Category: global health

Upstate and Kenyan medical school resume educational exchange

By Jean Albanese

After a hiatus due to COVID-19, Upstate Medical University has revived its bidirectional educational exchange program with Maseno University School of Medicine in Kenya.

In mid-May, Andrea Shaw, MD, assistant professor of internal medicine & pediatrics, returned to Kenya with three residents and one medical student for a medical service and educational experience in partnership with Maseno University School of Medicine at the Obama Children’s Hospital in Kisumu, Kenya.

Outside Obama Children’s Hospital, from left, are Head Nurse Beatrice Ontita; third-year pediatric residents from Upstate Jean Meneses, MD; Sophie Duron, MD; Ruby Sangha, MD; and Upstate Professor Andrea Shaw, MD.

“COVID changed a lot all over the world, but this recent trip was a great opportunity to get our feet back on the ground,” Shaw said. “There are a lot of things about the hospital that have changed since we were there, but our relationships with colleagues across the globe remains committed to a joint educational mission.

“The opportunities are many; at the end of the day learners are interested in this type of bidirectional exchange in medical education because it expands everyone’s mind and allows for robust learning across systems and cultures,” Shaw continued.

The Upstate team had been engaged virtually once a month for the past two years through a virtual case conference series between the two universities. Clinical cases presented by Kenyan medical students and Upstate pediatric residents are joined with the perspective of Upstate pediatric specialty providers and Maseno’s pediatric core faculty. In Kenya, the Upstate team engages in bedside clinical teaching, case-based learning as well as didactic lectures that fit into Maseno’s curriculum.

“It was really nice to re-engage,” Shaw said. “The bottom line is that the same incredible pediatricians who were working there through the pandemic were still there, and very committed to the educational mission. The students were just as hungry to learn. They were eager to get back to in-person experiences.

Shaw said that though the Upstate students had been engaging virtually with their Kenyan counterparts for the past two years, there is no substitute for being on the ground in a different country.

“A lot of their learning is just putting themselves in another person’s shoes and realizing the pathology and the medicine are very much the same but the culture of how patients understand illness, seek care, and deliver care is different. Learners have to figure out how they fit in,” she said. “When they approach it with humility and respect, we all go far together.”

The Upstate—Maseno collaboration was born out of Upstate’s Institute for Global Health and Translational Science, where former Upstate researchers committed to a great depth and breadth of work in a region including Mark Polhemus, MD, Timothy Endy, MD, and Rosemary Rochford, PhD.

When Shaw joined the faculty at Upstate in late 2016, she was committed to ongoing work in clinical service and educational collaboration in East Africa, a region she had been involved with in varying capacities over the prior decade. In 2008, amidst her years of medical training, she spent a year in Tanzania working with Upstate’s current Chief of Infectious Diseases Elizabeth Asiago-Reddy, MD. After that, she worked in South Sudan affiliated with Juba Teaching Hospital.

The first Upstate group of learners joined Shaw in 2018 and the program continued with a diverse array of learners from Upstate including public health and medical students, pediatric & emergency medicine residents, as well as faculty across disciplines until Covid-19 interrupted and forced Upstate staff and students to evacuate.

Upstate has sponsored Kenyan faculty and students to join observership time at Upstate in 2018 and 2019. This fall, two Kenyan final-year medical students and one junior faculty member will come to Upstate for observership.

Future plans involve the expansion of an international health fellowship that will engage Upstate faculty in Kenya consistently throughout the entire calendar year. 

“The academic teaching hospital to teaching hospital relationship leaves much room for collaboration across disciplines and silos for the improvement of care and enhanced educational experiences,” Shaw said.

Shaw is also working with Upstate Foundation for a formal path for donations to improve support for pediatric patients at Obama Children’s Hospital with items identified by the local staff, including pediatric-friendly wall murals, updating bed nets to protect from mosquitoes, and replacing thermometers and basic equipment.

“We’re serving Kenyans who have no means to pay for their care, just like we’re committed to serving everybody who comes into Upstate,” Shaw said. “Nobody gets turned away. That same model exists at a teaching hospital when you’re in a developing country. That parallel mission is essential, with a commitment to provide care to all and educate the next generation of care providers.”

Upstate’s Thomas again publishes in New England Journal of Medicine

By Emily Kulkus

Upstate Medical University infectious disease physician-scientist Stephen J. Thomas, MD, is a co-author of an article in the May New England Journal of Medicine describing the safety and efficacy of the Pfizer/BioNTech COVID-19 vaccine in adolescents ages 12 to 15. Thomas is the coordinating principal investigator for the late-stage Pfizer/BioNTech global vaccine trial and the principal investigator at Upstate, which enrolled 12- to 15-year-olds in the study.

The article, “Adolescent Safety, Immunogenicity, and Efficacy of BNT162b2 COVID-19 Vaccine,” was published May 27 in the NEJM, which is considered one of the most prestigious peer-reviewed medical journals in the world. Thomas is part of a large team of investigators, trial coordinators, recruiters, and lab and other science support personnel executing the trial.

Stephen Thomas, MD

The U.S. Food and Drug Administration expanded the emergency use authorization of the Pfizer/BioNTech vaccine on May 10 to include adolescents 12 to 15 years of age and follows authorization of the vaccine in those 16 and older in December 2020. The CDC reports more than 2.4 million 12- to 15-year-olds have been vaccinated since the authorization.

The NEJM paper describes results of the trial, which included more than 2,200 participants, half of whom received a placebo while the other half received the Pfizer/BioNTech vaccine in the same dosage as those 16 and older. Of those who received the placebo, 16 contracted COVID-19 while there were zero cases reported among vaccine recipients, translating into a vaccine efficacy of 100%.

“The safety profile was similar to what we have seen in people 16 years and older who have been vaccinated,” Thomas said. Participants reported post-vaccination symptoms similar to what older recipients reported including pain at the injection site, fatigue and headache. Volunteers rated the symptoms as mild to moderate in severity and there were “no vaccine-related serious adverse events,” according to the paper.

“The immune responses in the 12- to 15-year-olds were great,” Thomas said. That data, combined with the increasing burden of COVID in that age group is why the advisory committee to the FDA voted 14 to zero to recommend emergency use authorization, he said.

Thomas, interim chair of microbiology and immunology, and serves as the director for Upstate’s Institute for Global Health, said his own 13-year-old son received the vaccine at the New York State Fairgrounds.

“I said, ‘Charlie, do you want to get vaccinated?’ and he said, ‘not really but I don’t want COVID either, so I guess I will,’ ” Thomas said. “I also have a 6-year-old and I’m waiting for the vaccine to be available for her age range.

“I firmly believe that one of the most devastating effects of this pandemic has been on our kids, caused, in part, by the lack of in-person learning and cancellation of numerous extracurricular activities. The only way that everybody – the teachers and the teachers’ unions, the parents and the administrators, and the departments of health – the only way that everyone is going to feel comfortable with bringing kids back every day, full-time is to create these bubbles of immunity in our schools. To do this requires wide-scale vaccination among these groups.”

Thomas was a co-author of a paper in the New England Journal of Medicine about the effectiveness of the Pfizer/BioNTech vaccine in December. He reflected on the latest achievement for Upstate.

“I’m the lucky guy here at the right time waving the flag for a team of dozens and dozens of committed professionals who have not had a single break during this pandemic. For me, it’s special to have Upstate and CNY attributed to this work. It shows we did our part. We chipped in and we participated.”

Upstate is involved in additional Pfizer/BioNTech COVID vaccine trials. Joe Domachowske, MD, is a pediatric infectious diseases physician-scientist at Upstate and the principal investigator of a trial testing the vaccine in children as young as 6 months of age.

Upstate MPH program adds Global Health concentration

Upstate Medical University endocrinologist Barbara Feuerstein, MD, (right) and third-year medical student Moje Omoruan (middle) speak with patients in Bahía de Caráquez, Ecuador, during a 2019 medical brigade offered through the Upstate Institute for Global Health and Translational Science and NGO partner Walking Palms Global Health Initiative. A new Masters in Public Health concentration at Upstate will include students traveling to Africa or South America as part of their studies.

SYRACUSE, NY — Upstate Medical University College of Medicine is expanding its Masters of Public Health program, adding a concentration that will see students traveling overseas to cap their studies.

The Global Health and Translational Science concentration joins Data and Analytics, in which students learn how to use “big data” to address public health concerns, and Population Health for Clinicians, a program for medical students and those who have already earned an MD.

“There has never been a greater understanding of the importance of public health, or a greater need for motivated people to step up to the challenge,” said Christina Lupone, MPH, director of the new concentration.

The COVID-19 pandemic brought home for many the link between individual health and public health, she said. “The pandemic  has shown that a virus can overwhelm our individual efforts to be healthy and conversely, the important ways public health practitioners can help protect the health of individuals in our communities.”

Each of the MPH concentrations require 42 credits, mostly earned on campus.

The new Global Health concentration will launch next summer and will run for 14 months, with students spending the final six weeks at one of Upstate’s Institute for Global Health and Translational Science affiliates in South America or Africa.

“The new program is an opportunity for students to apply public health knowledge with on-the-ground action in places where public health challenges are ongoing,” said Lupone. “Now, more than ever, we recognize the need to train students in innovative and collaborative public health solutions locally and globally.”

The new concentration, which is planned to be presented on campus, includes a course on researching and developing approaches to global health problems. Taught by Stephen Thomas, MD, the global lead principal investigator for Pfizer/BioNTech’s COVID-19 vaccine trial, the class will cover the special challenges of working on global health problems and how they can be successfully met.

Faculty for the program includes clinicians, as well as experts in regulatory science, public health and quality affairs. “The diverse faculty will help students learn what it takes to develop medical countermeasures for global health problems, such as COVID-19, from the laboratory to the community,” Thomas said.

Another course is designed to help students refine their interests and match them with existing Upstate projects overseas. There are opportunities for field work, lab research as well as clinical and non-clinical experiences. “The goal is not just for students to learn in a global setting, but to work alongside Upstate faculty and global partners to help improve the health of the people there,” said Martha Wojtowcycz, PhD, director of the Masters of Public Health program.

“Nothing has underscored the fact that public health is global in nature, more than the rapid spread of the COVID-19 virus around the world. Global Health & Translational Science is the right concentration to add to our portfolio of offerings right now, and we are lucky to have a great global health team with which to partner in order to get it done,” said Christopher Morley, PhD, chair of Public Health and Preventative Medicine at Upstate Medical University’s College of Medicine.

“This is yet another example of the College of Medicine responding to the evolving challenges to public health here and around the world,” said Mantosh Dewan, MD, president of Upstate Medical University.

Applications for the Upstate MPH, including the Global Health and Translational Science concentration, are available through SOPHAS. More information on the Upstate MPH is available at  https://www.upstate.edu/mph/academic/mph_degree/index.php . For questions about applying to the MPH program, contact Krystal Ripa, director of Special Admissions at [email protected] .

Citing COVID and other works, SUNY trustees commend Thomas

Stephen Thomas, MD, chief of Infectious Diseases at Upstate Medical University.

The SUNY Board of Trustees, at its Nov. 17 meeting, passed a resolution commending Stephen Thomas, MD, professor and chief of Infectious Diseases at Upstate Medical University on his appointment as lead principal investigator for the Pfizer/BioNTech global phase 3 COVID-19 vaccine trial.

Recent reports show that the vaccine candidate is 95 percent effective against COVID-19.

As one of the global phase three vaccine trial sites, Upstate has enrolled more than 300 adult volunteers in the trial.

The commendation also cited Thomas’s early leadership on international health issues, among them Dengue, Ebola, MERs-CoV vaccine trials as well as Zika vaccine development efforts.

Trustees also acknowledged Upstate’s role beyond the vaccine trials, including the development of the pooled saliva swab COVID-19 surveillance test and the use of wastewater to detect traces of COVID in residential areas, especially college campuses.

Thomas has been instrumental Upstate’s COVID-19 response, not only in the numerous research projects and clinical trials, but in the university’s response to the first wave of the pandemic, when he led the Upstate’s Incident Command process.

Trustees note that “Dr Thomas leadership role will have a significant impact on overcoming the COVID-19 pandemic” and that “Dr Thomas exemplifies the outstanding dedication to the community and extraordinary academic excellence that SUNY prides itself in fostering.”

Among his numerous academic and clinical roles at Upstate, Thomas also serves as director of the Institute for Global Health and Translational Research.

Students welcome phased resumption of clinical, other learning

When the COVID-19 pandemic forced Upstate Medical University to suspend clinical training for students in March, many were disappointed. For years they had read and studied to prepare themselves for the opportunity to help real patients.

Kevin Ivory

“Wow, this is going to stink,” Kevin Ivory recalled thinking when he got the news. The third-year physician assistant student in the College of Health Professions said his wife helped him put things into perspective. “Look at the big picture,” she told him.

It was the big picture Upstate leaders had to consider as they thought through allowing students to once again interact with patients.

There were safety concerns, of course, explained Lynn Cleary, MD, professor of Medicine and vice president for Academic Affairs. “How do we keep students safe? Should they be permitted to see COVID patients? Do we have enough PPE (personal protective equipment)?” Not just enough for students at the moment, but a reliable enough supply, so the supply needed for staff would not be threatened.

Additionally, were there enough faculty available to ensure students would have rich educational opportunities? Many Upstate faculty were working hard to address the immediate needs of the COVID pandemic and Cleary said it was important that those faculty not be overextended. “Were there enough patients when admissions were down, elective surgeries were put on hold and many visits were cancelled?” she asked. And, “could we integrate students into telehealth visits?”

There was the big picture of how student education coordinated with the safe operations and conduct of the hospital and the university. That was addressed by Incident Command, the large team headed by Steven Thomas, MD, professor of medicine, professor of Microbiology and Immunology, and the division chief of Infectious Disease. The question of when students could return was regularly before the Incident Command team. 

“There were a lot of details to work out,” said Cleary. There were concerns about procurement and logistics, and very basic concerns such as how would things work with the number of people in an operating room limited to six.

Jonathan Thomas

Cleary complimented the work done by the deans of all four colleges, as well as Julie White, PhD, associate vice president for Educational Services and dean of Student Affairs, and Steve Marks and his team in Educational Communications for working out how learning could proceed with social distancing, including keeping classes smaller and holding some, or parts of some, online. “Most are going to be hybrid,” she added.

Students got the news that their clinicals were being suspended mostly by email. At first they were told it might happen, then they were told it had been decided that, for their health and safety, as well as the health and safety of patients, they would not be able to see patients.

Hannah Connolly

The suspension was well-timed for Hannah Connolly. She had been working on a community health project in Kenya and was able to fly home days before flights were widely canceled due to the pandemic.

With a months-old infant at home, Ivory said, “I got to see my son grow up more,” and did some work with his father’s private investigation firm. 

Students were kept informed about plans for reopening by email and through town halls, where students could hear what was happening in their absence, and learn that some students would be able to resume clinical work in May.

While they were absent, students weren’t necessarily relaxing. Some classes were being taught online. Others did volunteer work to help Upstate and the community cope with the pandemic. Some worked with faculty to research active questions about COVID and provided weekly summaries on selected questions and topics.

Ashis Sinha, a PhD student in the College of Graduate Studies, took the opportunity to work on his thesis on extracellular matrices in the brain. His research may shed light on causes of dementia and even schizophrenia, he explained.

Ashis Sinha

Jonathan Thomas, in his final semester in the Doctor of Physical Therapy program, was very happy to get the news that he could return to his field of study.

“It was an immediate, ‘oh, let’s get this started,’ ” he said.  The son of a dentist, he explained he has always been interested in the human body, “but not a fan of the mouth, per se.”

He had out-of-classroom work to keep him busy during the time away from clinicals, and also used his healthcare training to help family and friends interpret the news they were hearing about the pandemic.

“There was lots of overselling of information,” he said, noting that some medicines that were being touted first needed to be validated. “I tried to help decipher what we know.”

For Connolly, the return to clinical work was more than welcome. “I felt so rejuvenated.  Being able to sit with a patient and finding a connection, that’s the heart of medicine to me.”

Students are now returning in phases to clinical settings, with the support and coordination of faculty and staff from across the institution. “It takes the Upstate village to support good education, and the village couldn’t be better,” said Cleary. “It’s an honor to work with people from all over the hospital and university to welcome students back as partners in patient care.”

Upstate students help mine research for front line caregivers

By Charles McChesney

Upstate Medical University Students and faculty gather for video conferences twice weekly to discuss research on COVID-19 and pass along a digest of findings to the Incident Command team overseeing Upstate’s response to the pandemic.

Physicians and researchers all over the world are sharing research and information on what works, and doesn’t work, in the struggle against COVID-19. “Hundreds of papers are coming out every week,” said Upstate Medical University College of Graduate Studies Dean Mark Schmitt, PhD. “Clinicians just don’t have time to go through it.”

Sudie-Ann Robinson, a medical student at Upstate Medical University, is part of a group of students sifting through the deluge of research articles offered on COVID-19.

Schmitt, other faculty members and student volunteers at Upstate Medical University created an effort to read through literature, look for the most useful information, and share it with Upstate’s Incident Command team on a weekly basis.

Students read studies as they appear in literature, explained Joan Chou, a third-year medical school student who helped form the group.

Deferring to social distancing, the group gathers virtually twice a week to go over the latest research and share notes. “Students have been a fantastic auxiliary work force,” said Christopher Morley, PhD, chair of Public Health and Preventative Medicine at Upstate.  The students’ work has been instrumental in creating models used by the Incident Command team coordinating the University’s response to the outbreak.

“We are definitely using the students’ work product,” Morley said. “Students have responded with obvious professionalism – they see a need, and are eager to fill that need.”

A need is what Sudie-Ann Robinson was looking for after she and all other medical students were told in mid-March by the university that to help ensure the safety of students and the community, all direct patient care opportunities were prohibited. While she understood the need to protect students and conserve personal protective equipment, the third-year medical student felt drawn to help. “We should be plunging in,” she thought. She found out about the research effort and joined in.

Robinson has been focusing on what researchers report about gynecology and obstetrics regarding COVID-19. She said preliminarily indications are that babies born to mothers with COVID-19 are not born with the illness. She has also been looking at disparities in outcomes based on race or other matters.

But in both areas she has found little that is definitive. “There is so little information,” she said.

Vincent Xiao, a third-year-medical school student, said the effort has been evolving. At first, “we were trying to find a way to just condense a lot of the research that was out there for our front line physicians to look at.” 

Vincent Xiao, a third-year-medical school student at Upstate Medical University, has been helping front line caregivers keep up with research on COVID-19

The result was a report delivered each Friday with top findings and links to the original research. The group grew, added students from Upstate’s College of Graduate Studies and College of Health Professions, then added residents, hospitalists and even three students from medical schools in Pennsylvania.

Front line doctors responded by turning to the group with specific questions. For example, they wanted to know when research showed it was safe for COVID-19 patients to go home and what percentage of patients they could expect to need to be on ventilators.

The questions were a great help to the group, said Xiao. “Now we could tailor our research to some of the most clinically-relevant research.”

Caitlin Ward, a Master of Public Health (MPH) student at Upstate who will begin medical school here in the fall, said one challenge has been that much of the research involves a small number of patients, but more information keeps pouring in.

Despite the grimness of the pandemic, Ward says she sees reason for hope. “I think human effort, having all these students working together, is a really good sign.”

MD/MPH student focusing on mental health in Kenya

Hannah Connolly, a fourth-year MD/MPH student at SUNY Upstate Medical University in Kenya, where she is working on improving mental health services.

By Charles McChesney

Hannah Connolly, a fourth-year MD/MPH student at SUNY Upstate Medical University grew up in Watertown, N.Y., went to college at Hobart and William Smith Colleges in Geneva, N.Y. and is taking a gap year to pursue her master’s in public health and look into mental health services in Kisumu, Kenya, where she is living.

While delighting in the natural beauty of Kenya and the openness she has found among the people she has met there, Connolly recognizes Kenyans with mental health issues have few resources to turn to for help.  “There is one psychiatrist per three to five million people in Kenya, outside Nairobi,” she explained. By contrast, federal statistics show that in New York state there is one psychiatrist for every 5,100 people.

Connolly notes that many in Kenya do not have a medical understanding of mental illness. Those afflicted are sometimes considered “possessed” or “written off as stressed.” As a result, “those with mental illness are often outcast from their communities,” she says.

A proposal that Connolly has been working onwould help spread awareness and understanding around mental health. “The idea is to train community health workers — lay people trained in health advocacy — to identify mental health conditions in their communities and refer those they support to higher levels of care. This is especially useful in communities that are hard to reach.”

Part of Upstate Medical University College of Medicine’s Rural Medical Scholars Program, Connolly spent summers growing up along the St. Lawrence Seaway. She discovered Kisumu between her first and second year of medical school when she reached out to global health researchers who were working on interesting projects, looking for an opportunity to get involved on-the-ground in global health work. During that summer, she worked on a project in Kisumu that sought to understand the social determinants of perinatal mortality.

Mentored by Andrea Shaw, MD, African Regional Network lead at Upstate’s Institute for Global Health and Translational Science, Connolly has developed her plan to utilize community health workers to scale-up mental health services in Kenya. “Community Health Workers are considered trusted peers,” she said. As such, those with mental health challenges are likely more open to their help, “in comparison to the same messaging from someone in a white coat.”

When she returns to the United States, Connolly plans to complete her MD/MPH degree and apply to psychiatry residency programs looking to specialize in Child and Adolescent Psychiatry. 

Even then, her time in Kenya may not be at end. “I feel very connected to this place and this community,” she says, “and I look forward to returning to grow the roots I have planted here.”