THE GLOBAL ISSUE | April 2 15, 2012

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Mount Sinai
A Commitment to Global Health
The world is more densely populated, urbanized, and interconnected than ever before. In understaffed city hospitals and rural clinics throughout Africa, Asia, and Latin America, health care workers are encountering increasing rates of obesity, diabetes, lung cancer, and heart disease in their patient populations. These conditions once affected mostly people in industrialized countries. Now they are more prevalent in developing nations that are also battling infectious diseases such as AIDS, malaria, pneumonia, and tuberculosis. Mount Sinai Global Health, which unifies The Mount Sinai Medical Centers many international missions and programsas well as efforts in underserved U.S. communitiesis addressing these challenges through research, training, and clinical practice. With Mount Sinais innovative thinking and intellectual rigor, we are maximizing human and technological resources, and giving equal weight to the demands of the present and the predicted needs of the future. Philip J. Landrigan, MD, MSc
These women were among millions of people who gathered recently in Sirsa, India, for a one-week celebration and meditation camp. Mount Sinai physicians performed thousands of cardiovascular screenings at the event (see story below). Dr. Landrigan is Dean for Global Health, Ethel H. Wise Professor and Chairman, Department of Preventive Medicine, Professor of Pediatrics, Director, Childrens Environmental Health Center, Mount Sinai School of Medicine.

Providing Medical Care to the Masses

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Bringing Safe, Sustainable Health Care to Women in Guatemala In Colombia, Children Learn about Heart Health Improving Quality of Life on the Spirit Lake Tribe Reservation Building a Strong Health Care System in Haiti Mount Sinais Global Reach

Promoting cardiovascular health throughout the world is a priority for physicians at Mount Sinai Heart, led by Valentin Fuster, MD, PhD, Physicianin-Chief of The Mount Sinai Medical Center. They see the expanding spectrum of cardiovascular diseases increasingly affect low-and-middleincome countries. How do we reach the millions of people in remote areas of the world who are as likely to be affected by cardiovascular disease as those in high-income countries? Jagat Narula, MD, PhD, Associate Dean for Global Health, and Editor-in-Chief of Global Heart, the journal of the World Heart Federation, asks rhetorically. How do we reach the masses? For one day in January, Dr. Narula, the Philip J. and Harriet L. Goodhart Professor of Medicine (Cardiology), and Director of the Cardiovascular Imaging Program at Mount Sinai Heart, was able to do so. Through a program he co-founded, known as HAPPY (Heart Attack Prevention Program for You), Dr. Narula reached out to thousands of individuals who had converged in Sirsa, a remote area of India, for a one-week meditation
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Mount Sinais Partho P. Sengupta, MBBS, MD, DM, screens a patient in Sirsa, India.

Bringing Safe, Sustainable Health Care to Women in Guatemala

Tourism is robust in the Lake Atitln region in the Guatemala Highlands, an area known for its winding mountains, and beautiful volcanic lake. But in the outlying villages, far from the busy hotels, residents live without running water and electricity. Here, the maternal death rate is the highest in Central America. Mount Sinais Global Health Program is making strides toward sustainable womens health care here and in other indigenous societies throughout Central America. Taraneh Shirazian, MD, Director of Global Health, Department of Obstetrics, Gynecology and Reproductive Science at Mount Sinai School of Medicine, has spearheaded initiatives that provide onsite clinical care, and teach best practices in pre- and post-delivery protocol to local health care workers. Prior to being deployed to communities throughout Guatemala, El Salvador, and Honduras, Mount Sinai residents are trained to understand the local cultures. They are taught how to address global health issues such as womens rights, and access to family planning, along with cultural beliefs surrounding delivery and pregnancy. We focus on understanding, educating, and empowering women in the context of their local perspective, says Dr. Shirazian. Approximately one Mount Sinai resident goes on each of the six or so annual missions to the Lake Atitln region, which are conducted

Mount Sinai residents provided Guatemalan birth attendants with birth kits that contain necessities such as soap, gloves, clean sheets, and pictorial instructions for delivery.

in cooperation with a nongovernmental organization (NGO) called Saving Mothers. Local birth attendants have no formal training; theyre unequipped for lifethreatening complications such as postpartum hemorrhage and eclampsia, a convulsive condition that often follows pregnancy-induced hypertension. The Mount Sinai teams train birth attendants in critical practices such as clean and safe delivery, shoulder dystocia, and appropriate and timely referral in cases of emergency. The local hospital staff also receives training in appropriate administration of medications through a best-practices protocol manual. When Mount Sinais teams noticed the absence of even the most basic resources

for a clean, safe delivery, they began distributing birth kits with soap, gloves, clean sheets, blankets, and baby hats, along with simple, pictorial instructions for delivery. In May, they will begin distributing hemorrhage kits to the Guatemalan birth attendants to stem post-partum hemorrhage, the leading cause of maternal death. Mount Sinai prepares its physicians for responsible global citizenship, says Dr. Shirazian. They become better physicians when they can educate women from diverse backgrounds. Only through culturally sensitive collaboration can we hope to make any sustainable impact on global womens health.

Providing Medical Care to the Masses

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computing to their homelands on behalf of the American Society of Echocardiography. Using new handheld ultrasound devices, Mount Sinai investigators and their team performed scans on 1,030 patients over two days, also earning a Guinness World Records certificate. Joining Dr. Sengupta onsite was a second cardiologist and nine sonographers from the United States, including Mount Sinais Ingrid Altamar, and local cardiologists and health care workers. We saw really sick patients who had severe valve disease and undiagnosed congenital defects, says Dr. Sengupta. Five people were sent directly to the hospital. Ultimately, we connected 1,030 hearts with 75 experts from around the world, he adds. Dr. Narula says global initiatives like the one in Sirsa, help Mount Sinai by providing investigators with an opportunity to analyze and understand the disease process using modern technology.

camp. The Reverend Gurmeet Ram Rahim Singh Ji Insan, a spiritual leader whom they had come to hear, relayed a message from Dr. Narula on the importance of eating well, exercising, and not smoking. Over a 24-hour period, Dr. Narula led a health care team that screened 4,684 patients for blood pressure, glucose, and cholesterol, and performed carotid ultrasounds for more than 650 at-risk patients. The record-breaking feat was recognized by editors at Guinness World Records. The event also included an initiative led by Partho P. Sengupta, MBBS, MD, DM, Associate Professor of Medicine (Cardiology), and Director of Ultrasound Research at Mount Sinai Heart. Dr. Sengupta mobilized 75 cardiologists and sonographers from medical institutions around the world, including the United States, Australia, and Bulgaria, who volunteered to read echocardiograms that were sent via cloud

At the celebration in Sirsa, India, men lined up to receive echocardiograms.

In Colombia, Children Learn About Heart Health

Mount Sinai Heart researchers, in collaboration with Sesame Workshop, have shown that children ages four through six are eager to learn the importance of exercising and maintaining a healthy diet. With proper intervention, and support from parents and teachers, they can develop healthy habits that last a lifetime. These key findings were reported recently in a three-year study of thousands of preschool children in Bogot, Colombia that was led by Valentin Fuster, MD, PhD, Physician-in-Chief of The Mount Sinai Medical Center and Director of Mount Sinai Heart. across cultures. They say prevention programs like this will save lives and enormous amounts of money that governments now spend to treat CVD. We have to promote health and stop talking about disease, says Dr. Fuster, who is also Director of the Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Jose and Henry R. Kravis Center for Cardiovascular Health at The Mount Sinai Medical Center. Young children learn what you teach them. And children impact the behavior of their parents.

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We have to promote health and stop talking about disease. Young children learn what you teach them. And children impact the behavior of their parents.
VALENTIN FUSTER, MD, PHD

Dr. Fuster and his team have been examining ways to prevent the spread of cardiovascular disease (CVD) in both developed and developing countries as lifestyles become more sedentary, and high-fat, high-carbohydrate diets become the norm. In Bogot, CVD has become the leading cause of death, according to an assessment of seven Latin American cities that appeared in The American Journal of Medicine. The Mount Sinai team says their encouraging results in Bogot, using popular characters from Sesame Workshop, can be replicated
Pre-schoolers in Colombia perform for their peers, singing and dancing about the importance of exercising and maintaining a healthy diet.

Improving Quality of Life on the Spirit Lake Tribe Reservation

The Spirit Lake Tribe Indian Reservation covers about 405 square miles in the EastCentral part of North Dakota, an area in the remote Northern Plains bounded by lakes and flat terrain that gives way to rolling hills. This branch of the Dakotah tribe, with approximately 6,600 members, has lived on the reservation since the tumultuous days of 1867, when Native Americans fought to preserve their way of life. Today, Mount Sinai School of Medicine under the leadership of Jonathan Ripp, MD, MPH, Assistant Professor, Division of General Internal Medicine, Department of Medicine, and Associate Director, Global Health Training Centeris working with the Spirit Lake Tribe to improve their quality of life. Almost 60 percent of the community is unemployed, and about 50 percent live at or below the poverty level. Rates of obesity, diabetes, and alcoholism among Native Americans, in general, far exceeds that of the rest of the U.S. population, and members of the Spirit Lake Tribe are no exception. For three years, Mount Sinai has partnered with the tribes Cankdeska Cikana Community College (CCCC) to help educate and promote healthy behaviors among tribe members, and to encourage tribal youth to pursue careers in health care. Mount Sinais students helped the community conduct an elder health needs assessment in 2010. The data collected was used to help fulfill grant requirements for funding to support services for the tribes elderly population. For the past three years, CCCC has offered a health care course that is taught by Mount Sinais medical and public health students, residents, and faculty. In June 2012, approximately six of Mount Sinais medical and public health students, residents, and faculty will visit the reservation for a fourth summer to teach the course at CCCC, and help run a day camp for middleschool children that exposes them to different health professions, and encourages healthy habits. The camps activities include visits from Emergency Medical Service workers and nurses, and assistance in producing videos of public health announcements. The people of Spirit Lake honored and welcomed us into their lives with unexpected openness, says Dr. Ripp. Each experience we sharedthe elder interviews, traditional ceremonies, and family ceremoniesgave us a new appreciation of their complex community.
PHOTOS, FROM LEFT TO RIGHT: Cankdeska Cikana Community College students march at the Spirit Lake Tribes annual celebration, which culminates with a traditional pow wow.

Building a Strong Health Care System in Haiti

Haitis catastrophic earthquake in 2010 quickly drew physicians, nurses and other health care workers from The Mount Sinai Medical Center and around the world. As expected, National Hospital, Haitis Ernest Benjamin, MD, demonstrates large hospital in the capital critical care procedures for Haitian of Port-au-Prince, was in a medical students. shambles. What the outside world did not realize, however, was how inadequate and fractured Haitis health care system had been long before the earthquake hit. The earthquake was a catalyst that opened peoples eyes to how bad things were, and what we could do to make it better, says Ernest Benjamin, MD, Professor of Surgery and Anesthesiology, Chief, Division of Surgical Critical Care Medicine, and Director of the Surgical Intensive Care Unit at The Mount Sinai Medical Center. Dr. Benjamin, arrived at National Hospital three days after the earthquake, and led Mount Sinais medical relief efforts there. Now, Dr. Benjamin is galvanizing Mount Sinais physicians, residents, and medical students, and members of other U.S. medical centers to help establish a strong health care infrastructure in Haiti. Their multiple efforts include the following initiatives: Twice a year, Dr. Benjamin and Adel M. Bassily-Marcus, MD, Assistant Professor of Surgery, at The Mount Sinai Medical Center, travel to Haiti to teach fifth-year Haitian medical students an intensive, four-day course in critical care medicine. Dr. Benjamin and Franois Lacour-Gayet, MD, Chief of the Division of Pediatric Cardiothoracic Surgery at Montefiore Medical Center in New York, are planning four missions to Haiti in 2012, in which they will perform heart surgery on a total of 60 children. Ultimately, Dr. Benjamin would like to help create a Heart Institute of Haiti to treat adults and children, and develop an advanced cardiac care program that includes cardiac surgery. A group of third-year medical students at Mount Sinai are conducting research on the prevalence of neurological problems in Haiti, under the supervision of Isabelle M. Germano, MD, Professor of Neurosurgery, Neurology, and Oncological Sciences.

In Colombia, Children Learn About Heart Health (continued from page 3)

The study in Bogot, started with 1,000 children in 2009, and has grown to more than 25,000. Research supervisors spend 40 hours over a five-month period with the children, using specially designed Sesame Workshop characters that promote healthy habits in books, posters, videos, games, and songs. Their teachers attend training sessions, and their parents participate in workshops, and receive weekly notes containing positive health messages about nutrition and active lifestyles to share with their children. The changes in knowledge, attitudes, and habits were measured using a standardized tool. Children in the intervened group exercised regularly and maintained their weight over six months. The children provide the impetus for families to change their lifestyles, says Michael E. Farkouh, MD, MSc, Associate Clinical Professor of Medicine (Cardiology), and a co-author of the study. We are promoting good health and we can do this across countries, says Dr. Farkouh. Our program opens up a whole new area for cardiovascular public health. A larger effort in Spain that is modeled after the program in Bogot currently involves 100,000 children. In Spain, Dr. Fuster plans to add a second level of educational intervention for when the children turn seven. The project also examines whether the control of emotions can help prevent drug addiction after the age of 10.

Mount Sinais Global Reach

A SNAPSHOT OF INITIATIVES AROUND THE WORLD:
Argentina Bangladesh Belize Brazil Cameroon Chile China Colombia Costa Rica Dominican Republic Ethiopia Grenada Guatemala Haiti Honduras India Iran Ireland Italy Kenya Liberia Malawi Mexico Mongolia Mozambique Paraguay Peru Rwanda St. Vincent and the Grenadines South Africa Spain Tanzania Thailand Uganda United States Uruguay Vietnam

Inside Mount Sinai

2012 Marketing & Communications Carrie Gottlieb, Editor Marilyn Balamaci, Editor

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