This summer, a group of medical students saw firsthand the struggle to strike a balance between appropriate pain management and overprescribing when they spent a month rotating through various hospitals and clinics in Quito, Ecuador.
Although the United States is currently experiencing an opioid epidemic, fueled by overprescription, such pain relievers are under-utilized throughout much of the world.
“While we were in Ecuador, we noticed that opioids and other pain management modalities seemed to be really underused,” said Grace Haser, who completed the trip with her fellow second-year medical students Paul Micevych, Jessica Marone, Jesse Shechter and Michael Musharbash. “As such, we wanted to use a case report as a way to highlight the need to find a middle ground between the overuse in the U.S. and underuse in Ecuador.”
The students presented their research — a case study on the pain management of a 60-year-old male with an incarcerated urinary catheter in the emergency department of a Quito public hospital — during a poster session at Feinberg’s Global Health Day on Monday, October 23.
Global Health Day, an annual event, was co-sponsored by the Center for Global Health, the Student Committee for Global Health and the Global Health Initiative, supported by Northwestern Medicine Primary and Specialty Care.
In the Ecuador case report, the patient received only ibuprofen and a topical anesthetic, and experienced intense pain as physicians attempted to remove the catheter. The students compared the treatment with standards of care in the U.S., and suggested key barriers interfered with appropriate pain management in Ecuador — including legal limitations on opioid use, lack of access to anesthesiologists and other financial resources, and various cultural forces.
“Here, we are taught to be so cautious about opioid use in the ED, so it was an interesting experience to see the other end of the spectrum,” Shechter said. “This was a really striking example of a patient who wasn’t given the opioids he needed.”
Other research showcased at the poster session ranged from approaches to male acceptance of family planning in Kenya, to understanding the health effects of urbanization in an indigenous Maya population in Guatemala.
Carly Loveland and Karly Raber, both second-year medical students who spent a month in India learning about the healthcare system, presented a case study that highlighted the challenges of access to healthcare in rural areas of the country.
“This trip inspired me to continue doing global health work,” said Raber, who was funded through the Center for Global Health. “It really laid the foundation for helping to understand different cultures and realize that there are so many things underlying what it takes to provide good, long-lasting care in other countries.”
Global Health Day also included a keynote address on public health approaches to preventing the adverse health effects of global climate change, delivered by Peter Orris, MD, MPH, adjunct professor of Preventive Medicine at Feinberg and chief of Occupational and Environmental Medicine at the University of Illinois Hospital and Health Sciences System.
“There are a number of things we can do in our institutions that will have a global impact, all while we’re doing our primary mission of taking care of people in our communities,” Orris said.
He encouraged healthcare providers to play a key role in tackling climate change. “When nurses and doctors in the 1960s stopped smoking themselves, it had a tremendous impact on the smoking rate in the population as a whole,” Orris said. “We have an important position in society as opinion setters on big issues related to health.”
After the keynote, Robert Murphy, MD, ’81 ’84 GME, the John Philip Phair Professor of Infectious Diseases and director of the Center for Global Health, presented three students with awards for their poster presentations.
Chris Feng and David Shapiro, both fourth-year medical students, won honorable mentions for their research in Guatemala and Nigeria, respectively.
Smitha Sarma, also a fourth-year medical student, was awarded first place for her research into the availability and affordability of tobacco cessation medications in Kerala, India. The project was one she completed during her Fogarty Fellowship, which supports one year of research to study diseases in developing countries.
Tobacco is the leading cause of preventable death and India is the second largest consumer of tobacco in the world, Sarma noted. But her research demonstrated that tobacco cessation medications are still vastly underutilized in India.
“Our estimate was that just about .3 percent of patients who are eligible are actually using pharmacotherapy during their quit attempts,” explained Sarma, whose mentor is Mark Huffman, MD, MPH, ’09 GME, associate professor of Preventive Medicine in the Division of Epidemiology and of Medicine in the Division of Cardiology. “What we hope to do is advocate for nicotine replacement therapy to be incorporated into the essential medicines list, which will hopefully increase prescribing of these medicines and help more people quit.”
During the event, Murphy also announced Kate Klein, MA, MPH as the new deputy director of the Center for Global Health.