Reports from Suriname, East Timor and Vietnam

Students return with insights on traditional healing in the Amazon, the effects of war in East Timor and a needle exchange program in Vietnam.

Second-year medical student Christopher Herndon spent last summer in Suriname’s Amazon jungle working on a project that seeks to improve the health care of indigenous people while preserving the skills of their traditional healers. Shamans, Herndon said, possess a wealth of information about medicinal plants and herbs in the Amazon. Yet the Westernization of their cultures has led to a loss of that knowledge. “Many of these shamans are over 70 years old,” Herndon said during a presentation in October. “Most don’t have apprentices to whom they can transmit this knowledge that has been accumulated for generations.”

Medical Mission Suriname, which delivers primary care to remote regions of the country, has begun a pilot program in which shamans practice alongside primary care physicians. Shamans and physicians refer patients to each other and participate in joint workshops to learn about their respective healing systems. “This is an unprecedented opportunity to create a model for the integration of traditional medicine into primary care delivery in indigenous communities throughout tropical America,” Herndon said.

He was one of three students to make presentations at the Fall Symposium, Poster Session and Reception sponsored by the Committee on International Health. The annual event, held on Oct. 18 last year, highlights the work of students in medicine, public health, nursing and the Physician Associate Program who have conducted research abroad. Joining Herndon in making presentations in the Hope Building were Bahar Firoz, a second-year medical student who studied the effects of war and human rights violations on mental health in East Timor, and Laura Phan, a public health student who studied a needle exchange program in Vietnam.

The three were among 18 students who traveled abroad last summer on Downs International Health Student Travel Fellowships, which honor Wilbur G. Downs, M.D., M.P.H., a Yale faculty member and expert in tropical diseases who encouraged students to learn by doing. “In all of you who traveled abroad to do research, he would have found a kindred spirit,” said Curtis L. Patton, Ph.D., professor of epidemiology (microbiology) and director of the Downs program.

Firoz surveyed the mental health of patients in the Bairo-pite Clinic in Dili, the capital of East Timor. After Indonesia invaded and occupied the country in 1975, the East Timorese population lived under martial law in a land where assassinations, kidnapping, rape and torture were commonplace. Violence increased in late 1999 after East Timor, in internationally monitored elections, voted for independence.

Firoz recounted the story of a 27-year-old woman who fled to the mountains during an attack by militias opposed to independence. After three weeks in hiding, the woman returned to her village to find her home and possessions burned. “This is very common in the lives of most people I spoke with,” Firoz said. Of the more than 100 patients she interviewed, 95 percent had experienced similar trauma and lost family members in the violence. A preliminary data analysis found depression in about 40 percent and symptoms of post-traumatic stress disorder in about 7 percent of those she interviewed. “The timing of this was very important,” Firoz said of her study, which was done on-site within months of the trauma. “Most studies on mental health are done a couple of years after the event.”

Phan, who was born in the United States to Vietnamese parents, traveled to Ho Chi Minh City, home to almost a third of Vietnam’s 100,000 injecting drug users. The Hope Café is one of two sites in the city offering clean syringes to drug users, who are most at risk for infection in the country’s growing aids epidemic. “It is the first big step at embracing harm reduction,” Phan said of the cafe.

Most of the 195 drug users who responded to Phan’s survey reported that heroin was their preferred drug and that they did not share needles. Despite high levels of syringe hygiene, they reported low levels of sexual-risk reduction. Prevention efforts, Phan said, should be expanded to all 11 districts in the city, and their scope should include prevention of sexual transmission of HIV.

—John Curtis

Chase scenes

Anyone who has met the relentlessly upbeat deputy dean for education, Herbert S. Chase Jr., M.D., knows that he’s nothing like the grumpy schemer depicted in 2001: A Chase Odyssey, the Class of 2003’s second-year show. As most faculty members will attest, being lampooned in the show is a rite of passage, a sign of acceptance. For Chase, who took up his duties in July, this show was his initiation.

The plots of most recent shows revolve around an errant faculty member engaged in shenanigans for the perceived betterment of the medical school. This show was no exception. It has Chase arriving at Yale after two decades at Columbia only to be horrified by what he finds—boring lectures, low attendance at classes and widespread apathy among students, all things which surely never happen here. His scheme to subvert the hallowed Yale System by suborning students to fail exams goes awry when a copy of the plan finds its way into The Kit, the orientation guide for first-years. With the help of Yale’s own Charlie’s Angels, Chase succeeds in confiscating all but one of the kits. The plot then detours through the medical school as it follows the remaining kit, poking fun along the way at targets such as Britney Spears, medical students, Top Gun, the med school dining hall, Japanese cooking shows and, of course, the Yale System.

In the end Chase comes to realize the virtues of the Yale System and all is forgiven. Erik Weiss, the medical student who portrayed Chase, was joined onstage by three deans who bought their way into the show at the annual auction to benefit the homeless and hungry. Associate Dean Ruth Katz, J.D., M.P.H., and Associate Dean for Student Affairs Nancy R. Angoff, M.P.H. ’81, M.D. ’90, HS ’93, appeared onstage as a ladybug and bumblebee. Dean David A. Kessler, M.D., hopped onstage in a bunny suit, with his microphone disguised as a carrot. “At this year’s auction, I bid some money,” sang Kessler, to the tune of Louis Armstrong’s Wonderful World. “That’s why I’m here, dressed as a bunny. And I think to myself, what a wonderful school.”

—John Curtis