What's New at GWUMC

Due to inclement weather, classes are CANCELED Tuesday, February 9.

Administrative offices are CLOSED Tuesday, February, 9.

The Campus Advisories web site can be accessed from the GW Homepage, www.gwu.edu or directly at http://campusadvisories.gwu.edu.

For Medical Center Status, please call 202-994-3501 or visit www.gwumc.edu.

For information regarding GW's Virginia Campus, in Loudoun County, call 703-726-8333 for updates.

Carry your GWorld Card with you at all times for identification and access to streets and buildings.
 

The GW Frontiers in Medicine lecture, The Empowered Patient: The Truth behind Drugs, Herbs, and Vitamins, scheduled for February 10, 2010 at the Jack Morton Auditorium has been canceled due to inclement weather. 

GW DOCTORS RETURN TO D.C. FOLLOWING 15-DAY DEPLOYMENT TO HAITI WITH FAIRFAX COUNTY URBAN SEARCH AND RESCUE

By Anna Miller (mcmamm@gwumc.edu)

“Haiti is the poorest country in the Western Hemisphere.” This factoid, cited among prime-time reporters and casual conversers alike, may be true or false.  But, at a panel discussion hosted at The George Washington University (GW) Elliott School of International Affairs, Jan. 25, one thing became clear: the liberal use of this phrase only exacerbates the country’s already plentiful problems.

“Having uttered [this phrase], one need not examine the causes and context of poverty in Haiti,” said panelist Dr. Drexel Woodson, associate professor of Applied Research in Anthropology at the University of Arizona. “One can also easily—but falsely—assume that poverty somehow explains corruption, illness, incompetence, ignorance, miseducation, violence and much else.”

The four other panelists—whose expertise varied and whose relationships to Haiti ranged widely—agreed.   The recent earthquake, they asserted, has engendered a denigrating caricature of the Haitian population, which, in reality, is “compassionate, resilient and genius,” according to panelist Kyrah Malika Daniels, junior curator, National Museum of American History. And, in order to respond appropriately to the current crisis, a careful evaluation of the nation’s history and culture is vital.

“The Damage was Done:" Haiti’s Turbulent History

Since achieving independence in 1804, Haiti has been paying for its freedom—literally. Indebted to foreign nations for loans and reliant on others for humanitarian aid, the nation has yet to enjoy real independence. “When you start in the red, how do you gain voice?” asked Ms. Daniels, whose mother is Haitian. “How was Haiti supposed to begin a life, begin a history, without a voice and with very little material property?”

Panelist Dr. Robert Maguire, Randolph Jennings Senior Fellow, United States Institute for Peace, agreed that “the damage was done in Haiti much before the quake.” Dr. Maguire, who has traveled to Haiti an estimated 150 times, pointed to “misinformed and erroneous development policies and programs” that ignored the rural existence of Haitians, forcing the population to unnaturally concentrate to Port-au-Prince. This migration, said Dr. Maguire, worsened Haiti’s poverty, widened its distribution of wealth and enhanced its dysfunction. 

“Haitians use [the French word for insecurity] to describe the cycles of political violence, crime and economic deterioration that have plagued the nation as it attempts to consolidate its democracy,” said panelist Dr. Erica James, associate professor of Anthropology, Massachusetts Institute of Technology. Dr. James, who critiqued interventions of Haiti’s past, warned against a repetition of the responses that gave rise to the nation’s insecurity.

Picking up the Pieces: Haiti’s Short-term Recovery

The fact that Haiti needs help after the Jan. 12 earthquake is unquestionable; how to help, however, is often miscalculated. According to the panelists, altruistic instincts must be monitored: “Rushing to the site of emergency is a very destructive and irrational thing to do; people who do that end up becoming secondary victims. Instead, we want to capitalize on people’s good intentions and use them effectively,” said Dr. Julia Frank, associate clinical professor of Psychiatry at the GW Medical Center.

Dr. Woodson concurred: “Haitians need temporary shelter, medicine, medical supplies, treatment for psychological and physical trauma, food, water and clothing. What they don’t need is U.S. Americans flocking to Haiti to help—if those U.S. Americans do not have specific skills.”

In addition, noted Ms. Daniels, Haitians would benefit greatly from a hastened method by which doctors and supplies can travel to the suffering areas. “A really strong infrastructure needs to be put in place in terms of arrivals, treatment, recovery, rescue and sustenance,” she reported. “Doctors are stranded at airports because there is no way to get to the cities where they are needed the most.”

“A Marathon, Not a Sprint:” Haiti’s Long-term Recovery

All panelists maintained that a focus on Haiti’s long-term recovery is essential. Because psychological needs can only be met after basic physical needs are addressed, Dr. Frank was particularly supportive of this perspective. “This is a marathon, not a sprint,” she said. “Now, we need to focus on our Haitian community here. The need for our services in Haiti will be later—long after the cameras have left.”

Dr. Frank, who supported an approach to psychological treatment that neither pathologizes nor normalizes the victims, endorsed “culturally aligned” mental health care that considers the social context of the affected persons. As echoed by Ms. Daniels and Dr. Woodson, a thorough understanding of and respect for Haitians’ values, and particularly their spirituality, is critical for successful treatment.

Finally, the panelists urged responders to view the crises in Haiti as an opportunity. Through thoughtful responses that consider the nation’s history and culture, Haiti can—and will—come out on top. “We have, in a sense, a silver lining coming out of a deep, dark cloud,” concluded Dr. Maguire. “We have a historic opportunity to rebalance Haiti, and, if that is neglected, we are going to pay the price.”  

About the Panel

This panel, entitled, “Risk, Suffering and Response: The Haiti Earthquake Crisis of 2010,” was moderated by Associate Dean of Faculty Affairs Barbara Miller of The George Washington University’s Elliott School of International Affairs. The event was co-sponsored by the Culture in Global Affairs Program, the International Development Studies Program in the Elliott School of International Affairs and the Department of Global Health in the School of Public Health and Health Services.

By Anna Miller (mcmamm@gwumc.edu)

His first day on the job, Dr. Joshua Sharfstein, principal deputy commissioner of the U.S. Food and Drug Administration (FDA), was challenged with a food safety crisis involving contaminated pistachios. Swiftly telling the public to halt their pistachio consumption until further investigation, his reaction set the stage for the FDA’s renewed commitment to public health principals such as prevention, communication and risk-benefit analysis.

“As a public health agency, it is important to communicate about risks very clearly,” said Dr. Sharfstein, who characterized the FDA as a public health agency at The George Washington University’s Public Health Grand Rounds, Jan 12. “Although it is very difficult to talk to people about uncertainty — about things that might be a problem, but probably won’t be — you can’t let the fear of misinterpretation keep you from saying something important,” he said.  

Using smoking as an example, Dr. Sharfstein illustrated how the FDA is approaching problems from a public health perspective. Through its newly established authority to regulate the amount of nicotine in cigarettes, the FDA has taken steps to prevent smoking initiation, improve smoking cessation and reduce tobacco-related deaths. “We would really like public health to be the principal of this program,” he said. “Even in the law, the standard for decision-making comes down to what is good for the public health.”

Dr. Sharfstein also detailed the FDA’s values: “As a public health agency, it is important to have integrity and transparency,” he said. “Integrity reflects respecting the science at the agency and transparency is opening up the agency so that people can understand what we are doing.”  To improve transparency, for example, the FDA has created “FDA Basics,” a segment on its Web site that outlines what the agency does and how it works.

Dr. Sharfstein also commended the FDA’s “Safe Use” initiative for its collaborative and preventative nature. This program, launched in late 2009, is a collaborative endeavor between the FDA and medical professionals that combats manageable adverse drug events by identifying and minimizing risks associated with medications.

Looking towards 2010, Dr. Sharfstein hopes for greater investments in regulation that will lead to an improved and hastened approval process. “We have put in a lot of money into the basic science in the United States,” he said. “But the regulatory science investment is very minimal, so we wind up with all of these ideas circulating out there that just can’t get through all the way to products.”

In the future, Dr. Sharfstein also anticipates that the FDA will pursue innovative ways to conduct studies and will strengthen its own expertise. Finally, he assured, the agency will continue to build preventative, rather than reactive, initiatives. “Right now, if there is an outbreak, we run out and deal with it,” he said in light of the pending food safety legislation. “Instead, we should be doing basic things like setting and enforcing preventive standards so that there isn’t an outbreak in the first place.”

Dr. Sharfstein’s lecture was delivered just days before he announced the reversal of the FDA’s position on the safety of Bisphenol A (BPA), a potentially harmful chemical found commonly in plastics. While the FDA continues to investigate whether BPA should be banned from consumer products, Dr. Sharfstein’s announcement reinforced the agency’s increasingly visible commitment to protecting public health.

About Public Health Grand Rounds

Now in its fourth year, The George Washington University’s Public Health Grand Rounds focuses on innovative leadership strategies crucial for successfully addressing present and evolving public health challenges. The monthly series features prominent public health practitioners, and is open to the Medical Center, the University and all those within the public health and health care communities.

GW Experts Available to Speak on Haiti Earthquake

EMERGENCY MANAGEMENT AND NATIONAL RESPONSE

On December 5, 2009, a 16-member team of surgeons, anesthesiologists and nurses from The George Washington University Medical Center traveled to rural Guatemala to provide surgical services to the area’s impoverished and underserved population. The project, led by Joseph Giordano, M.D., chair of the Department of Surgery, was coordinated by Partner for Surgery (PFS), a non-profit, humanitarian organization based in McLean, VA.

The mission took place in Centro de Salud Barbara, a small rural clinic just outside of San Juan de Sacatapequez in southwest Guatemala. The clinic, which provides ongoing outpatient services and has two newly constructed operating rooms, was developed and is supported by a foundation of the Facultad de Medicina, Universidad Franscisco Marroquin.

Prior to the arrival of Dr. Giordano and his team, local physicians triaged their patients for surgical diseases, under the direction of PFS. After further evaluation by the GW team, 56 operations were performed on 48 patients, with many patients requiring multiple procedures. The surgeons, who provided their own supplies, sutures, bandages, anesthetics and medications, were pleased to work in two well-constructed operating rooms with good basic equipment.

 The team treated both adults and children for a myriad of conditions, including breast cancer, benign breast tumors, large soft tissue tumors and many large and unusual abdominal wall hernias — a common problem amongst the local population. Some of the more rare conditions treated included a large abdominal abscess and a case of pediatric scrofula. Fortunately, all surgeries were completed with no complications.

The local community expressed great appreciation for the work of the GW team, thanking them with many hugs and “gracias.” Likewise, the team found the opportunity tremendously rewarding; so much so that each member has already “re-upped,” or requested to return on the next mission. Some have even begun a fundraising campaign for a subsequent trip. All in all, the trip was “¡Trabajo bien hecho!” or, a job well done.