Open access learning in tropical

medicine?

Rob Davidson

When did you last photocopy a journal article?

When did you sit in a medical library to read a paper journal?

When did you last buy a textbook?

How do you study now?

1900

2015

Are tropical schools still relevant?

James Lind 1771

James Johnson 1818

Joseph Chamberlain Cecil Rhodes Patrick Manson

1899

e.g.

Polio

Guinea worm

Filariasis

Onchocerciasis

Schistosomiasis

Even malaria!

Classical tropical diseases are on the wane

Leprosy, Brazil 1988-2012

Human African Trypanosomiasis 1997-2012

A different sort of medical expertise is needed

GHHM Overview

MSF UK collaborating with academics and experts

AIM: Global access to high quality teaching materials

In order to improve patient and programmatic care in low and middle income countries

Why MSF?

• Many existing courses that focus on tropical

medicine and global health:

- Are based in Western locations

- Have high-cost tuition fees

- Require a full-time commitment of at least

three months to complete

- Are outdated and not in touch with field

realities

DTM&H Exam

• Royal college of Physicians has ‘pre-approved’ the course for the next two years – as a trial

• The course will be piloted to a group of trainee doctors

• Weekly face-to-face seminars that will support their learning for the DTM&H examination

• They will sit the exam in April 2016 or 2017

Seminar structure

18:00 – 18:20 Self assessment quiz

18:20 – 19:00 Talk 1 (Field talk)

19:00 – 19:45 Talk 2 (Lecture)

19:45 – 20:00 Group discussion

Overview of Course Content

Core content is loosely based on the requirements for the

DTMH exam:

PUBLIC HEALTH

WATER AND SANITATION

BACTERIAL INFECTIONS

HIV

MALARIA

STIs

NCDs

VIRAL INFECTIONS

TB

CLINICAL PARISITOLOGY

TROPICAL DERMATOLOGY

LEPROSY

SURGERY

DIARRHOEA

MATERNAL AND CHILD HEALTH

TROPICAL

OPTHAMOLOGYTRAVEL

MEDICINE

PAEDIATRICS

TRAVEL MEDICINE

NUTRITION

PUBLIC HEALTH

OUTBREAKS

SURGERY

TECHNOLOGY and HUMANITARIAN MEDICINE

FIELD TALKS

Lectures for non-medical key players in Humanitarian Medicine? Project Co-ordination in Emergency SettingsPolicy and advocacy Mental Health

Also topics from an MSF Field Perspective

• Course materials are currently aimed at clinicians

• The structure is loosely based on the Oxford Handbook of Tropical Medicine, and the syllabus for the DTM&H exam in the UK

PUBLIC HEALTH

What is Global Public

Health?Primary Health Care and

Global Health

Global burden of disease

The Global Fund for AIDS,

TB and Malaria

Global disease

surveillanceElimination of Neglected

Tropical Diseases

Many online resources already exist

Many online resources already exist

Many online resources already exist

Many online resources already exist

But the internet is mainly cluttered with junk

and it is hard to sift through it...

We intend our course to be free of charge to study, but it will

require registration

- not “open access” like YouTube etc.

Many online resources already exist

-Could the Royal College of Physicians run DTM&H exams

simultaneously and cheaply in other countries?

- can the South African DTM&H course join with our course?

-can South African DTM&H exam be run in other countries?

For the future:

end

Here are some examples from the course - test yourselves!

(a) What is this?

(b) When would you make one?

Trench latrine

Refugee camp – early phase

(a) What is being done?

(b) What does it show?

mid upper arm circumference (MUAC)

severe malnutrition

(a) What is this?

(b) What disease does it transmit

female Anopheles mosquito

malaria

Fresh graves in a refugee camp

(a) How do you calculate the Crude Mortality rate?

(b) What does a CMR of >2 mean?

Fresh graves in a refugee camp

(a) How do you calculate the Crude Mortality rate?

Deaths per 10,000 persons per day

(b) What does a CMR of >2 mean? Out of control

This 1 week old child has purulent discharge from both eyes

(a) What is the diagnosis?

(b) How would you prevent this?

Source: CDC

This 1 week old child has purulent discharge from both eyes

(a) What is the diagnosis? Gonococcal ophthalmia

neonatorum

(b) How do you prevent this? Povidone iodine 1 drop in each

eye at delivery, repeat x1 at 1 day of age; treat mum before

delivery

Source: CDC

Thin blood film in a patient from with fever.

(a) What is the diagnosis?

(b) What is the treatment?

Q6

Thin blood film in a patient from with fever.

(a) What is the diagnosis?

Severe P falciparum malaria with >50% parasitaemia

(b) What is the treatment?

ITU; IV artesunate; consider exchange transfusion

A6

A wet preparation of stool from a Nepalese patient with 2 months of non-bloody diarrhoea

(a) What is this organism?

(b) What has the specimen been stained with?

10 M

A wet preparation of stool from a Nepalese patient with 2 months of non-bloody diarrhoea

(a) What is this organism? Cyst of Giardia intestinalis (G lamblia)

(b) What has the specimen been stained with? Iodine

10 M

A woman has been sexually assaulted by armed men 24 hrs

ago. Which of these interventions are appropriate?

Post exposure HIV prophylaxis; treatment with ceftriaxone and

doxycycline; Hepatitis B vaccine; Tetanus vaccine; emergency

contraception; examine and treat physical injuries;

psychological support; help with police

A woman has been sexually assaulted by armed men 24 hrs

ago. Which of these interventions are appropriate?

Post exposure HIV prophylaxis; treatment with ceftriaxone and

doxycycline; Hepatitis B vaccine; Tetanus vaccine; emergency

contraception; examine and treat physical injuries;

psychological support; help with police - offer all of these