Caduceus Newsletter 2013.09: Week of March 4
In case you become interested in psychiatry, you may be called in to deal with the consequences of a mass shooting.
For more information, please go to Article #6.
Table of Contents:
1. Events coming up.
1. Events coming up.
· Wednesday, March 13: The Ohio State University College of Optometry will be hosting a Virtual Open House. For more information, please go to Article #2;
· Saturday, March 16: The Lincoln Memorial University – DeBusk College of Osteopathic Medicine (Harrogate, TN) will be hosting an Open House on Saturday, March 16;
· Saturday, March 23: The University of Tennessee College of Pharmacy is hosting the inaugural 4-mile Race for the Summitt on Saturday, March 23, to raise funds for the Pat Summitt Foundation. For more information, please see Article #2.
2. The Ohio State University College of Optometry will be hosting a Virtual Open House on Wednesday, March 13.
3. The Consortium for Optometry Summer Enrichment Programs announces a series of week-long programs for pre-optometry students.
The Consortium for Optometry Summer Enrichment Programs is pleased to share the upcoming dates and deadlines for our individual programs. We encourage you to share this email among your preoptometry students and we look forward to hosting them on our campuses during the summer of 2013.
Do note that prospective students may apply to and attend multiple summer programs; we do not restrict or cap an individual's participation between or among any of the programs described below:
Illinois College of Optometry, Focus on Your Future
July 15-19, 2013
The Illinois College of Optometry is pleased to announce our annual summer program for underrepresented minority undergraduate students. The program is a weeklong experience that will expose undergraduate students to the profession of optometry in a variety of settings. Participants will have the opportunity to meet and work with current optometry students, ICO Faculty & Staff, as well as practicing optometrists. Students will be housed at no charge in our Residential Complex. There is no cost to participate in this program. Participants are responsible for their travel expenses and/or transportation cost to and from ICO.
For more information, please visit: http://www.ico.edu/optometry2011/index.php/events-for-prospective-students/summer-program
Program Contact: Teisha Johnson, 312.949.7407, tjohnson@ICO.EDU
The Ohio State University, I-DOC
June 17-19, 2013
The Improving Diversity in Optometric Careers program is an intensive three-day program for people from an underrepresented ethnicity (American Indian or Alaskan Native; Asian or Pacific Islander; African-American, not of Hispanic origin; or Hispanic) interested in finding out more about an optometric career. The program provides information about optometry through hands-on experiences, and it aims to increase the number of underrepresented ethnic minority optometrists. Thanks to underwriting by the Vision Service Plan (VSP), there is no cost to attend the program and includes all meals and activities. There are also a limited number of scholarships for airfare reimbursement (up to $500) and accommodations for out-of-state college applicants.
For more information about the program and information regarding the application process, please visit the I-DOC webpage:
Program Contact: Justin Griest, 614.292.8825, JGriest@optometry.osu.edu
University of California, Berkeley, Opto-Camp
Session I, June 17-19, 2013
Session II, July 15-17, 2013
The goal of Berkeley Optometry's Opto-Camp is to introduce underrepresented pre-health science majors to Optometry as a potential future career track and to prepare them to be successful applicants to optometry school. The objective of Berkeley Optometry's Opto-Camp is to present a three-day in residence experience that will provide participants with opportunities to learn about the profession of optometry and the process of becoming an optometrist.
Program specifics and the application, available in March, 2013, are linked here:
Cost: $125 program fee; limited amount of scholarships to waive program fee per session, as demonstrated by financial need.
Program Contact: Heather Iwata, 510.642.9537, email@example.com
A special thanks to the Association of Schools and Colleges of Optometry (ASCO) for providing seed funding for all of our programs and continued support as funding is available and requested. ASCO is currently in its eighth year of the Optometric Education Diversity Mini-Grants program. This program assists optometry schools in developing and implementing activities/programs that are designed to recruit and/or retain underrepresented minority students, financially disadvantaged, and/or first-generation college students pursuing the optometric profession.
Sharon T. Joyce
4. High Debt and Falling Demand Trap New Vets: From the New York Times.
Declining companion pet populations in the United States is resulting in decreased demand and lower pay for veterinarians. It’s not a pretty picture:
5. ===AAMC STAT===, News from the Association of American Medical Colleges, February 25, 2013 edition.
6. In case you become interested in psychiatry, you may be called in to deal with the consequences of a mass shooting. From Medscape Infectious Diseases: School Shootings and Lessons Learned.
The URL is http://www.medscape.com/viewarticle/776891?src=wnl_edit_medn_wir&uac=40240FX&spon=34 . Registration may be required, but it’s free:
School Shootings and Lessons Learned
In the aftermath of the Sandy Hook Elementary School shootings in Newtown, Connecticut, that took the lives of 20 very young children and 6 adults, the experience of mental health professionals who have been at the center of similar tragedies offers up some valuable lessons.
Montreal is a city that has experienced 3 school shootings that included 15 dead at the École Polytechnique in 1989, 4 dead at Concordia University in 1992, and most recently, Dawson College.
Psychiatrist Warren Steiner, MD, was the McGill University Health Center's psychiatrist-in-chief when 25-year-old Kimveer Gill stormed the atrium of Dawson College on September 13, 2006, killing 18-year-old student Anastasia De Sousa and wounding 19 others before killing himself.
That moment launched a "psychological first aid" response that was very different from the city's responses to previous school shootings.
With hindsight, Dr. Warren said he would do some things differently — and some the same — lessons that he hopes might help others who are dealing with similar situations.
"The consequences do continue for years afterwards, and they were not the consequences that we expected," he said. "It went far beyond PTSD [posttraumatic stress disorder].
In fact, research carried out by the team 18 months after the Dawson College shooting shows that substance abuse and major depressive disorder emerged as bigger players than PTSD.
"One thing we would have done very differently is talk about all sorts of psychological reactions, not just PTSD," he said.
When the first shots were fired at Dawson College, Dr. Steiner was across the street having lunch with his son. He returned to a Code Orange (community emergency) at the Montreal General Hospital, in which mental health services had all but been forgotten.
"It was just chaos. I went into the control room and they had no idea why I was there. We hadn't been thought of," he recalls.
"It was clear after 9/11 that the psychological consequences of these kinds of major disasters outnumber the physical consequences about 10 to 1...yet they had no idea why I was there."
But before long it was clear.
"Some of the shooting victims were coming for surgery, but then there was a flood — it's called a surge — of nonphysical trauma. We had hundreds of kids, parents, and staff. They were feeling completely overwhelmed. They were hysterical, sobbing, terrified, and having panic attacks," Dr. Steiner told Medscape Medical News.
"One fellow had been holding Anastasia [the victim who died] and talking to the shooter. Other people were covered in blood. These were horrible things these young people experienced."
From that moment, a massive psychological first-aid effort was launched, aimed at damage control.
"We decided to be proactive," he explained at a recent meeting of the Canadian Psychiatric Association. "We sought out people and tried to actively identify those at risk for late-onset distress."
But there was little to guide the team's proactive instinct.
It is not known whether specific interventions can reduce the risk for PTSD, and previous tragedies have yielded little research.
Within hours, a call made to Columbine High School generated little advice about how to proceed proactively, and there was even some lingering uncertainty about the potential of retraumatizing victims.
"It was at that point we realized we were on our own and had to develop a plan very, very quickly on the fly," said Dr. Steiner.
From there, a marathon began.
For the first week, Dr. Steiner and his team were on the scene of the shooting 24/7. At one point they numbered more than 100 mental health workers.
When the school reopened, floaters scanned the crowd for traumatized individuals, approaching them and offering psychological support.
They launched a focused outreach aimed at psychoeducation.
Articles were commissioned in the school newspaper, and handouts were distributed about the risks and signs of PTSD.
For more than 6 months, a block of 12 therapy rooms at the college remained constantly staffed, attending to a steady stream of traumatized students and teachers.
The message to everyone was "be very careful not to pathologize the normal healing process," said Dr. Steiner.
"You could be waking up at night with terrible nightmares and reliving it, or jumping at the sound of someone dropping their books — these are normal reactions; you are not ill because you're experiencing them."
Psychological First Aid
"Psychological first aid" has become "the intervention of choice" in the immediate aftermath of a tragedy, agrees psychologist Christopher Flynn, PhD, director of the Cook Counselling Center at Virginia Polytechnic Institute and State University in Blacksburg.
But the nature of that aid is still a subject of debate.
Within 15 minutes of the first shots in the 2007 Virginia Tech massacre — which eventually left 32 dead — Dr. Flynn too was mobilizing psychological first aid for survivors and the families of victims.
"They used to talk about critical incident stress debriefing, in which people would get together and talk about their immediate reactions to trauma, and that was thought not be particularly effective and in some cases actually did harm," he toldMedscape Medical News.
"Psychological first aid suggests that the sooner we can bring resources to bear, the more likely it is that immediate stress disorders can be handled with decreasing likelihood of posttraumatic stress."
Indeed, the study carried out after the Dawson College shootings suggests this theory may hold true when it comes to PTSD. But the research also points to the risk for other outcomes, Dr. Steiner warned.
As expected, the study, which included a sample of 949 Dawson college students and staff, showed a 3-fold spike in the prevalence of any form of mental disorder after the shooting as compared with rates reported in the Canadian Community Health Survey (30.9% vs 10.9%), which was carried out the previous year.
In addition, PTSD prevalence was higher than in a Canadian military peacekeeping cohort (3.4% vs 1.4%).
But the unexpected finding was that the increase in PTSD was stunted compared with the increases in both alcohol and illicit drug abuse (8.7% vs 2.6% and 2.6% vs 0.8%, respectively) and major depressive disorder (12.1% vs 4.8%).
"So the rate of PTSD was not as high as we expected. Is that because we focused on that? Would it have been even higher if we hadn't focused on it?
"People react in different ways.... They may be very jumpy or very anxious all the time, and their reaction may be to turn to drugs or alcohol to self-medicate. So one thing I would do differently is I would say, 'you are at higher risk for the development of mental health problems in general — not just PTSD,' " said Dr. Steiner.
But a similar study carried out by Virginia Tech, in collaboration with Harvard University, during the 4 months after that campus massacre shows a much higher rate of "probable PTSD" (15.4%), based on a cross-sectional survey of 4639 students.
The reasons for this apparent difference are not clear. Compared with the Dawson study, the Virginia Tech study was carried out much sooner after the tragedy and included a larger number of participants.
Despite intense counseling over prolonged periods at both schools, the nature of mental health interventions may have differed, and the time point in the school year (September at Dawson and April at Virginia Tech) may have affected the dissemination of psychological first aid.
In addition, the scope and duration of the shooting at Virginia Tech extended beyond that of the Dawson College incident.
Mental Health Prognosis
One thing both studies suggest is that the proximity of a person to a shooter or a victim can, to some extent, predict their future mental health risk.
In the case of Dawson, 13% of respondents saw the shooter, 35.8% saw someone wounded or killed, and 3.3% tried to help a wounded or dead victim.
Down the road, these were the people most at risk for psychological trauma, said Dr. Steiner, adding that in addition to degree of exposure, the study showed that female sex carried a higher risk for PTSD (odds ratio [OR], 3.54) and major depressive disorder (OR, 3.93).
At Virginia Tech, during several hours of uncertainty over the shooter's whereabouts, 64.5% of survey respondents were unable to confirm the safety of their friends, and 9.1% had a close friend who was killed.
In that study, the ORs for high levels of posttraumatic stress symptoms were highest for those who experienced the injury or death of someone close (2.6 - 3.6) and those who were unable to confirm the safety of friends (2.5).
Perhaps knowledge of these statistics may one day guide mental health professionals in counseling trauma victims about their future mental health, Dr. Steiner suggests.
"I would now say, if someone was in the atrium at the time of the shooting, it is imperative that they meet with a mental health professional to be evaluated, because they're going to be at the highest risk down the road."
The long-term effect of the tragedy on the students of Sandy Hook Elementary School remains to be seen, and efforts are underway to help them recover some sense of normalcy.
When their classes resume in a new building, the pain and fear will still be fresh, but the act of returning will be an important step toward healing.
That was the case for the thousands of Dawson College students who on September 18, 2006, made a symbolic reentry into their college atrium — which just days before had been filled with bloodstained books and backpacks.
"It takes a lot of courage to come back 5 days later," Dr. Steiner acknowledged. He had fought for the resumption of classes as soon as possible, against some resistance.
"Quite a few teachers said we should just cancel the semester. But that builds up, and your negative expectations grow and grow. So we met all the teachers on the Friday in the gym and persuaded them. And they were on board after that," he said.
The following Monday, when the students returned, the teachers met them inside, and the atrium was filled with applause. Today, a peace garden stands as a memorial to the tragedy.
Medscape Medical News © 2012 WebMD, LLC
Send comments and news tips to firstname.lastname@example.org.
Cite this article: School Shootings and Lessons Learned. Medscape. Dec 31, 2012.
7. The health problems in poor countries can be overwhelming.
Joe Fong, CBU alum, is doing volunteer work in Senegal, and has shared a number of photos taken in the clinic of boys with serious dermatological issues:
Just a few photos from my work the past 2 weeks. These are not the worst, just some that are not too distasteful to say the least.
Fungal infection gone wild. The hole in the boy's foot was deep enough to pack about an inch of iodoform gauze inside.
The head wound is from a boy who got hit in the head with a rock. We bandaged him Friday but he accidentally left his antibiotics over the weekend. This is what it looked like a few days later. I cleaned it and rebandaged it.
The worm is a personal favorite. It is a mango worm. We squeezed and abscess on the side of the boy's head and poww - it shot out. I was like, wow this is the most perfectly encapsulated pus pocket I've ever seen. Then it started moving.
Where is Senegal?
Questions and Answers: Talibés of Senegal
World Vision is eager to answer any of your questions regarding talibés, and how it is working to address the exploitation of these young boys in Senegal. Below are some of the most commonly asked questions.
What is a talibé?
How many talibé
children are there in Senegal?
Where do the talibé
What physical risks do the talibé children face?
What is the root cause of the talibé problem?
How do children in Senegal become part of
the talibé system?
How did the talibé
tradition begin in Senegal?
How and when did the talibé
tradition become skewed into a child exploitation issue?
By criticizing the talibé
system in Senegal, is World Vision criticizing Islam?
How is World Vision helping to address the problem?
Prevention: Preventing children from ending up in a Dakar daara is the first step in addressing this complex social issue. World Vision staff, comprised of both Muslim and Christian Senegalese professionals, are educating parents about the perils of sending their children to the city. They are helping them to keep their children at home by improving village living conditions and opportunities. Communities are more likely to keep their boys at home if they have school facilities, potable water, sufficient food and income-generating opportunities—all development activities that child sponsorship helps to make possible in more than 600 villages.
Care: World Vision is caring for talibés are already on the street. World Vision Senegal recently launched an innovative, pilot project. Five marabouts agreed to take their collective 150 children off the street—despite the significant loss of income—and enroll them in school. In exchange, World Vision covered school fees and supplies, and upgraded the daaras with latrines, showers and running water. Monthly stocks of vegetables, meat and rice are provided so the boys have regular, nutritious meals. The marabouts receive small, income-generating loans to help break their dependency on the children’s income. The loan of a few hundred dollars is enough to start a fruit stand or to rent a taxi to drive. The marabouts have agreed to send the boys home after two years, where World Vision will help to ensure that they are integrated back into their communities and into public school.
Advocacy: World Vision is addressing aspects of this
cultural tradition that exploit children and their rights. Senegalese Muslims
are also concerned about this. World Vision is working in coalition with
other organizations (Muslim, Christian and secular) and the Senegalese
government to ensure that children and their rights are protected, according
to existing laws and conventions. Talibé children
have the same right to education, health, security and protection as all
other Senegalese children.
Who funds World Vision’s pilot project in
As a Christian organization, why is World
Vision offering financial support to marabout
Senegal’s population is 98 per cent
Muslim. As a Christian organization, how does World Vision work in this
How long has World Vision been working in
What does World Vision do in Senegal?
· 668 borehole wells drilled
· 186 classrooms constructed
· 359 literacy centres built or equipped
· 43,000 literacy students trained
· 76,520 farmers trained
· 16,503 families granted micro credit loans
· 5,216 latrines installed
· 305 health posts equipped
· 2,062 community health workers trained
Can I sponsor a child in Senegal?
Can I sponsor a talibé
How many children are sponsored in
Senegal through World Vision?
8. School for Field Studies e-newsletter, February 27, 2013 issue.
9. Marginalia: Football camera provides ball’s-eye view of the field.
Dr. Stan Eisen,
Caduceus Newsletter Archives: http://www.cbu.edu/~seisen/Caduceus.html