TMC PULSE

t m c » p u l s e | n o v e m b e r 2 0 1 5 19 what the impact of that is on an individual level," Richards-Kortum said. "When our students travel and have the opportunity to be part of the team that's trying to provide care in a setting like that, they come back with a new sense of purpose and inspiration to address health disparities." In our increasingly connected world, a global perspective has become a priority for students. With that in mind, TMC institutions are offering more opportunities to study and practice out- side the United States. One such program, the Center for Global Nursing Scholarship (CGNS) at Texas Woman's University, dispatches students around the world, with trips to China, Indonesia, Korea, The Netherlands and Peru, just to name a few. "We want our students to have an apprecia- tion for what nursing is globally and what they can do to contribute during their professional lives," said Joan Edwards, Ph.D., an associate professor and director of CGNS at TWU. "We are so blessed in the United States with our knowledge and resources, and we need to share that." Edwards emphasized that the goal of all trips is to be mutually beneficial to TWU students and the citizens of the countries they visit. "It's not like, 'Hey, we're here and we can teach you everything.' It's that we can learn from each other," she said. "They have circumstances that they have been creative in solving to advance nursing, and we can learn from that and both benefit." The program began in 2001 and was approved by the Board of Regents as an official Center of Texas Woman's University in 2012. CGNS goes on several trips each year. Students work on research and in clinics, and participate in international nursing conferences. A group of students recently had the unique opportunity to interview Japanese nurses who treated victims of the Hiroshima atomic bombing. CGNS has been involved in some locations for years. The intent is not to travel to a place once, do what they can and then move on to the next location. CGNS is looking to establish true partnerships and collaborations in each country. "This is long-term work," Edwards said. "We're committed to working with people in these coun- tries for years. You're not going to get much done in one visit—it takes relationship building." For Sheryl McCurdy, Ph.D., principal investigator of the Tanzanian AIDS Prevention Project (TAPP) and an associate professor at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in the department of health promotion and behavioral sciences, local relationship building is a key to success. Through in-depth interviews, McCurdy dis- covered Tanzanian women injecting heroin were sharing blood, a practice called "flashblood," to help friends avoid withdrawal. McCurdy also presented findings showing 42 percent of intra- venous drug users in Dar es Salaam were HIV positive. As a result, the Tanzanian government, along with the CDC and PEPFAR, issued a call for outreach programs, leading to the develop- ment of TAPP—a partnership between UTHealth and Muhimbili University of Health and Allied Sciences in Dar es Salaam. With the help of Tanzanian community- based organizations (CBOs), TAPP maps out areas where intravenous drug users congregate. TAPP trains CBOs and sends mobile vans to those areas to conduct outreach and educational activities. The program began by offering bleach kits and teaching people to sanitize needles. In 2011, TAPP expanded to connecting users with their families and bringing the users into its new methadone clinic, the first public access clinic in Africa. There are now three addiction treatment clinics in Dar es Salaam that have enrolled nearly 3,000 people, and Kenya has opened two methadone clinics based on TAPP's model. McCurdy's next goal is to expand to help smokers. When TAPP began, 60 to 90 percent were injecting, she said. Now, 10 percent of users are injectors, while the rest are smokers. "Smokers want in, too, and the Tanzanian president wants to upscale the program around the country for everyone," she said. "In 2014, I worked on a policy document with Tanzanian colleagues to show how that would work and how it would go through the Ministry of Health." McCurdy also recently received a Fulbright Scholarship to follow people in recovery through March 2017. Meanwhile, other countries in Africa are looking at TAPP as a model program for starting their own clinics. Becoming integrated into the fabric of local communities was a common thread among the Texas Medical Center global programs. These are not one-off trips—to be impactful, they must be in for the long haul. That commitment is embodied by BIPAI, the oldest of these four programs. Twenty years in, BIPAI has grown significantly from the orphanage-turned-clinic in Constanta, Romania, though that first clinic is still operational. In an auditorium packed with young, eager medical students, the next generation waiting in the wings to affect global change, Kline summed up the feeling he had when he first saw success in the developing world—a feeling shared by the globally minded across the medical center. "The experience was nothing short of addic- tive," he said. "When you see little stunted, wasted children begin to grow tall, put weight back on, go to school. Once you have that experience, you want to do it over and over and over again." We never want to turn a child away, whether he has HIV or meningitis. We're care and treatment focused. — MARK KLINE, M.D. President and Founder of the Baylor International Pediatric AIDS Initiative (BIPAI) A Ugandan mother takes her infant for an antenatal doctor's visit.

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