Abstract. Recent interest in global health among medical students has grown drastically, and many students now spend time abroad conducting short-term research projects in low-resource settings. These short-term stints in developing countries present important ethical challenges to US-based students and their medical schools as well as the institutions that host such students abroad. This paper outlines some of these ethical issues and puts forth recommendations for ethically mindful short-term student research.

The global rise in non-communicable disease (NCD) suggests that US-based refugees are increasingly affected by chronic conditions. However, health services have focused on the detection of infectious disease, with relatively limited data on chronic NCDs. Using data from a retrospective medical record review of a refugee health program in the urban Northeast (n = 180), we examined the prevalence of chronic NCDs and NCD risk factors among adult refugees who had recently arrived in the US, with attention to region of origin and family composition. Family composition was included because low-income adults without dependent children are at high risk of becoming uninsured. We found that half of the adult refugees in this sample had at least one chronic NCD (51.1%), and 9.5% had three or more NCDs. Behavioral health diagnoses were most common (15.0%), followed by hypertension (13.3%). Half of adults were overweight or obese (54.6%). Chronic NCDs were somewhat more common among adults from Iraq, but this difference was not significant (56.8 vs. 44.6%). Chronic NCDs were common among adults with and without dependent children (61.4 vs. 44.6%, respectively), and these two groups did not significantly differ in their likelihood of having a chronic NCD after adjustment for age and gender (AOR = 0.78, 95% CI = 0.39, 1.55). This study suggests that chronic NCDs are common among adult refugees in the US, including refugees at high risk for uninsurance. We propose that refugee health services accommodate screening and treatment for chronic NCDs and NCD risk factors, and that insurance outreach and enrollment programs target recently arrived refugees.

This student-run free clinic provided preventive services at comparable rates to national levels, but short of goals specified in Healthy People 2020.

BackgroundTetraethyl lead was phased out of gasoline in Uganda in 2005. Recent mitigation of an important source of lead exposure suggests examination and re-evaluation of the prevalence of childhood lead poisoning in this country. Ongoing concerns persist about exposure from the Kiteezi landfill in Kampala, the country’s capital.ObjectivesWe determined blood lead distributions among Kampala schoolchildren and identified risk factors for elevated blood lead levels (EBLLs; ≥ 10 μg/dL).Analytical approachUsing a stratified, cross-sectional design, we obtained blood samples, questionnaire data, and soil and dust samples from the homes and schools of 163 4- to 8-year-old children representing communities with different risks of exposure.ResultsThe mean blood lead level (BLL) was 7.15 μg/dL; 20.5% of the children were found to have EBLL. Multivariable analysis found participants whose families owned fewer household items, ate canned food, or used the community water supply as their primary water source to have higher BLLs and likelihood of EBLLs. Distance < 0.5 mi from the landfill was the factor most strongly associated with increments in BLL (5.51 μg/dL, p < 0.0001) and likelihood of EBLL (OR = 4.71, p = 0.0093). Dust/soil lead was not significantly predictive of BLL/EBLL.ConclusionsLead poisoning remains highly prevalent among school-age children in Kampala. Confirmatory studies are needed, but further efforts are indicated to limit lead exposure from the landfill, whether through water contamination or through another mechanism. Although African nations are to be lauded for the removal of lead from gasoline, this study serves as a reminder that other sources of exposure to this potent neurotoxicant merit ongoing attention.

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is working to design and implement an updated version of its curriculum. As part of this new curriculum, the university would like to establish a policy for student engagement in the community. The dean, Dr. Grant, suggests that students need to be active in serving the larger community in which they live and study during their medical training. He emphasizes that this would be an excellent learning experience for the students, inasmuch as he views the urban community where the university is located as a different world from that which the majority of the medical students have previously experienced. Several other faculty members agree with Dr. Grant's opinion.Ramona, the medical student representative to the committee, agrees that that many of her classmates entered medical school wanting to make a difference and improve the lives of others. She suggests to the committee that both local and international experiences could enhance the new curriculum and students' education. She is intrigued by the opportunity to visit a foreign country for an elective. She suggests to the committee that prospective students look for global health experiences when choosing a medical school. She stresses that she believes that experiences in developing nations provide unique educational opportunities that students cannot get in their local surroundings.Several of the faculty members express concern over the idea of the university's devoting resources to international electives. They suggest implementing a policy which would not permit students to go on international rotations for academic credit, preferring that they work to address the local need that surrounds them. Commentary 1 by Cynthia Haq, MD, and Heather Lukolyo, MHSSuffering, loss, and death are part of the human condition, but physicians today have more knowledge and capacity to address suffering than ever before in history. Accelerated travel and instant access to information make the world feel smaller. Images and stories of the billions of people living in poverty in low-resource settings reveal stark evidence of health and economic disparities. While human suffering has always been present, today we are constantly reminded of the gaps between what we know and what we do. Physicians and health professionals are called to respond to the needs of millions at home and abroad who lack access to basic health care.

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