April_eMagazine Volume 40

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OUR PEOPLE, OUR MISSION Global Health eMagazine April 2022 Watch this video!! Bani Adam by Saadi Shirazi Highlights Perspectives Behind the Scenes Announcements Spotlight Reflections Nursing Division SARS COV-2 Pandemic and Us Clinical Case Report A New Column Global Health and the Arts Articles of the Month Videos of the Month Calendar Resources 2021 Report from the Desert: “Borderlands Infectious Disease Prevention Program” Written by Jonathan Melk MD FAAP CEO, Chiricahua Community Health Centers, Inc, Douglas, Arizona Since 1996, Chiricahua Community Health Centers, Inc. (CCHCI) has provided primary care to the diverse communities and special populations of Cochise County as the region’s only Federally Qualified Health Center (FQHC). Cochise County is an area the size of Connecticut and Rhode Island combined (including one hundred miles of the U.S./Mexico border), and both geographic isolation and prevalence of poverty makes preventive and primary health care inherently complex and challenging. All of Cochise County is designated as a Health Professional Shortage Area. CCHCI is uniquely positioned to respond to these challenges via a team of 400 highly trained employees and an extensive network of both fixed site and mobile clinics that currently cares for over 30,000 patients. As a FQHC, CCHCI provides culturally competent care and does not turn any patient away based on ability to pay or insurance status. In 2016, a case of dog tick-born Rocky Mountain Spotted Fever (RMSF) was missed by an astute Chiricahua pediatrician in our pediatric clinic (located just blocks from the US/Mexico border) in Douglas. RMSF is an unusual diagnosis for our region and was not on this pediatrician’s differential. RMSF can be fatal to children, particularly when there is a delay in diagnosis and treatment. Although this child survived and is now well, he required an extensive stay in a Tucson intensive care unit. Shortly after learning about this case, a CDC field officer traveled to Cochise County to provide education to CCHCI medical providers to better recognize and promptly treat this ‘rare’ and ‘unexpected’ diagnosis. However, ironically, a coincidental conversation between a CCHCI staff member and a Mexican doctor soon revealed just how little American and Mexican health colleagues communicate and how dangerous this shortcoming is for border communities. At the time of the RMSF case that was presented to our clinic, Agua Prieta (the sister city on the other side of the Douglas border wall) had dozens of cases of RMSF, with multiple pediatric deaths. This unfolding and deadly epidemic was entirely unknown to CCHCI, to the county health department and apparently to the CDC. Had CCHCI been alerted, it would have been less likely for this child to suffer from an illness that is otherwise curable with a common antibiotic when promptly treated. Following this revelation and close call, CCHCI proactively worked with the Mexican Consulate to set up tours and meetings between CCHCI and Mexican medical leadership and colleagues. We hosted them and they hosted us. A Whatsapp group resulted and continues in use to this day. With this minimal leadership effort, multiple patient collaborations have since developed to better manage individual patients who were deported to Mexico, who now live in the United States, or who utilize medical services on both sides of the border. However, despite our creative and practical approach, this effort is limited in its application and results, as exhibited by the disparities in the current Covid-19 illness and death on both sides of the border as compared to Arizona as a whole. It also doesn’t address the reality that no matter what laws are passed by either nation, ticks, mosquitos, vermin and other vectors don’t stop for Customs checkpoints or a border wall. Epidemiologically, border communities are one single community, and the reality is that Cochise County, Arizona and Sonora, Mexico are separated only by a metal barrier and two different political systems. To address this challenge, CCHCI wrote for and received a grant from the global nonprofit Direct Relief through funding from the Pfizer Foundation. The goal of the grant is to establish a “Borderlands Infectious Disease Prevention Program”. Over the two-year grant period, CCHCI is working to build a robust and sustainable infectious disease surveillance, prevention and treatment program guided by both external and internal data that will incorporate all of CCHCI delivery sites and staff. The program will incorporate collaboration with both Mexican and United States public health entities. This data-based program will establish consultation and oversight by CCHCI clinicians as well as regional infectious disease and public health experts from both sides of the border. Finally, CCHCI will seek to document, publish, and present our approach and outcomes for other border communities (on the US/Mexico border or elsewhere) to learn from and to replicate. 10
OUR PEOPLE, OUR MISSION Global Health eMagazine April 2022 Watch this video!! Bani Adam by Saadi Shirazi BEHIND THE SCENES Written by Marty Scholand in recognition of Sally Yelland and Dr. Stephen Scholand As we learned with Covid, there was no quick way to end its scourge. It took many months to learn how to best deal with the many proposed solutions that we were offered and determine which were truly effective. Sometimes both medicine and politics are not exact sciences. With the following comments, I would like to express my sympathy for a great loss to me and the Global Health Program and share what sometimes happens behind-thescenes. Highlights Perspectives Behind the Scenes Announcements Spotlight Reflections Nursing Division SARS COV-2 Pandemic and Us Clinical Case Report A New Column Global Health and the Arts Articles of the Month Videos of the Month Calendar Resources Most of you have never heard of a wonderful lady named Sally Yelland from Hanover, PA as she never sought notoriety. She was a simple yet complex woman who had a close circle of friends of whom I was proud to be one of. If you saw her at work or the grocery store, you would never know she was well-off. But if you ever ate a “Snyder’s of Hanover” pretzel or a “Lance Cracker,” you were connected to her. A few years ago, before Covid, my nephew Dr. Stephen Scholand of the Global Health Program asked if I would help raise money for a project he was working on in a hospital in Zimbabwe. While I was retired and a bad golfer, not a fund raiser, I attempted to raise some money through my small 100-year-old rural Country Club. How can you say no to the family doctor? I arranged for an upscale banquet and invited people I thought might donate more than I was paying for the dinner. My goal was to raise $8,000 to $10,000. I had about fifty friends agree to come knowing it was going to cost them. Dr. Scholand delivered a thirty-minute presentation which induced many of them to open their checkbooks. I was pleased that we raised almost $12,000 by the end of dinner. In my mind, it was a remarkable success. When I got home that evening, I received a call from Sally asking if it was okay for her to send me an additional check as she was inspired by Steve’s presentation and felt she wanted to do more. People often want to do more but I did not know what “more” might mean. She must have driven to the post office that night as on Monday morning I found a check in the mailbox for around $20,000 to add to my total for the Global Health Program. It brought tears to my eyes as I went into the house and showed my wife Connie who worked through the exhausting project with me. We significantly exceeded our goal. I was honored at a Global Health Program dinner for raising funds, but a scant few knew where the over-the-top success of the program came from. It was Sally Yelland. She was well-known in local circles as a supporter of hospital and historical causes. But a hospital on another continent—who knew? In February 2022, I was saddened to learn that Sally suddenly passed away in just two days. A loss to the community and to me. For that reason, I wanted to direct my sympathy to her family and express my gratitude for being able to know and collaborate with her. Dr. Stephen Scholand visited again to thank her personally. To the right is a picture from the dinner we shared with Sally and her Husband Sidney. God bless her! The world could use more people like her. 11
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