February 10, 2010
In today’s world of diversity, cultural melding and vast range of socioeconomic conditions, it is crucial for physicians to be culturally competent, understanding and appreciative of human differences. With that in mind, a group of 22 AUC students took part in a Pan American Health Organization(PAHO) vaccination coverage survey in September 2008.
AUC students, as well as several St. Martin University students, partnered with PAHO (a regional branch of the World Health Organization) and St. Maarten’s Sector Health Care Affairs (SHCA), to act as the field survey arm of the research. Under the guidance of James Dobbins, Ph.D., of PAHO, and Joseph Ichter, AUC’s director of public health research, the student volunteers were not only responsible for collecting data on children’s immunization, but also educated on the research and survey processes.
The first survey consisted of randomly sampled data from 37 geographic divisions across Dutch St. Maarten. Children between the ages of 12 and 59 months were identified by choosing a single home, and each survey team would then continue visiting contiguous homes until eight children meeting the sample criteria were found. The second survey used a blanketing methodology to identify and record immunization records of all children in the same age group, but in very limited geographic areas. The latter was meant to obtain more detailed coverage of those areas known to have a significant number of undocumented immigrants in their demographic.
AUC students were able to gather invaluable data that will help improve the island’s immunization policy.
According to Ichter, St. Maarten modified its vaccination policies after a 2002 report showed coverage of only around 60 percent of children. The revised policy, enacted after the initial report, included free vaccinations for all children in hopes of encouraging parents to continue the process in spite of economic or citizenship barriers.
“The 2008 survey was meant to show how that policy may have affected childhood immunization rates,” explained Ichter.
According to Ichter, an initial look at PAHO’s analysis showed that the cumulative number of children immunized at the correct time in the first year was exceedingly low — about 10 percent — far short of the goal of 90 percent.When looking at the 52nd week of age, however, the rate increases to 85.2 percent and, by the end of two years, that rate reaches 89.6 percent.
“This is well below the WHO’s recommended target rate of 95 percent,” Ichter said. “Obviously, the target wasn’t reached, but on the other hand, a vast improvement was made from the 2002 rates.”
The experience taught the students about the importance of public health research in informing health care policies. This is especially true in regard to children’s immunization, an issue of special interest to tourist destination communities such as St. Maarten.
The project also showcased the diversity of AUC’s student body. The group of student researchers collectively spoke five languages, namely English, Chinese, French, Portuguese and Spanish, and were able to complete the island-wide survey in only three days.
“When I realized that a language barrier could be in the way of collecting the data, I had to reassure the parents that was not a problem and switch to one of the other languages I speak,” said third-year student Briza Junqueira, who is fluent in Spanish.
“I would encourage every medical student to participate in this type of project. In the future, we will have to be as flexible and willing to accommodate the needs of our patients,” she added.
The opportunity to be part of a project that can bring improvement to the island undoubtedly enriched the lives of those who volunteered — both on a personal and professional level.
“I felt it was an eye-opening experience to venture away from the tourist attractions and into the residential areas where the local people live and witness them in their daily lives,” third-year student LindseyWhiteman noted. “[I realized] that even though it’s another country, values and familial bonds are exactly like our own.”
AUC students have also volunteered in two dengue research platforms, one focused on how patients contracting dengue accessed the health care system, while the other was a case-control study centered on risk factors of the disease during epidemics. Another research project being conducted is helping the local health care system develop a case-based evaluation tool for their new community nursing LPN program in St. Maarten.
“More projects are in the works,” said Ichter.
“Once the more encompassing research agreement is completed with the governments of St. Martin/St. Maarten, we expect to be able to expand the research through grant applications,” he said.