Also participating in the visit were three international students currently completing an elective in social medicine and global health at LAU’s Gilbert and Rose-Marie Chagoury School of Medicine (SOM).

Nima Sheth, a fourth-year medical student at the Saint Louis University in Missouri, joined the program because of her interest in social justice and her desire to work with the phenomenon of post-traumatic stress disorder among refugees.

“The team has great energy and everyone shows real empathy with the patients,” she says. “It’s good to be exposed to underprivileged environments, because there’s much more we can help the patients with here.”

More than 8,500 residents currently live in acute privation within the one-square-kilometer bounds of the Shatila camp, one of Beirut’s most impoverished communities.

Established in 2001 by physicians, medical students and volunteers from the American University of Beirut, VOC offers primary care services to camp residents every Thursday, and occasionally for half-days on Saturdays.

The clinic is now run primarily by students and physicians from SOM’s Social Medicine and Global Health program.

Under the supervision of Dr. Mona Haidar, the program’s coordinator and an SOM instructor at LAU Byblos, and Dr. Myrna Doumit, assistant professor and assistant dean at the Alice Chagoury School of Nursing, students participate in the assessment, diagnosis and treatment of patients.

“We believe in the team approach. One person can’t cover all of the patients’ needs, and we cannot function solo,” says Doumit.

“Inter-professional education is the founding pillar of healthcare education and delivery, and that’s what we’re implementing through VOC,” she notes, adding that the nutrition and social work programs will soon be joining.

VOC’s mission is to provide, at minimal or no cost, quality health services to underprivileged and neglected individuals in Lebanon, regardless of race, gender, geographic location and religious affiliation. VOC promotes a message of solidarity among both patients and practitioners.

Despite limited availability of medical equipment at the clinic, the LAU team provides reliable care and responsive support to VOC patients.

Since most Shatila residents can rarely afford the laboratory tests they need, however, financial support is needed to make the clinic an ongoing primary healthcare facility for its patients, as well as a comprehensive learning site for students.

Impressed with the students’ involvement and performance at the clinic, Assistant Vice President for Development Robert Hollback hopes to find ways to increase the community’s involvement with the clinic.

“Our students and faculty members are providing the only healthcare available at the clinic right now,” says Hollback, adding that sustainability remains an unresolved problem since the clinic relies mostly on donations.

“We currently have a $50,000 funding proposal, and we’re waiting for it to come through. But this is still not a sustainable source of funding,” he says.

Up to ten patients frequent the clinic every Thursday, and the numbers are steadily climbing.

“We want to attune our students to the idea that the patients are coming from a certain community, and thus tailor our care accordingly,” Haidar says, adding that community assessment lies at the core of the process.

Lara Oson, a third year medical student at LAU, finds the VOC experience to be genuinely gratifying.

“We get to see the patient from the very beginning, make a plan and discuss it with Dr. Haidar. It’s a big responsibility and we feel that we’re truly making a difference,” she says.

The gathering took place in an informal, friendly setting where faculty members introduced themselves to students and vice versa.

The event “set the spirit of the School of Medicine at LAU — we’re all one family,” says Dr. Zeinat Hijazi, LAU assistant dean for Medical Education.

First-year med student Serge Gabriel Geara agrees. “I like the human aspect of LAU, the kindness of the staff and faculty,” he says.

The gathering shed light on the School of Medicine’s innovative teaching approaches, which allow students to have early exposure to real patients in a clinical setting starting in their first year of study. More conventional programs delay the student–patient contact until the third and fourth years of study.

“This [early exposure] helps the students to better understand diseases because they get to examine their underlying causes, pathophysiology and symptoms at the same time,” explains Hijazi.

In addition to early clinical exposure, simulation training is also provided to all medical students so they can better understand the anatomy and physiological functions of the human body.

LAU’s School of Medicine focuses on small-group teaching and problem-based learning, where students are divided into groups for case discussions and exchange of ideas.

The new med class is “an exciting group of students who have a lot of talent. I hope they will learn quickly how to work together,” says Dr. Lynn Eckhert, interim dean of LAU’s School of Medicine.

At the same time, a lot of attention is given to each student individually, as they are also encouraged to think critically and come up with solutions on their own.

Continuous learning is also at the heart of medical education at LAU, according to Hijazi. “We want the young doctors who graduate to be lifelong learners,” she explains. “I believe that medical education starts at the medical school, but it doesn’t stop there. It’s for life.”

Eckhert says there will be a lot of focus on year-long community-based projects. First-year medical students will get the chance to visit a clinic in the Shatila Palestinian refugee camp, in order to increase their exposure to the impact of poor socio-economic conditions on patients and the development of their diseases.

“If you have diabetes, for example, and you’re wealthy, you probably have good insurance and can afford the medication and the equipment that goes with being a diabetic patient. If you live in poverty, managing diabetes is more challenging,” Eckhert explains.

In previous years, students could choose whether or not to volunteer in Shatila, but it has now become a crucial part of the curriculum that all students have to go through.

“They like the idea of giving back to the public,” says Eckhert, who hopes to engage students in more community work in the future, and to secure more simulation material.
 

The workshop was hosted by Dr. Nancy Hoffart, professor and founding dean of LAU’s Alice Ramez Chagoury School of Nursing.

LAU’s IPE program is designed to prepare professionals in the university’s health and social care programs to function as effective, collaborative team members in order to improve health care and patient/client outcomes.

The program brings together students from the nursing, medicine, pharmacy, nutrition, and social work programs, to take part in IPE learning experiences in classroom, laboratory and clinical settings.

The aim of the retreat was to educate faculty about recent IPE developments and new approaches, which can then be incorporated into courses and clinical experiences beginning in the fall 2011 semester.

In her opening speech, Hoffart told workshop participants: “At LAU, I believe it’s important for us as faculty to develop trust and good communication, which is already evident among our 11-member IPE Work Group,” which consists of faculty members from the schools of Nursing, Medicine, Pharmacy, and Arts and Sciences.

“We’d like to extend this out to more LAU faculty. We are proud that the IPE program forms part of LAU’s new five-year strategic plan, to be launched in October 2011,” Hoffart added.

Leading an icebreaker during the retreat, Dr. Mona Haidar, who teaches at LAU’s School of Medicine and is a member of the IPE Work Group, asked faculty and other participants to write down facts about themselves and compare them with those of their colleagues.

The activity was a way to introduce the mission of IPE and highlight similarities among the health care professions for LAU students and faculty.

“We want to expose IPE to the rest of LAU’s health care faculty, so that more can join us in this initiative,” said Haidar. “We can work together, implementing learning activities with our students in hospital, community and classroom settings.”

Guest speakers Patricia Bluteau and Dr. Ann Jackson addressed the workshop participants via videoconference from the UK. They described their experiences with interprofessional education at the University of Warwick, and engaged participants in a Q&A session.

The workshop also addressed modes of delivering IPE, along with other challenges and constraints.

“One challenge might be that the five disciplines have different content to cover, with different time frames to complete them in,” said Hoffart. “We are taking small steps now, while seeking further guidance from Jackson and Bluteau.”

The retreat included a collaborative activity led by Dr. Anna Farra, faculty member at LAU’s School of Medicine and a member of the IPE Work Group. Faculty and attendees were divided into several groups to discuss various terms used by different groups of health and social care professionals. This enabled participants to identify faculty from other health care fields with similar academic interests.

The retreat ended with a tour of the new LAU clinical laboratories housing cutting-edge equipment and “patient-mannequins,” all in a hospital-like setting designed for clinical training.

“Implementing interprofessional education will be a hallmark experience for students and faculty in LAU’s health care programs,” Hoffart concluded. “We hope to become a leader in IPE, and a role model to other institutions within the region.”
 

The study, titled “Assessment of the Prevalence of Mental Health Disorders Among Adults,” was jointly conducted by LAU and Medécins Sans Frontières (Doctors Without Borders), and was based on interviews with 748 adults from 283 households that took place between June and November 2010.

“There is reason for concern when we have a population facing risk factors associated with poverty, war and displacement, which place individuals at increased vulnerability for developing mental disorders,” said Dr. Augusto Llosa, the study's principal investigator.

He identified those risk factors as insecurity, hopelessness, poor physical health, rapid social change, and limited opportunity.

Among the mental health disorders discovered among residents, the most common were mood disorders, afflicting 21 percent, followed by anxiety disorders (13 percent) and psychosis (3 percent).

The study also revealed that 96 percent of those afflicted had not sought treatment, despite medical and mental health services available at the camp by MSF.

Dr. Samar Zebian, assistant professor of psychology at LAU who served as a research consultant for the project, attributed the treatment gap to a two-fold lack of awareness.

“Sixty-one percent of the participants in this study felt they didn’t have a problem, and 64 percent believed there weren’t services to help them,” Zebian said. “Those who recognized they had problems weren’t aware of the help available to them.”

In his opening remarks, Dr. Abdallah Abdallah, the Palestinian ambassador to Lebanon, thanked MSF for its services to Palestinians in Lebanon and Palestine.

He cited previous studies revealing widespread poverty among Palestinians in Lebanon, noting that Palestinians face employment barriers in the country.

“Our residents are not healthy, the economic situation is bad, and the overcrowding is terrible,” Abdallah said. “Many of our students are dropping out of school. They say, ‘If I finish and receive a degree, I’ll still be unable to work, so why should I waste my time?’ This is a major problem for our young generation.”
 

For the first time, the event was organized through the collaborative efforts of the Student Development and Enrollment Management division, the Department of Natural Sciences, and LAU’s Hospitality Club.

“It was a team effort,” says Dr. Ahmad Kabbani, chair of the Natural Sciences Department at LAU Beirut and the mastermind behind the collaboration.

The event even drew some graphic design students who helped their friends studying natural sciences develop their posters.

“We emphasized teamwork,” Kabbani adds. “It’s very important that students learn about the interdisciplinary aspect.”

Kabbani also notes that the event created an opportunity for interaction between students and their community, and allowed them to realize their potential to learn and engage outside the classroom.

A health booth was set up during the event, where Dr. Nancy Hoffart, dean of LAU's School of Nursing, measured students’ blood pressure. Biology, pre-medical and nutrition students helped measure the body mass index of their peers visiting the booth.

During the event, over 50 posters were displayed outdoors that hit on a variety of health-related topics, including nutrition, cancer prevention, and substance use. Students voted for their favorites.

Spotlight on cervical cancer, HIV and travel safety

On the first day of the event, three LAU faculty members gave health-awareness presentations.

The first presentation focused on cervical cancer and was led by Dr. Wissam Ghandour, a part-time faculty member in LAU’s School of Arts and Sciences who holds an M.D. in gynecology.

The causes of most types of cancers, Ghandour said, are unknown, despite the association of some habits, such as smoking, with the disease. But unlike other cancers, he revealed a direct link between the HPV virus and cervical cancer, and said that 99.9 percent of cervical cancer patients have HPV.

HPV is most commonly transmitted sexually. Mothers may also pass it on to their newborns.

Many people who are infected with HPV, Ghandour said, are unaware and may lead perfectly healthy lives, but are still in danger of transmitting it to others.

“If someone gets infected, there is a high chance that the virus can clear up on its own without any type of treatment if exposure happens only once,” Ghandour said. “But if there is continuous exposure to the infection by having repeated sexual exposure to a person with HPV, that may lead into a pre-cancerous stage.”

According to Ghandour, 80 percent of women in the United States will be exposed to the virus by the age of 50. The peak age for developing cervical cancer is between 35 and 55, he said.

“Every two minutes, a woman dies of cervical cancer somewhere in the world,” he said. “Here in the Middle East, it’s every hour.”

Later in the day, Dr. Mona Haidar, a specialist in social medicine at LAU’s School of Medicine, gave a lecture on the global HIV epidemic.

More than 97 percent of new HIV infections occur in underdeveloped countries, she said, adding that the groups most vulnerable to the virus are sex workers, drug users, and sexually active people.

Haidar dismissed common misconceptions that HIV is passed through shared utensils, shaking of hands, kissing, using public toilets and swimming pools, and through mosquito bites.

The final presentation on travel safety was conducted by Dr. Anna Farra, who teaches immunology and microbiology (with an emphasis in infectious diseases) at LAU’s School of Medicine.

Farra said the first things to consider when traveling are the vaccines that need to be administered, paying particular attention to any viruses that the destination country is known to have a high prevalence of.

Ideally, she said, travelers should prepare six months before a trip and visit their health care providers for a pre-travel evaluation informing the physicians of all planned activities.

“It kind of takes the spontaneity out of life,” Farra admitted.

She said it is important to keep in mind the travel season, as different viruses spring up according to weather patterns, climate and other seasonal changes.

She also cautioned students against food safety hazards. Do not drink tap water, make sure it is not used to make ice cubes, and also avoid raw meat because it can carry parasites, she said.

She added: “A good saying when it comes to food is ‘boil it, peel it, or forget it.’”
 

Building on a workshop organized for the physicians in October 2010, last week’s event was held in anticipation of the first clerkships of the medical school’s founding class expected to begin in early summer.

“The students are going to show up at our doorstep before you know it so we are relying on your input,” said Dr. Lynn Eckhert, interim dean of LAU’s School of Medicine, as she explained to the UMC–RH physicians the importance of designing a successful clerkship program.

Also known as clinical rotations, clerkships will allow LAU students to perform the duties of physicians in different departments and specializations at UMC–RH. Under the supervision of UMC–RH doctors, the students will perform medical examinations, treat patients, and assist physicians with their medical tasks.

All medical students will be required to complete clerkships during their third and fourth years.

A key goal of the workshop was to help the physicians understand and meet a set of “global competencies” such as skills in communication and care giving, as well as professional standards in ethics and teamwork to pass on to the students.

According to Dr. Connie Bowe, a senior consultant at PHMI and one of the workshop presenters, setting consistent, universal medical standards remains a critical step to ensuring quality.

“Consistency in medical education has been a global concern,” Bowe said. “So this is how we can guarantee the public that the students we are graduating are in fact safe practitioners and that we vouch for their capabilities.”
 

Students were introduced to key members of the university and learned about different services, before being guided on a campus tour.

“We want you to think of LAU as a place to learn rather than a place to teach. Everything here will be supporting you to learn,” Dr. Abdallah Sfeir, LAU provost, told the incoming M.D. students.

“You have everything put at your disposal. The only thing we require from you is passion, time and love for what you do,” he added.

During the campus tour, the students got to peek at the site of their new medical school building currently under construction. For the time being, the students will make use of the temporary facilities inside the Dorms A Building.

Student training will also take place at University Medical Center – Rizk Hospital, and other hospitals with which LAU has clinical affiliations.

The medical school, which opened its doors to its founding class of 25 students last year, has a stated mission to “educate and train a new physician, one superbly trained in the art and science of medicine and who believes deeply that a physician is, above all, a merciful healer.”

The students were reminded of this mission, as the ethical and moral responsibilities of physicians were emphasized at the orientation.

Elie Samia, director of the Guidance Office in Byblos, told the students that LAU is a center for “diplomacy, conflict resolution, intellectual yearning, and emotional development.”

“Experience has taught us that the best way to unleash the potential of our students is to give them responsibility and authority,” Samia said, who informed them of the different avenues they were free to take as they enter the university, but encouraging them to follow a path toward “creative excitement.”

The Summer School on “Biomedical Informatics: Foundations and Research Directions” covered computational techniques and information technologies used for medical diagnosis, clinical decision making, personalized medicine, molecular biology, and health care systems.

It was co-organized by LAU’s School of Arts and Sciences and the Software Institute, under the patronage of Dr. Mohammad Khalife, Lebanese Minister of Public Health.

“The aim of this course is to lead participants to transform and implement this new information they are learning [concerning biomedical informatics] in the health sector, and to motivate participants to conduct research in this field,” said Dr. Nashat Mansour, LAU computer science professor, who is the director of the Software Institute and assistant dean of the School of Arts and Sciences in Beirut, during the launching ceremony on July 5.

Mansour added that one of the objectives of this summer school is to establish a network of researchers, from a number of universities, who will address challenging problems in biomedical informatics.

The course sessions were led by four world-class experts in the field: Dr. Bruce Bray, professor of biomedical informatics from University of Utah’s School of Medicine; Dr. Thomas Payne, medical director of IT Services at the University of Washington’s School of Medicine; Dr. Peter Tonellato, director of the Laboratory for Personalized Medicine at the Center for Biomedical Informatics of the Harvard Medical School; and Dr. Sami Khuri, computer science professor at San José State University.

The course attracted 45 participants, 35 from Lebanon and 10 from other countries in the region.

During the opening ceremony, LAU President Dr. Joseph Jabbra called on participants to “stay ahead of the curve” by “thinking outside the box.”

“The 21st century belongs not only to educated people, but to innovators as well,” Jabbra said. “All of us need to think outside the box … and this class is an attempt to do that.”

Minister Khalife also addressed the course participants during the opening ceremony, where he talked about recent and ongoing efforts inside the ministry to stay up-to-speed with information technologies.

“We cannot manage a health department without having an information system,” he said, adding that the ministry has incorporated a developed statistical system, but that includes some limitations.

Khalife also mentioned that the ministry was recently awarded the E-Government Web Award for its innovative website by The Arab Administrative Development Organization, which is affiliated with the League of Arab States.

The summer school at LAU was co-sponsored by the Lebanese National Council for Scientific Research, Philips Middle East, the Arab Computer Society, and Software Design.

Zalloua will be working with a research team from LAU in collaboration with Dr. Hatem El Shanti, director of the Shafallah Medical Genetics Center in Qatar, over the grant’s three-year duration with an ultimate goal of preventing the spread of the disease in the region.

“Type II Diabetes is very rampant in this part of the world, and the main reason for that is because we’ve changed drastically our lifestyles over the last 50 years making it very difficult for our genes to adapt,” Zalloua says.

The two main lifestyle changes that are responsible for the disease’s spread, Zalloua explains, are the sudden decrease in exercise, and the shift in diets, which used to be rich in vegetables and low in fats and carbohydrates. A third, less significant, cause is the increase in stress.

“In the past, we used to walk to the market and to work, we had a lot less cars than we do today, so people were a lot more mobile, and our genes were adapted to the fact that there was not a lot of food available,” Zalloua says.

“And now all of a sudden, we have a lot of food stored in our bodies and we’re not walking anymore, we’re not exercising. We’re spending 24 hours a day either sleeping or on a chair behind a screen,” he adds.

Identifying susceptibility genes for Type II Diabetes will allow doctors to target individuals predisposed to the disease and deliver a clear message: avoid certain triggers such as having bad eating habits, and not exercising, or else you’re going to get diabetes.

“Those genes are not necessarily bad, but they are adapted to a certain environment,” Zalloua says. “We have to mimic that environment again, and the way to do that is fairly simple: exercise.”

Zalloua believes he was awarded the grant because of his proposal’s unique, hands-on approach to the problem.

The research team will visit villages throughout the region and meet with couples that have been living together for decades and that lead similar lifestyles, in order to find a correlation between their genes, habits, and the disease.

Zalloua says the Middle East is conducive to carrying out their research because of an aging population that has been living together for a much longer time than people from other regions of the world.

“This is something we can do, but nobody else can, because of our easy access to these people who live in rural areas,” he adds.

In an email last month announcing that Zalloua had received the grant, Dr. Kamal Badr, founding dean of LAU’s School of Medicine, noted that the research topic is in line with the school’s mission to foster “regionally relevant translational research.”

“Type II Diabetes is one of the most fast-spreading and devastating diseases affecting the populations of Lebanon, Qatar, and the entire Gulf region. Its prevalence is expected to reach nearly 50 percent in some of the Gulf countries over the next decade,” Badr wrote.

He added: “Coupled to his [Zalloua’s] existing grant on cardiovascular disease awarded by the European Commission, the grant [for the study of Type II Diabetes] will constitute a firm basis for the basic science component of the Cardiovascular and Metabolic Disease Center, which the School of Medicine is establishing at LAU and its affiliated clinical training sites, principally the University Medical Center – Rizk Hospital and the clinical research consortium being developed through the LAU Institute for Human Genetics (headed by Dr. Zalloua) at Rafic Hariri University Hospital, Clemenceau Medical Center, and other medical centers and hospitals in Lebanon.”

“I am not surprised that you landed this important grant from the Qatar National Research Fund. Hard and smart work always pays off. Dedication to one’s research and scholarship will always be noticed and always rewarded, no matter what the challenges are,” wrote LAU President Dr. Joseph Jabbra, in an email message to the LAU community.

Jabbra added: “I am sure you will, with your Qatari collaborators, bring this important project to successful completion for the benefit of our entire region.”

Established in 2006, QNRF’s stated mission is to provide support to researchers within academia and throughout public and private partnerships.

Reflecting a rapidly growing global interest in social medicine, both publicly and socially, LAU’s Gilbert and Rose Marie Chagoury School of Medicine has integrated its study as a key part of the curriculum.

“Our vision is to produce a new kind of physician — one who is well-rounded and trained to treat the patient and not the disease,” says Dr. Mona Haidar, a faculty member from the School of Medicine. She adds: “And to do that, you need to understand the context in which the patient lives. Social medicine is essential to producing this new kind of physician.”

Another major objective of social medicine is to nurture the environment in which an understanding of the affecting socio-economic factors can allow society to improve public health.

Last month, Haidar gave a presentation entitled “Social Medicine and Global Health: Do They Really Matter?” at the University Medical Center – Rizk Hospital.

In her talk, she introduced the basics of the field of social medicine. “I presented an overview of its history and its three main themes which are: Social determinants of health; social meanings of diseases; and social approaches to disease,” she says.
“Physicians also have social responsibilities and they can be agents of change in their societies — they have both the responsibility and ability.”

“I tried to make the case that social medicine does matter if you want to provide good care or the best care to your community, and I presented cases for that,” Haidar explains.

In March, 25 LAU medical students, along with School of Medicine faculty members and LAU staff, got to know their local community better when they visited the Ministry of Public Health’s Byblos District Health Center, the Lebanese Red Cross, the Ministry of Social Affairs’ Center and local historical sites in Byblos.

The visit was organized by Haidar, as part of the school’s social medicine curriculum.

After the visit, Haider said that the school hoped it enabled students to understand what constitutes a community and what factors, elements and stakeholders shape community heath.