Welcome to Well Beyond Medicine, the world's top-ranked children's health podcast, produced by Nemours Children's Health. Subscribe on any platform at NemoursWellBeyond.org or find us on YouTube. Each week, we'll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar, and now that you're here, let's go. Let's go, oh, oh, well beyond medicine. We are in Orlando, Florida. We are at the Ginsburg Symposium. And with me today is the executive director of the Ginsburg Institute, Nancy Malello. We also have Treasure Ray, who's with us. She's a Ginsburg scholar. She's been through the scholar program and coordinator now at Uplifted, which is part of the heart of Florida United Way. And also Ariba Ali. She is a community health division worker working on K-Readiness here at Nemours Children's Health. We're talking about a new program, and it takes people away from Orlando, away from the U.S., all the way to Uganda. So I want to start with you, Nancy. Talk about what inspired what you're calling the Global Health Experience Program and your goals in launching a partnership with McCary University and Johns Hopkins University to do all of this. Hi, Carol. Nice to be here again. So our Ginsburg Scholars Program is a program that we designed two years ago for young folks who are taking a gap year before going off to medical school or school of public health. And during that year, we hire them here at Nemours, and we give them opportunities to work with pediatricians in a clinical setting, doing research, and then working in the community with our community partners. And as part of that experience, it's always been my desire to have them have a global experience to really understand what is public health, what is public health globally, and to really have them have an experience of thinking about what other cultures are like and how they can bring that back as they become budding physicians or folks that want to be in the world of public health. Connect this back to me, if you will, to Nemours' mission, and that is whole child health. It is making certain that people like Treasure, like Ariba, are well-rounded in their goals to become physicians, and we'll talk a little bit about that later. How does it connect to Nemours' focus on pediatric and adolescent health? Well, as we know, only 85% of a child's health happens outside of the walls. Only 15% of a child's health happens inside of the walls of Nemours. And so if you don't understand all of the factors that help children be healthy and thrive in the community, you can't serve them as well. You will be a better and more empowered physician. Both of these young ladies will be physicians one day. It will help them in their career as they look at how they treat their patients, how they understand those social factors that drive health. And if you talk to any physician that we work with who have had the experience of traveling globally, it expands their mind around the idea of that we are a global community. And the experiences that children face in Uganda, in Liberia, in South America are the same experiences and same struggles that the kids in our own backyard have. It has us understand that we are a global community and we have a shared humanity and that that shared humanity, you can only experience seeing it on the ground, not reading it in a book, not looking at a movie, not reading an article. And so this opportunity was really for them to serve them for their careers as physicians. Well, I'm going to turn to Treasure and Ariba. I want to talk about what your interest, A, in the Ginsburg Scholars Program was and what your first impressions were when Nancy proposed the idea, you're invited to go to Uganda, you're going to learn about public health there. Ariba, I'm going to go to you first. Applying for the scholars program, it really aligned with what I wanted to learn about and continue being a lifelong learner when it comes to aspiring physician and someone who was in the pre-health field. When you go through like all these experiences of shadowing and clinical experience, you don't really get the public health aspect of it. So I really believe that the scholars program did a great job at showing me that and providing me that knowledge in the public health world. when Nancy brought up the the trip to Uganda we were completely shocked or I was completely shocked because it was not in the scholar's description at all so we were most of the things we do are not in the scholar's description and it's developing the scholar program is developing in and of itself yes go ahead Ariba I was in shock I literally said I can't believe this is happening so many times ever since she told us and yeah just really grateful for the opportunity and the Ginsburg program for allowing us to be part of it. And Treasure is nodding her head. So I want to hear your reaction to hearing that you were going to go to Uganda and what it was like when you first got there. I remember distinctly, this was during our Christmas dinner. They love to feed us. So it's always great to have dinner with them. But they brought us out to dinner and Nancy was like, okay, guys, like she always kind of like will tell us things in a way we're like, what's coming next. And she was like, so what do you guys think about going to Uganda? And I remember initially when I heard it, I was a little scared at first because I had never been to a developing country before. I never really traveled a lot. I had been on like a couple of cruises with my family, but other than that, like I hadn't had that experience. And so I was like, okay, this is going to be a lot for me to have to adjust to. And I remember thinking like, can I really do this? Is it something I'm going to get the most out of? But knowing that Nancy had already had that experience being there. It made me feel a lot better. And then I remember we had to learn about the process of getting there and how long the flight was going to be and having to get like a yellow fever vaccine And I was like oh my goodness this is like too much But then I had to remind myself like why I going there and what I going to be able to get out of it And that made the difference especially it took us about a full day So like 24 hours to get there And I mainly slept on the flight So it was fine. But then initially arriving there, I remember I was definitely shocked at first. I was like, OK. What shocked you? Just more so the environment and the people. I will say the people were actually very friendly. I was not expecting that. I thought they were going to be a little bit maybe standoffish towards foreigners, but they were very nice. But I would say mainly just like things just operate very different there. It doesn't look like the U.S., but I think mainly just that aspect of it. I had to get adjusted to that certain things in terms of like resources there just is a very different environment that I had to adjust to. I would say for the most part, I really did enjoy my experience there. But it was just certain things that I knew that I was like maybe uncomfortable about and then had to like adjust and like really just be in the moment. What made you uncomfortable, if I might ask? Yeah, no, of course. Sometimes when we were there, there would like always be people around. And then also like there would be a lot of animals around. Monkeys specifically. Yes, I was going to get into that. On the street. Yeah. So I love animals. Like we went on a safari and I love that. But one thing that I do not like are monkeys. And the monkeys are very scary. I remember. I didn't see that. They're coming right up to you. Yes. One of the monkeys tried to take things from us. And there was a time when they were out on the balcony and they completely shocked us. And they were running towards us, almost ran into our room. So there are certain things like you are not protected from the wildlife there. They are immersed in your everyday experience as well. Well, let's focus in a little bit in Treasure and then I'll come to Ariba. On the health care system, what surprised you about the health care system? You were there a month, I believe. And was it different? How different was it? It's very different there. I would say one of the most shocking things that I saw there was when we went to the malnutrition unit. That was a really transformative time for me because I had never really seen something like that. So babies from all across Uganda are coming there. So in Kampala, it's like the national referral unit, the most malnourished, like most sick babies are coming to get treatment there. And not only it's the babies, it's their mothers as well. So I would say the biggest thing that shocked me was just the actual structure of the systems. When we think of like hospitals here, there's like all this equipment and so many things, but they don't have a lot of resources there for that. When we walk into this room, you know, we're in this hospital, but it honestly, I could compare it to almost a shelter in like the most respectful way. There is a room with like 50 beds, 25 beds on each side, babies laying on the beds. And it's just very heartbreaking to see because I had never been exposed to anything like that. And then especially to seeing the mothers and thinking how much time and energy it took for them to get there. That was probably one of the most shocking things about the healthcare system there was just the way that it's structured and how different it is from the U.S. Arriba, continue on. What surprised you? I mean, that seems shocking to me, but what else do you feel was really different and maybe shocking to you with the healthcare system? Yeah, similar to what Treasure mentioned, just the resources that they had are nothing compared to what we have in the US. When we were shadowing Dr. Sabrina Kitaka, who is a pediatrician there. We're gonna talk to her next episode. Yeah. And she took us to her infectious disease ward. And we walk into a room full of tetanus patients. And there were three in this really small crowded room, bed sheets hung up on the wall because you really need peace and quiet and minimal sunlight when it comes to tetanus patients. But even then, they were still being disrupted just because of how small the area was and how many people were in the room. Just thinking about those things and how they have to work with what they have, and they still manage to provide care to their patients in those settings. And tetanus is not something you normally see here in the U.S. It's not really all that common, is it? Key challenges. You were in these units for a month, various places. You also went on a safari, but mostly in the health care work that you did. What were some of the key challenges you saw? Yeah, I think a big thing for us, and we kind of talked about it throughout the trip as well, is that when everything moves so fast in the U.S., you need something from someone, quick teams message, quick teams meeting. But over there, things take a little longer. An email can take a couple of business days. And sometimes you would have to show up at their office to get things done. And we were really trying to make the most that we can of the time that we were there, try to work on as many projects as we could. So that would be a key challenge for me when I was over there, but we learned how to adapt and kind of understand everyone's schedule and what everyone prefers so we can be more efficient in the work that we were doing. Treasure, same question. What were some of the challenges you observed? Sounds like communication was a big barrier. What else did you see? I think in terms of the challenges for Uganda and like in Kampala is access to technology. Like Ariba was mentioning, it would be difficult to contact them because they're not really used to having to use technology as their primary source of communication. And especially I noticed that when we were working with the students, I would say other than like the technology, it was probably, like she said, like having to wait and having to be like not in control over different situations because you had to really go with the flow, especially with certain times we would arrive and like have to wait on things and we would just have to make use of our time there. And I think it really made us feel so much more impactful in the work that we were doing because it's like, OK, we don't have this set schedule. We have to get this done. But whatever we're able to do, whatever we're able to accomplish, we felt that much more happy about how we were impacting the people there. You were there for a month and you made some impact in various areas. I know you did some research. What was it like, Treasurer, talking with or working alongside with Ugandan physicians, researchers and other students that you might have met along the way? Yes the people are wonderful Like we mentioned Dr Sabrina Kataka was amazing Dr Esther I really loved working with the physicians there I will say one thing that I did take away from them was just how thorough they are and how patient they are Compared to the U.S., we move so fast and physicians do everything that they can to best serve their patients. But oftentimes I've shadowed physicians here. They're always on the move. I mean, you don't get a lot of time to see your physician typically when you're going to the hospital. and I remember we were shadowing in the adolescent clinic and Dr. Sabrina, I remember she spent, I don't even think less than 30 minutes with each patient that she was talking to. And it was, you could tell she was not trying to rush through it. She was working with her students very thoroughly. Anytime something would come up, she would ask a question, dig into it. And there are so many things that I think she was able to find that maybe in the U.S. if that same patient were to have been here, they might have missed. And that is one thing that all of the physicians are amazing at doing there. Some things we can learn here in the U.S. from that kind of work and that kind of time taken with patients. Ariba, same question in terms of working alongside the researchers in particular. I know there were specific projects that were worked on by the scholars who went over. What do you think you learned working alongside the folks over in Uganda? I definitely feel like we learned a lot about the patient population as well and just like how culture plays a role in the healthcare system. For example, they're not really big on talking about sexual education. So you kind of see that, especially when we were in the adolescent clinic, that who knows, maybe they weren't honest about some of the things that they answered, or they felt that they couldn't talk about these things with their parents. And those are some things that you kind of have to respect and not question why, because culture plays a big role in that. But it was very different compared to here in the U.S. where we're trying to be more open about it. And when it comes to family planning as well, they're really big on having a big family. I think Dr. Sabrina mentioned that the average is like six kids per family. So it doesn't matter what health conditions are running in the family. They will continue to have kids because family means a lot to them. Nancy, as you hear Ariba and Treasure glow about this trip to Uganda and what they learned, how have you seen them grow as people and as future physicians? It makes me cry, actually. You put so much into planning something and to developing a partnership with a hospital and a research unit in a foreign country. And to come back and just sit across from them and really see how my desire was to give them the opportunity to grow and the opportunity to bring that into whatever career they end up having. And if they end up, which I'm sure they'll both be physicians, is someday 20 years from now, they will for sure think of this experience and for sure think of the opportunity that they had to actually travel there and to actually see how, can I be a better physician? can I rush less for Treasure to say, we're on super speed. And 10 years from now, she's a physician in a clinic that says to the clinic staff, we're not going to rush through our patients. I'm going to be the physician that spends more time and that it's tied back to the experience that she had in Africa. Or for Ariba to say, you know what, the culture of someone impacts how they show up in my office as a physician. And I need to know that. I saw that firsthand. And it's just such an honor and a privilege to know that I've had a small piece into ensuring that they are going to be the kinds of physicians that you and I, Carol, want to see. Absolutely. You and I want to be the patient who sits across from them one day. I'm going to challenge you. I don't think it's a small piece. I think it's a big piece. Not at all. And I'm going to go to Ariba and Treasure to talk about this. Would you consider this, I don't want to put words in your mouth, but would you consider this a life-changing experience professionally and personally? talk about that. A hundred percent. Everyone, while we were there, the Muju team have always said, once you come to Uganda, you're not the same person when you go back, because it truly is a transformative experience. And I've always been interested in a global health experience. But of course, you know, finances and logistics, like they're always a big concern. But the fact that Nancy put in the effort to want this for us truly means so much and that there are people out there who really want us to be the best physicians that we can be. So thank you. I'm seeing treasure, not her head. Yes, I can say so much. I can go on and on and on. Personally, this trip challenged me so much. Like I mentioned, I was initially scared and I didn't know what to expect and then getting there. And I was that person who would often like complain about little things. I would be like frustrated because I couldn't control certain situations. And I really had to let all of that go. And so it changed me as a person. I remember the first half of the trip, the entire group was there. The second half of the trip, it was just us scholars. And we were in a different living situation than the first half. They stayed in a, where all the medical students stay in Uganda. So they actually had the opportunity to be in what they call the guest house, right next door to other medical students who are from Uganda. Oh my goodness. And I did that intentionally. Okay. The first half of the first two weeks, we stayed in a hotel, very nice hotel, very similar to the US, but I wanted them to have a true experience of what it's like in a developing country. Initially, when we moved in, I was like, oh my goodness, what have I gotten myself into? I remember the first couple of days, I did not have hot water. Turns out I didn't have hot water the entire trip. but I had to use a kettle and a bucket. And I was like, so upset about it at first. I was like, this is like so awful. I have to do this. And then I think back and I'm like, I'm complaining about this. And then I learned that most of the people are over 60% of the population lives off of less than a dollar a day. Like, how do I have the energy to complain about this? And I know that I get to go back home to my comfortable place. And so that really challenged me personally on so many levels but also like I said professionally working with the physicians there I know there are certain things that they may have done that I didn agree with or that I did want to take back to the U And so I really just had to remember to stay in the moment and try to be, not like put my own lens and my own thoughts onto what the physicians and what the patients were doing as well. In some ways, it was a humbling experience. Very humbling. As you move into your professional future, what is your professional future, Treasure? Sure. You want to be an MD, don't you? Yes, I do. That would be my dream. And as you move into that, what kind of leadership skills did you learn here? And what kind of lessons are you going to take forward? Yes, I think it's really important. I didn't understand the importance of it to continue to do global health work. It was something that was in the back of my mind. But when we started to go here and see all the things that they were facing there, I know that eventually I want to get into global health work. And it's my duty as a physician to not only impact my community, but other communities that don't have access to those resources. We met some medical students there from across the country, and we met some other great people. And I think the world of global health work is just an amazing thing that I want to be involved in. And so I'm so thankful for this experience. And then I just want to continue to be a compassionate physician. I think it's a long journey to get there, and I'm just in the beginning. And I can understand now why sometimes physicians are the way that they are. They have so many things that's on their plate, but I have this moment now to look back on to remind me of what I saw and what type of physician I want to be. Yeah. Ariba, how did all of this influence your leadership skills moving forward as you move into being a physician? You're applying to medical school right now. So it definitely taught me a lot of teamwork, communication and just being adaptable. There were a lot of instances in Uganda where we just had to adapt to the teams that we were working in and the projects that we were working on. That played a key role in the leadership skills that I hope to carry on, as well as just taking the global health lens and applying it to the future patients that I hope to serve. Because they will be coming from these diverse backgrounds and thinking about this trip to Uganda and applying it in those settings. and now it has opened my eyes to hopefully continue global health work as well when I become a physician and just because our duty, like Treasurer mentioned, is not only to serve our communities, but to serve communities all over the world as well. It really is a global public health world, if you will, which is kind of redundant, but the world is pretty small. It's well-connected. Nancy, I'm going to have you finish up here. This This has been obviously a wonderful experience for these young ladies, these budding physicians. Is this a program you're looking to continue? And how are you going to move it forward with the next group of scholars, the next cohort, which I think is number three? So now we're on number four. Oh, okay. Yes, absolutely. We will continue this. I think we will perhaps bring some medical students next time that we travel. So we have a scholars program, a Ginsburg scholars program for medical students at UCF. So we'll incorporate some of the medical students as well. And in talking about the trip, there are a number of physicians who said, I'd like to go too. Is there a way that I can do this trip? And so I've already been in conversations with the folks at Muju or Malago Hospital about could we bring physicians? Could they, what kind of credentialing do they need to actually practice? and how would we make that happen so that when they land they could do surgeries, they could see patients. So I see a lot of opportunity and promise. And as you can see, the pride that I have in these two young ladies, it's the same pride you have in children, that your child, is that to see them grow, to see them change as people, to see them really expand who they are in this short one month, it has been an honor for me. And, you know, oftentimes in our careers, we don't always have an opportunity to do what we love. And I am passionate about making sure that this program continues and that we make sure I'm committed to making sure that we help the next generation of physicians be the best that they can. Nancy Malello is the executive director of the Ginsburg Institute at Nemours Children's Health, which offers eye-opening opportunities both here and abroad for young health care and public health professionals through its Ginsburg Scholars Program. We also heard from two Ginsburg scholars, Treasure Ray, she's at the heart of Florida United Way in Orlando, and Ariba Ali. She's working in K-readiness with the Nemours Community Health Division. Both scholars are currently applying to medical school. Giving future physicians a worldwide lens on health care and public health. That's what Nemours, and specifically the Ginsburg Scholars Program, aims to do. Yet what is the scholars' impact on the ground? That's coming up in part two of this series when we talk with their mentors, Dr. Lana Gordon with Nemours Children's Health and Dr. Sabrina Kataka from the McCary University College of Health Sciences. She joined us from her home base in Kampala, Uganda. Don't miss it. Thanks to Nancy, Treasure, and Ariba for such a great conversation. And thank you for listening. Don't forget, you can make sure you never miss an episode of the Nemours Well Beyond Medicine podcast by heading to our website, nemourswellbeyond.org, and subscribing to it. Stay in the know by subscribing to our monthly e-newsletter while you're there. You can also leave a podcast episode idea and a review. That's nemourswellbeyond.org. You can also find us on your favorite podcast app, your handy-dandy smart speaker, and on the Nemours YouTube channel. Our production team for this episode includes Lauren Tata, Cheryl Munn, Susan Masucci, and Alex Wall. Video production by Sebastian Riella and Britt Moore. Audio production by Steve Savino and yours truly. I'm Carol Vassar reminding you that we can change children's health for good. Well beyond medicine. Thank you.
