A. R. Oddo1, A. Bales1, R. Siska1, D. J. Dennis1, E. VanderWal2, H. VanderWal2, R. Markert1, M. McCarthy1 1Wright State University Boonshoft School Of Medicine,Department Of Surgery,Dayton, OHIO, USA 2The Luke Commission,Sidvokodvo, MANZINI, Swaziland
Introduction: Educational objectives for medical student international electives are an important part of any travel program. Objectives such as learning research methodology or engaging in research projects focus students during their travels and are a valuable way to reinforce curriculum goals. Our project focuses on the use of an international database by medical students to produce clinically significant findings impacting international health policy. Our study examines the adverse event rate in voluntary medical male circumcision, a procedure demonstrated to reduce HIV transmission by over 60%. Not only is voluntary medical male circumcision a method of HIV prevention; it is also nearly 40 times more cost effective in comparison with the treatment of HIV using antiretroviral medications. By engaging in an academic research study during the international elective students increased the educational value of the trip.
Methods: The Luke Commission is a NGO that provides mobile health outreach to rural Swaziland, including HIV testing and prevention. They perform more than 100 voluntary medical male circumcisions each week. The Luke Commission maintains a database demonstrating program productivity and effectiveness. Information collected from 1500 Swazi males during the first six months of 2014 was de-identified and analyzed after approval by the Wright State University School of Medicine IRB.
Results: During this time period 34 adverse events occurred in 31/1500 patients, these included bleeding, infection, and wound dehiscence. The overall adverse event rate for the procedure was 2.3%. Boys ≤12 years old had adverse events in 22/1022 circumcisions (2.2%) and patients ≥13 incurred 11/478 (2.3%; p=0.66). Patients ≤29 kg body weight had 19/662 (2.9%) and patients ≥30 kg had 13/838 (1.6%; p=0.40). There were no adverse events reported in 75 HIV-positive patients included. There were more wound dehiscences during the summer months, 10/333 (3.0%) versus 10/630 (1.6%) in fall and 0/517 (0%; p=0.001) in winter.
Conclusion: Aid organization databases provide a source of information that can be used by medical students for research during international medical electives. The relationship between aid organizations, medical students, and patient populations can be a collectively beneficial one. Global health research has many complexities, but through careful planning and cultural awareness, medical students can contribute by publishing research that brings attention to global health issues and improves policies while having a significant positive effect on their own educational experience.