“Nebraska Goes Global” selected as finalists in American Medical Association Global Health Challenge, led by UNMC ID EMET Student
UNMC medical students Olivia Sonderman, Laura Newton, and Rohan Khazanchi have been selected as finalists in a national competition for future healthcare professionals interested in global health equity. Their team, “Nebraska Goes Global”, was selected as one of 10 finalists in the American Medical Association’s (AMA) 2018 Global Health Challenge for their submission advocating for evidence-based medical volunteerism and global health work that addresses social determinants of health.
The AMA Global Health Challenge is a competition for undergraduates, medical students, and residents sponsored by Timmy Global Health, a non-profit organization with community health partnerships domestically and internationally in underserved areas. Finalists were selected based on initial essay submissions; winners will be chosen based on a combination of judging and voting on the essays and videos. Contest winners will have the opportunity to work alongside Timmy Global Health in Ecuador, Guatemala, or the Dominican Republic to help provide high-quality health services to local underserved populations.
The UNMC students, led by M2 Team Leader Rohan Khazanchi (UNMC ID EMET student interested in Infectious Diseases) wanted to share a bit about themselves as they ask for your vote.
What drew each of you to competing in this global health competition, and to a broader interest in working with underserved communities? How do you foresee these interests developing throughout your career?
Olivia: During my studies at UNL, I became interested in underserved communities after volunteering at the People’s City Mission (PCM) free health clinic. While at PCM, I interacted with patients who fell through the cracks in our healthcare system, a system that I have always been able to access. Soon after, I began to recognize disparity in my hometown of Columbus, NE in patients living in rural areas who struggle to meet with urban specialists to manage their health problems. Furthermore, my major of Global Studies took me to Mumbai, India where I met patients diagnosed with epilepsy who faced a great deal of social stigma surrounding their disease.
In each setting, I was fortunate to encounter people working to help these communities: healthcare professionals and staff who volunteered their time, urban doctors making efforts to travel to rural communities, and non-profit organizations that fought to reverse social stigmas and increase access to care. I quickly realized how important and rewarding their work was and decided to pursue medicine to join in their efforts. After I complete my third year of medical school, I will take a leave of absence to pursue a one-year Masters in Health Policy at a different institution. I hope this training will prepare me to both critically examine existing health policy and create novel legislation that improves the care our global medical community can provide to its patients. This global health competition specifically interested me as a way to better understand how to effectively serve a community with a well-respected organization like Timmy Global Health.
Rohan: My interest in health disparities largely stems from the time I spent as an undergraduate in St. Louis. Following the shooting of Michael Brown in Ferguson, a neighborhood 10-15 minutes from where I lived at the time, I became acutely aware that St. Louis, like Omaha, is a city with historically ingrained divisions that create disparities in the social determinants of its citizens’ health. I was inspired by the widespread activism I saw around St. Louis and involved myself in a narrative-based music outreach program to help uplift the stories of young community members. I was also motivated to leverage my own leadership positions on campus to advocate for the mental health of students of color and LGBTQ+ students.
I spent time with a team of students and physicians working with a rural community in Honduras, through which I learned about the scope of global health disparities by hearing the stories of local patients and providers. By the end of college, I was inspired by the compassionate work of my peers and mentors and decided to apply to medical school to continue caring and advocating for underserved communities as a physician. These goals drew me to the HIV Enhanced Medical Education Track (EMET), through which I am working on a project characterizing the social, demographic, and clinical factors impacting changes in the outcomes of people living with HIV. Like Olivia and Laura, I was drawn to this competition to continue exploring these interests with Timmy Global Health, an organization that has well-established local partnerships and values high-quality, evidence-based care on a global scale.
Laura: Through volunteering at community organizations growing up, I became aware of differences in wealth, educational opportunities, and neighborhood resources between Omaha communities. During a college course in Ecuador which focused on social and political transformations, I gained a broader understanding of the global pervasiveness of inequalities, especially in health. In Minnesota where I attended college, I volunteered at a community health clinic teaching an exercise and nutrition class for Hispanic and Somali women struggling with obesity and diabetes. The hard work, persistence, and camaraderie of these women left me inspired and grateful for their friendship and the privilege to take part in their path to better health, and I felt drawn to a vocation in health care.
In medical school, I travelled twice with a group of UNMC students and faculty to Falmouth, Jamaica to provide medical care to that community and the surrounding villages. I was again struck by the injustice of inequities in health and access to medical care both between countries and within communities. I participate in UNMC’s Enhanced Medical Education Track for Underserved Health Care, which immerses students in community partnerships and prepares us to be leaders in advocacy for the unique health care needs of these populations, both inside and outside clinic walls. This global health competition appealed to me as an opportunity to explore with my fellow students the challenges of global health and witness firsthand how an organization such as Timmy Global Health provides high quality service to underserved populations.
Click this link to watch their video, read more about their mission to combat health disparities throughout their careers, and vote for their team DAILY until July 30th!
Content and photos provided courtesy Olivia Sonderman, Laura Newton, and Rohan Khazanchi
Independence Day is the 
Hot Dogs/Deli meat: Staphylococcus aureus – causes nausea, vomiting, diarrhea, cramps within 30 minutes-6 hours
Burgers: Escherichia coli – causes diarrhea, stomach cramps, vomiting within 3-4 days
Step 1 – Clean: Wash your hands, utensils and food handling surfaces often
Step 4 – Chill: Refrigerate your food promptly, and at most within 2 hours (within 1 hour if outside temperature is above 90°F). After cooking, put the food back in the cool refrigerator and make sure it can keep temperatures below 40°F. Food left at room temperature for long periods invites bacteria to multiply rapidly, increasing likelihood of foodborne illnesses.
Most importantly, WASH YOUR HANDS before and after handling raw meat, before handling non-meat items, and before you sit down to enjoy the fruit of your grilling prowess. (Or at least use hand sanitizer!)
In 2006, the Centers for Disease Control and Prevention (CDC) recommended universal HIV screening, which was endorsed by the United States Preventive Services Taskforce (USPSTF) in 2013. Despite these recommendations, 1 in 7 persons living with HIV (PLWH) in the United States are unaware of their diagnosis. When stratified by age, young people between the ages of 13-24 account for 
Our Specialty Care Clinic works closely with the Douglas County STD Clinic and NAP. We treat PLWH diagnosed with HIV at these locations and provide pre-exposure prophylaxis (PrEP) for patients who are at risk. Our nurse and case manager Precious Davis BSN, MSN has been very involved with reaching out to our community to spread the message of HIV testing. At an event in the Spring, Precious shared some of these statistics and information on treatment and stigma of HIV care in a poem (pictured here). At that event, 25 people were tested for HIV.
The 
Then it got worse. Around 1 week later, the cough started. The body aches. The headaches. The sore throat. The “influenza-like illness,” or ILI, arrived with no apologies. I thought the virus had done its worst; then, as I made my morning coffee, Wacky Wednesday started. I could not smell it. It seemed strange, but I thought it was just congestion. I took a sip. Hot liquid, tasteless. I rummaged through my kitchen–smelling and tasting noxious things, testing my senses. Garlic? Nothing. Chili Lime seasoning? Nothing. Pepper, salt, ginger? All nothing.
For most infections, think the common cold or upper respiratory infections, it seems that the post-infection loss of smell is generally temporary due to the phenomenal plasticity of the olfactory system. In fact, after URI’s, 32-66% of patients will recover their sense of smell spontaneously. For those struggling, training your sniffer can carry significant advantages toward recovering with intentionally smelling various types of odors a few times per day to “retrain” the olfactory system. It’s physical therapy for the nose!
After almost a year of planning, the First Annual Nebraska Antimicrobial Stewardship Summit convened on Friday, June 1st, 2018 in La Vista, NE. This conference is the first of its kind in Nebraska in which information on antimicrobial stewardship in various healthcare settings is the focus of the meeting. The conference center was abuzz with excitement as close to 270 healthcare professionals attended the Summit that included over 130 nurses, 80 pharmacists, and 30 providers. While the majority of the attendees were from Nebraska, healthcare professionals from neighboring states such as Iowa, Kansas, Missouri and South Dakota also attended the Summit.
The morning session continued with presentations from Dr. Diekema (Professor, University of Iowa Carver College of Medicine, pictured to the left) on the Role of the Laboratory in Antimicrobial Stewardship; Drs. Vivekanandan (Associate Professor of Medicine, Creighton University) and Horne (Assistant Professor of Medicine, Creighton University) on “Is Antibiotic Stewardship the Answer to C. difficile”; and Kate Tyner, RN, CIC (Nurse Coordinator, Nebraska ASAP and ICAP) on the “Role of the Infection Preventionist in Antimicrobial Stewardship”. The morning session concluded with a presentation from Drs. Tierney and Pedati (Medical Epidemiologist, Nebraska DHHS) on “Public Health Support for Antimicrobial Stewardship” in which they discussed the state MDRO outbreak detection and management protocols as well as the state antimicrobial susceptibility registry and antibiogram.
During lunch, Summit attendees had the opportunity for roundtable discussions with 
Education in antimicrobial stewardship continues in the afternoon with breakout sessions in the Acute and Ambulatory Track and the Post-Acute and Long-Term Care Track at the Summit. Dr. Bergman (Pharmacy Coordinator, Antimicrobial Stewardship Program, Nebraska Medicine, pictured to the left) started the acute and ambulatory session with his presentation on “Regulatory Requirements for Hospitals and Outpatient Antimicrobial Stewardship”. This was followed by presentations from Dr. Van Schooneveld (Medical Director, Antimicrobial Stewardship Program, Nebraska Medicine) on “Antimicrobial Stewardship Interventions in Acute Care Hospitals”; Dr. Kuper (Senior Clinical Manager, Infectious Diseases, Vizient) on “Antibiotic Stewardship Metrics: How Do You Measure Up?”; and Drs. Marcelin (Associate Medical Director, Antimicrobial Stewardship Program, Nebraska Medicine) and Green Hines (Medical Director, Antimicrobial Stewardship Program, Children’s Hospital & Medical Center) on “Antimicrobial Stewardship in the Outpatient Setting (#OutptASP)”. The session was well attended and appreciated by Summit attendees.
Equally well attended is the post-acute and long-term care session that was opened with a presentation from Dr. Crnich (Chief of Medicine and Hospital Epidemiologist, Williams S. Middleton VA Hospital, pictured to the left) on “Regulatory Requirements for Post-Acute and Long-Term Care Antimicrobial Stewardship Programs”. This afternoon session continued with Dr. Ashraf (Co-Medical Director, Nebraska ASAP and Medical Director, Nebraska ICAP) speaking on “Antimicrobial Stewardship Implementation in Post-Acute and Long-Term Care Facilities”; Dr. Crnich on “Management of Common Infections in Long-Term Care Facilities”. The session concluded with a presentation from Tammi Schaffart, RN (Infection Control Nurse and QAPI Coordinator, Douglas County Health Center) and Dr. Ortmeier (Consultant Pharmacist Team Lead, Community Pharmacy Services) on the “Role of Nurses and Consultant Pharmacists in Antibiotic Stewardship in Post-Acute and Long-Term Care Facilities”.
Track shared their thoughts. Dr. Crnich said it takes a team to establish a stewardship program while Dr. Ashraf (pictured to the left) echoed a similar sentiment that no one is alone in this journey. Tammi emphasized to the many nurses in the audience the importance of documentation to show their efforts for the numerous clinical activities they performed in nursing facilities, including antimicrobial stewardship. Dr. Ortmeier stressed the importance of persistence and the need to continue to ‘keep at it’ for eventual success.
We genuinely appreciate the support Summit attendees expressed. It is our hope that this type of Summit will continue annually in the future and that new topics and updated contents in antimicrobial stewardship will be presented. Additionally, we hope to make many more connections with healthcare professionals in Nebraska and neighboring states to improve the care and safety of our patients and residents by improving prescribing of this precious resource, antimicrobials, through antimicrobial stewardship.
PADDLE Trial4: A pilot, non-blinded, non-randomized, non-parallel, 48 week trial in Argentina. This trial enrolled 20 patients that were naïve to ART, viral loads ranging from 5,000 to 100,000 copies/mL and CD4+ greater 200cells/mm3. The participants in this trial were primarily assessed to see the rate of success at achieving HIV levels of 50 copies/mL or less at 48 weeks. At 48 weeks, 18/20 (90%) patients reached the viral levels desired, including 4 patients with viral loads greater than 100,000 (albeit to protocol). Additionally, safety and efficacy of this dual therapy was analyzed in this trial. Only one protocol failure developed; however, participants achieved levels less than 50 copies/mL from Week 4-24 and developed no resistance to any of the agents.
GEMINI I1 and GEMINI II2: Two, nearly identical large phase III, randomized, double-blinded, multinational, multicenter, parallel studies that enrolled 719 and 722 ART naïve participants. The primary purposes of these studies were to assess the percentage of subjects with viral loads between 1,000-100,000 copies/mL and CD4>200/mm3 who achieved viral suppression (HIV VL<50 copies/mL) at Week 48. Preliminary results for these trials are expected to be released in the summer of 2018 and study completion is scheduled for March 2020.
Content provided by Freddy Orellana, UNMC PharmD Candidate ’18, and Joshua Havens PharmD
Dr. M. Salman Ashraf, MBBS is an Associate Professor of Medicine and Medical Director of the Nebraska Infection Control Assessment and Promotion Program (ICAP). He also Co-Directs the Nebraska Antimicrobial Stewardship Assessment and Promotion (ASAP) Program with Dr. Trevor Van Schooneveld, and is Associate Medical Director Infection Control and Epidemiology at Nebraska Medicine. Dr. Ashraf’s clinical and research interests in antimicrobial stewardship and infection control in long-term care facilities (LCTF) have led to countless national speaker invitations and significant research funding granted to study antimicrobial stewardship and infection control in LCTF.
Dr. Bradley Britigan, MD is the Dean of the University of Nebraska Medical Center College of Medicine, and Department of Internal Medicine Stokes-Shackleford Professor. Despite his busy administrative duties, Dr. Britigan still finds time to practice clinically at the VA hospital, attends on our General ID teaching service, and contributes to our Division research meetings. His research interests include the pathogenesis of Pseudomonas spp. and Mycobacteria spp. Lung Infections, and Microbial Iron Metabolism as a target for Novel Antimicrobial Therapies.
is a Professor in the Department of Pathology and Microbiology, Medical Director of the Clinical Microbiology Laboratory and Research Vice Chair of the Department of Pathology and Microbiology. Our Division collaborates closely with Dr. Fey and the microbiology lab on implementation and improvement of diagnostic testing to improve clinical care. His research interests include the Metabolism and Pathogenesis of staphylococcal infections. Just recently, Dr. Fey was honored with the 2017-2018 Outstanding Graduate Student Educator award in the department of Pathology & Microbiology at UNMC.
is an Infectious Diseases-Trained Pharmacist with primary focus in the Specialty Care Clinic (SCC) which serves persons living with HIV (PLWH) in our Omaha and neighboring communities. He is leads the management team for the Ryan Wite AIDS Drug Assistance Program (ADAP) for the state of Nebraska. In his clinical role at the SCC, Dr. Havens not only facilitates discussions with clinicians and PLWH about complex medication issues, but runs a clinic for HIV pre-exposure prophylaxis (PrEP). This has fueled his primary research focus on the prevention of HIV as well as developing novel adherence strategies to keep PLWH healthy. He collaborates in these projects with Drs. Sara Bares and Susan Swindells.
, MD is a Professor of Internal Medicine, and Director of the Transplant Infectious Diseases practice group at UNMC ID. He also holds board certification in Critical Care Medicine and has a special interest in infections occurring in the intensive care unit. Dr. Kalil is nationally and internationally recognized for his work in the field of severe sepsis, hospital acquired and ventilator acquired pneumonia, and was the first author and writing group leader of the recent IDSA/American Thoracic Society Guidelines on Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia. Dr. Kalil has acquired numerous grants with funding to study cytomegalovirus and other infections associated with solid organ transplantation.
, MPH is an Associate Professor of Medicine and Fellow in the Infectious Diseases Society of America (FIDSA). He is the Director of International Programs and Innovation, at the Global Center for Health Security and has led several teams to countries in West Africa focusing on Public Health Emergency Preparedness. Dr. Lawler, a former White House Homeland Security Council biodefense policy director, has national expertise on Biosecurity and viral hemorrhagic fevers, and is the current Director of Clinical and Biodefense Research at the National Strategic Research Institute.
Dr. Uriel Sandkovsky, MD is an Associate Professor of Medicine and Medical Director of Employee Health at UNMC. He attends on the Transplant Infectious Diseases service. His research interests include cardiac device infections and viral infections in transplantation.
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