the importance of sustainable solutions for international health. Her official blog is http://jaotte.wordpress.com.

TM: Jessica, you are a med-blogger. Why do you blog? What is blogging all about?

JESSICA: Although I started my blog as a way to collect and share information, I had an ulterior motive: fundraising. I worked very hard to compile various resources about the culture and language I would encounter on my journey to the Himalayas and to think critically about the local politics, ethics in cross-cultural healthcare, and other ’sticky’ issues I was about to be in the middle of. I had never done a trip of this magnitude before, and developing the blog was a great way to prepare. I was lucky to have a lot of traffic and managed to raise over $500 from friends, family, and strangers interested in my trip.

Blogging is a different experience for everyone that tries it. Generally, it’s a way for one person to communicate with many, and for people with common interests to unite and share knowledge. For me it was a learning tool, a way to make contacts and raise funds, a venue for sharing my stories, and it now serves as a personal record of my experiences.

TM: Your blog is called To the Himalayas, and you in fact recently completed a trip to the Himalayas. Why did you travel there and what was your experience like?

JESSICA: I travelled to Ladakh in Northern India, and then to central Nepal last summer, in between my first and second years of medical school. I’ve always had a fascination with Eastern religions and recognized the area as a hot-bed for Buddhism and Hinduism. I knew I wanted to do some international healthcare work, so I searched high and low for a program that was well-organized, sustainable, and which was designed for individuals including those with the (limited) level of training I had. The organization happened to work in Northern India. Talking to a senior peer about his past experiences overseas, he mentioned that the Nepali people were the most generous of heart; I had time to add a few weeks in Nepal to my adventure, and found some contacts there who were happy to receive me.

TM: During your trip you provided care to underserviced areas of Northern India, yet you were only a first year medical student! How prepared were you to treat patients and did you have any reservations about these aspects of the trip (especially with the langauge barriers you faced and limited resources available to you)?

JESSICA: I was a little nervous heading into the experience due to my low-level of training. Thorough history taking, basic physical exams, and CPR were about the only clinical tools I possessed. We were lucky to have a few local translators through most of our time in India, but we had to learn to communicate without them. We worked in groups of 4 students to 1 physician, and would see 2-3 patients in each group at a time. Slowly we fell into a routine. As we as students became more comfortable with a focused exam and physical for the most common illnesses - GERD and arthritis - we were able to do the majority of the work. We charted, sent patients for lab work (at our crude portable laboratory), wrote prescriptions and then went to our supervising MD to approve our suggestions.

The time in India really prepared me for work in Nepal. I had become familiar with commonly used drugs and common ailments in that population, had honed my physical exam techniques, and had gotten used to language barriers and scarce resources. I was able to learn some basic medical Nepali so that I could examine patients well and help with history taking in the native language. I spent a lot of my time studying how a sustainable health care center could be run, and used the clinic I worked at as a case study for progressive ideas such as capacity building and micro-insurance health schemes.

TM: What is your stance on global health? What are some of the most pressing global health issues to you and how do you address them?

JESSICA: I don’t know if one can have a ’stance’ on global health, exactly, but there are a few key things that concern me regarding this topic. Primarily, I think we have a tendency to think of ‘global health’ as something you have to go overseas and do. That’s what I did - but it’s not the only way. Global health includes our own backyard; practicing it can be as simple as offering services in another language or being culturally sensitive when dealing with patients’ special needs. Even thinking about how our own actions affect the health of those in other countries can be important. Which coffee we drink, how often we drive our cars, what aid groups we support, which news we read and react to, or which diamonds we buy can all make a change in the health status of someone half-way around the world.

TM: Would you encourage medical students and premeds to travel abroad and work in clinical settings like you did? What does the experience offer them?

JESSICA: Travelling abroad and being engaged in the community through work in it is an excellent way to get to know the culture. One has to be very careful about expectations before travelling. As a pre-med or junior medical student, there may not be a lot of positive change you can leave behind. If you want to save the world, stay home.

If you want to explore other cultures, test your limits, improve your clinical and communication skills, and see medicine in an entirely different context, a trip abroad may be for you. I just don’t think it is realistic to believe you are doing a lot of good for a community if you are only there for a brief time; however, what you take away will be invaluable for your personal development and for the patients that you interact with in the future.

To make sure you do more good than harm, select a program that is sustainable and supported by the local community. You can also work on the periphery of medicine; helping to build a school or a clean water source, developing an agricultural or micro-lending program, or being an instructor in hygiene or HIV/AIDS awareness are all ways to influence the social determinants of health.

TM: What was your most memorable moment during your trip to the Himalayas?

JESSICA: There were many amazing times with patients and even after work when we hung out with the locals, playing cricket or dancing to our homemade music. Getting caught in a riot on the day I left Nepal was exciting, however, the most other-worldly experience was in Northern India on the Chang-la pass.

We were driving from Leh to Tangste where we would camp and hold clinic. We drove all day on rough mountain roads, enjoying the view but always a little worried on those hair-pin turns. Finally, we reached the highest point: The Chang-la pass at 17 300 ft altitude. Stopping briefly to marvel at the idea, we had to move on quickly.

We continued down the extremely steep road. All the cars stopped and everyone got out. A snowball came flying at me! I was in the middle of a snowball fight with glacial snow, near the top of the world (as I knew it).

Being so high up, we quickly ran out of breath from running around and had to collapse back into the Jeeps so we could descend and avoid altitude sickness.

TM: What will Jessica Otte be doing after she’s graduated from medical school? Do you have any future plans to travel abroad again?

JESSICA: I have no idea what I’ll be doing once I graduate! Many fields including Family Medicine, Emergency Medicine, and Neurology are currently of interest to me, but this changes as I experience new things on my clerkship rotations. I’ve spent some time doing rural medicine and working on fly-in reservations in Northern British Columbia recently, and I could see myself making that a part of my career.

I do hope that whatever specialty I choose will be portable so that I can take my skills overseas again. I would like to spend at least a year on this but I’m not sure yet where my travels will take me . . .

John Lynch, M.D., F.A.C.C., is a physician consultant of Cardiovascular Diseases at the Mayo Clinic in Arizona. Director of the Cardiovascular Rehabilitation Program. Dr. Lynch is the former Director of the Echocardiographic Non-invasive Hemodynamic Laboratory at the Mayo Clinic Arizona, and current President of the Arizona Society of Echocardiography. He and his family live in Arizona.

Dr. Takyi is a board-certified OBGYN physician. He is originally from Liberia. He and his family live in Michigan.

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