8/30/2019 Omni Med Distributes Oral Rehydration Solution Tubes
In October 2016, Jacob Dubner and Jack Waters—two high school seniors from Pittsburgh, Pennsylvania—set out with one goal—reducing mortality from diarrheal diseases. Diarrheal diseases are the second leading cause of death of children under the age of five, with infections such as cholera, rotavirus, and E. coli claiming the lives of over 500,000 children per year. In Uganda, an estimated 10,637 children under five years of age die each year due to rotavirus alone. Oral rehydration solution (ORS), a simple solution of salts and sugar, has been hailed by the Lancet as “potentially the most important medical advance of the 20th century” for its revolutionary role in combating the fatal levels of dehydration caused by diarrheal disease. ORS is an effective, inexpensive, and potentially widely accessible treatment for diarrheal diseases, but organizational inefficiencies and high costs of distribution have prevented pre-measured packets of ORS solutes from achieving widespread coverage across Uganda, and alternate methods of preparing ORS are unable to achieve the specific concentrations of salt and sugar that are needed for the treatment to be safe and effective.
Jacob and Jack—now undergraduate students at the University of Pennsylvania and Brown University respectively—have spent the past three years developing and testing the ORTube (pronounced “O-R-Tube”), a measuring tool they have designed to allow individuals in areas without access to ORS packets to quickly and precisely measure the exact amounts of salt and sugar needed to make safe and effective ORS with the resources available in their own communities. In May 2018, Jack and Jacob traveled to Uganda to partner with Omni Med to conduct a preliminary study on the viability of the ORTube within Uganda’s VHT program. With the help of Omni Med, 50 VHTs from 38 villages in Mukono used the ORTube over 175 times in two weeks and returned with positive survey feedback that strongly supported the ORTube’s ease of use and an increased likelihood of preparing ORS for patients when the ORTube was present. These initial findings support the ORTube’s potential to create widespread access to safe and effective ORS in Uganda and to empower VHTs by providing them with a symbol of their valuable role in caring for their communities.
With the help of Omni Med, the ORTube team is now preparing to conduct a large scale, longitudinal study on the long-term effects of the ORTube within Ugandan communities. Jack and Jacob hope for a day when all VHTs are equipped with ORTubes that allow them to provide instant access to safe and effective ORS for community members who need it. Omni Med has played a key role in allowing the ORTube to grow to this stage, and Jack and Jacob are excited to continue to grow this partnership. On August 1, 2019, Omni Med hosted a gathering of 175 VHTs in which each received an ORTube as both a reward for prior work and as an incentive to treat diarrheal illness aggressively and correctly.
In June 2019, ORTube was incorporated as an independent 501(c)(3) nonprofit. If you have any questions regarding the ORTube or would like to support Jack and Jacob’s work, please email firstname.lastname@example.org.
Jacob (left) and Jack (right) at the Omni Med compound in Kisoga (June, 2018)
Jack and Jacob with the Omni Med staff and other volunteers at the Kisoga compound (June, 2018)
Jack and Jacob leading ORTube training sessions with community health workers in Mukono (June, 2018)
VHTs practicing using an ORTube prototype in Mukono (June, 2018)
Omni Med staff, volunteers, and VHTs with their new ORTubes after a training session (June, 2018)
Omni Med Completes Construction for Compound in Makata
Omni Med Secures the Land Title for Compound in Kisoga
We have been saving to purchase the compound in Kisoga for many years. In September, following some generous donations from Omni Med board members, we were able to wire the funds to purchase the land and housing. We will be the outright owners before the year's ending! Thanks to all those who have supported our work for many years. Now that we own the compound, we have much more construction to do!
Dr James O'Donovan Signs on as Omni Med Research Director
Dr James O'Donovan started to work with Omni Med in 2015. Following a successful 18 months coordinating, executing, and then submitting our Tablet Trial for publication, Dr O'Donovan has agreed to serve as Omni Med's overall research director for the next three years. A physician currently, Dr O'Donovan is currently pursuing a PhD at Oxford University in the UK with a focus on community health workers in the developing world. He will coordinate various research projects with incoming students and Omni Med staff while working closely with Drs. Kabali and O'Neil to move the Enhanced VHT Pilot and Full Trials forward. We welcome Dr O'Donovan and look forward to a productive three years.
Mays' Study Accepted for Publication
Dr Daniel Mays and the Omni Med Team's paper on VHTs accepted for publication. The manuscript, "Supporting and retaining Village Health Teams: an assessment of a Community Health Worker program in two Ugandan districts" (IJEH-D-16-00365R1) has been accepted for publication in International Journal for Equity in Health.
Congratulations to our friend and colleague Danny Mays, currently a second year medical resident at Mt Sinai in New York for this achievement. As many will recall,l Danny spent 9 months working wtih us in Uganda and this effort represents the culmination of many years of hard work. Congratulations to Danny and all who contributed!
E O'Neil receives Bates College Benjamin E Mays Medal
Recognizing the contributions of the many incredible staff, board members, and volunteers at Omni Med through the years, on June 10, Bates College President Clayton Spencer awarded E O'Neil '82, the Benjamin E Mays Medal, given only 16 times since its inception in 1982. The award is, according to the College, "the Alumni Association's highest award, honoring an alumna or alumnus who has performed distinguished service to the worldwide community and been deemed a Bates College graduate of outstanding accomplishment."
To read the full story, please see the following link
New Partnership Produces Innovation via Tablets
James O’Donovan is a far from typical physician-in- training. Two years ago, he won a pres- tigious prize as a medical student
training Kenyan medical students on physical exam techniques using low cost tablets, i.e. small computers. Now a medical intern at Cambridge in the UK,, he has collaborated with Omni Med for the past year to answer a basic question. Can Ugandan VHTs, similarly,
learn from hand-held tablets? James channeled grant support into what has become a randomized trial currently going in via Omni Med in Mukono. One arm uses standard didactic teaching. The other arm employs 30 Kindle Fire tablets with pre-loaded training materi- als. Wash U Medical student Jackie Kading conducted a pilot study last summer. We will know by early 2017 if the tablets work well. If yes, imagine the possibilities if every VHT owned their own tablet: training, patient referrals, data collection, and connection to the Internet all await. Following this first trial, we are planning a much larger trial in 2017. We are very optimistic!
To date, we have served 1250 VHTs and 225,000 people, conducting home visits, quarterly meetings, and regular trainings, with all efforts aimed at improving health in the district. We have completed construction of 26 protected water sources that now bring clean drinking water to 1,300 households and 7,800 people. We have constructed over 5,500 cookstoves in our partnership with The Cookstove Project. This means much less respiratory illness and much less carbon dioxide in the atmosphere.
We expanded the ITN Distribution & Monitoring Program, with over 550 ITNs distributed and monitored in 3 villages in Bunakijja Parish. The Ministry has authorized an additional1000 nets for us to distribute.
We completed two clinical trials, submitted one for publication, have a third trial ongoing and a fourth planned. Measuring the impact of our work remains a key guiding principle for us, and one we hope others will emulate.
Omni Med & GWU’s Rodham Institute Launch The Health Equity Scholars Program
Over the past four years, two GWU medical students, Daniel Mays, MD ‘16, and Ann Waldrop ‘17, working closely with Omni Med and GWU’s Rodham Institute (created in memory of Dorothy Rodham) piloted a new program for GW Medical students. The Health Equity Scholars Program seeks to harness the transformational power of the international service experience and redirect young physicians’ careers toward health equity. In this 4 year program, students spend their first summer with Omni Med in Uganda, years two and three working with GWU Rodham Institute’s Dr Jehan (Gigi) El Bayoumi on inner city health equity issues in Washington DC. Then in year four they return to Uganda with Omni Med or can choose another global health experience. The program involves mentoring, extensive readings, and an immersion in health equity issues, seeking to develop doctors grounded in social justice who will make a difference in our country and our world. Two students annually receive grant support. First year applications went out December 12.
Omni Med Builds New Undergraduate Partnerships: UCU and Bates
It has long been apparent to us here at Omni Med that we have much to offer young, idealistic people. Yet, of over 90 volunteers sent to Uganda thus far, only three have been undergraduate students. That is changing. We are now large enough (and have so much work!) that we are expanding to include undergraduate students. In October, we welcomed two students from nearby Uganda Christian University, working with us as interns three days per week. They have had considerable hands-on experiences, reading, and mentoring. In November of this year, we opened discussions with staff of the Harwood Center at Bates College, the alma mater of Omni Med’s founder.
While discussions are ongoing, we hope to pilot sending Bates students this spring and summer, and may well host a Bates student in the Newton office during May’s short-term month.
Of course the goal of these affiliations remains the same. We seek to transform young people by directly exposing them to poverty, having them read extensively on underlying causality, and give them the opportunity to make a measurable impact working with the poor in a well-established, sustainable program. We need many more young people to engage in the developing world, and part of our mission is to equip them to serve well. We hope both new ventures work out; more will likely follow.
Omni Med-Uganda and Climate Change: An Update and a Plea for Solar Panels!
As we pointed out last year, 98% of current population growth occurs in developing countries, driven by a lack of social safety nets for the elderly like Social Security and Medicare. When you get old in Africa, you rely on your kids; and you have large families to ensure that at least some of them are still around when you can no longer care for yourself. Fertility in Uganda is 6.2 children/ woman, vs. 1.9 children/ woman in the US—Africa’s population will double by 2050. More people means more energy use, more CO2 in the atmosphere and more global warming; The developing world is where the real battle against climate change will move in the coming decades. We can stop this by improving health of rural Africans and thereby decreasing family size (well proven) and carbon use. Omni Med is doing that and mod- eling energy use by putting solar panels on our home in Kisoga. We are currently seeking support to have all electricity supplied by solar panels. I hope some of you will consider sup- porting these efforts. We have one panel now, but need several more.
Omni Med Forms Partnership with Child Family Health International (CFHI)
Omni Med recently finalized a partnership with Child Family Health International (CFHI), which will greatly increase the number of volunteers that come to our site in Mukono annually. CFHI is one of the largest NGOs involved in health service and training. The partnership makes sense since both CFHI and Omni Med share an ethically based approach that focuses on community development while responsibly employing volunteers in poor communities. Neither NGO sends volunteers to tour poverty areas. Rather, we both strive to work with those communities to improve health standards there. Dr Jessica Evert is CFHI’s Executive Director and has been a friend to Omni Med for a number of years. We are all excited about the partnership and have the first volunteer from CFHI planned for a March departure. To read more about this on CFHI’s website, please see the following link: community-health-workers-and-global
Over 2,200 cookstoves constructed through our partnership with The Cookstove Project. This means much less respiratory illness and much less carbon in the atmosphere.
20 protected water sources constructed, with a 11/15 survey showing these sources bring potable water to 936 households, or 5,616 people; that is a lot of water-borne illness prevention!
Two clinical trials completed, with a third planned for 2016
Danny Mays, MS-4, GWU/ Omni Med Complete Second Clinical Trial (and Wins Award)
Fourth-year GWU medical student Danny Mays has completed his year- long Lazarus Scholarship. He completed a clinical trial with Omni Med in Uganda, living and working with our staff for 9 months, while completing graduate coursework in global health policy at the London School of Hygiene and Tropical Medicine. Danny helped Omni Med in so many ways, helping staff reorganize the budget & administrative structure. Danny got IRB approval for this clinical trial from Makerere University (no easy feat), conducted scores of interviews and completed questionnaire data on 134 VHTs in Mukono and Wakiso Districts. This data is unpublished, so we can’t release details yet, but suffice it to say that these compelling results should impact policy makers in Kampala.
Danny is currently applying to residency positions in Primary Care/ Internal Medicine throughout the country, and is currently writingup the data alongwith a few of usfrom Omni Med and Makerere. To recognize Danny’s intellect, talent and dedication, Danny also received a $125,000 Primary Care Scholarship from GWU, making his lifelong quest to reduce global health inequity a bit easier. Our heartfelt thanks, and congratulations to Danny Mays for a wonderful year, and some quite compelling research. We wish Danny well, with confidence he will continue this quest for many years to come.
ICATCH Grant Initiated In Bunakijja Parish
Last year, we informed you that Omni Med had won the ICATCH grant from the American Academy of Pediatrics. This is a three year grant that will help us establish a bed-net (insecticide treated net—ITN) program in Mukono District. Under the leadership of Dr Alan Penman and our staff, several volunteers, including Corinne McNichols of Tulane School of Public Health initiated a study of ITN usage patterns in Bunakijja Parish within Mukono district. We hired 7 VHTs to monitor the program and then hung 236 new ITNs. As of our second round of check- ing in August, the number of new ITNs hung properly was 206/236 or 97.7%. Monitoring is ongoing. The long-term goal is to ensure high compliance with life-saving ITNs in Mukono. We are seeking to hang and monitor many more ITNs this year.
Omni Med Wins ICATCH Grant, Finalist for DFL Prize
Omni Med won the American Academy of Pediatrics ICATCH Prize. This prize is worth $6,000 and will be paid out over three years. Many organizations competed fro this prize and Omni Med came out on top. For this grant, we will improve coverage rates of ITNs (Insecticide Treated Nets), and save many lives in the process. We will then measure the impact through standardized testing know as a Lives Saved Tool (LIST).
Omni Med is currently a finalist for the Data for Life Prize (DFL), a prestigious honor that brings broad acclaim if successful. Over 200 organizations competed for this prize. 35 organizations made it to round two. Omni Med is now one of 8 remaining organizations. Two organizations will be chosen to receive one of two $50,000 prizes. We will certainly keep you posted on the outcome. If successful, we will start work in January 2015.
Danny Mays Wins Lasker Prize, Spends 9 Months with Omni Med-Uganda
"I am taking this academic year off from medical school to work with Omni Med, research policy issues affecting VHTs, and study global health policy through the London School of Hygiene and Tropical Medicine. During my first experience with Omni Med 2 years ago, I began to appreciate the depth of health disparities and how structural violence manifests itself amongst the poor. This year offers a tremendous opportunity to learn how health disparities can be rectified and the poor protected through empowering and sustaining grassroots health workers. Ad hoc humanitarian aid alone is not enough to fix the problem of health disparities. People have to be empowered. It is difficult work, to be sure. But I’m telling you, I see magic happen when VHTs are given practical tools to save lives. Many VHTs are subsistence farmers and live on $2 or $3 a day. Despite working without pay and regularly facing significant challenges, they still volunteer. My research is focused on the policy question, is this model in which VHTs are unpaid volunteers efficient and sustainable? Omni Med is empowering VHTs to save lives and, with the mentorship of Dr. O’Neil and Dr. Edison Mworozi at Makerere University, we are investigating the optimal method of supporting and sustaining these life-saving health workers for decades to come." -Daniel Mays GWU School of Medicine & Health Sciences '16
Over 1,000 Cookstoves Constructed
We told you last year about our exciting new partnership with Global Peace Women (GPW) constructing cookstoves around Mukono. They work closely with the Omni Med staff and local VHTs, turning local banana trees, termite mound dirt, and a lot of sweat into functional, nearly smoke-fee cookstoves, which dramatically re-duce respiratory illness. Indoor cooking over open fires andthe resultant indoor airpollution (IAP) is the equivalent of smoking 2packs of cigarettes perday, causing at least13,200 deaths per year inkids under age 5. Omni Med’s partnership gets whole communities together to construct stoves, reducing firewood use by 75%, and creating nearly smoke-free households, One 1 inch wide log powers the cookstove, bringing two pots to boil, vented out through the “chimney” seen as a bulge in the wall to the left of the pots. To date, over 1,000 cookstoves have been constructed in Mukono District. GPW plans to expand with us in the coming year.
New Partnership with the Global Peace Foundation, (The Cookstove Project)
Pneumonia is the leading killer of children under age 5 in the world, while diarrheal illness is #2. A main contributor to this pneumonia mortality is the common practice of indoor cooking over open fires and the resultant indoor air pollution (IAP), the equivalent of smoking 2 packs of cigarettes per day. The WHO estimates that 4 million children under age 5 are exposed to IAP, causing at least 13,200 deaths per year.
The Global Peace Foundation is an NGO that recently agreed to work with Omni Med in Mukono District to build indoor cook stoves throughout the areas served by our VHTs. These cook stoves are built inexpensively from local materials, and, as of October, our VHTs are beginning to construct them with the GPF’s oversight and financial support. We are indebted to Mike Sommer, who heads up the GPF’s “Global Peace Women” section, which builds these cook stoves all over the world. GPF will provide the know-how and the funding to build 200 cook stoves in Mukono this year—40 thus far.
As per usual, we are not just assuming that this will work. We are collecting data on rates of occurrences and deaths due to diarrhea and pneumonia in Mukono before and after our program is in place. We will measure what impact our VHT program, combined with building protected water sources and cook stoves will have on the mortality of these communities. Given what we know from our initial work, we expect the impact will be profound.
2013 is the 16th year of Omni Med’s work overseas. With work in several countries, close to one million dollars worth of donated supplies, over 6,000 books sold, several hundred health volunteers sent overseas, 1100 VHTs trained to date, and many, many lives saved, we are pleased with what we’ve been able to accomplish and greatly appreciative of all the support we have received.
Randomized Trial is Completed: Under 5 Mortality Reduced by 9-11%
As we have reported here previously, Omni Med completed a randomized controlled trial measuring the efficacy of our VHT training and maintenance program. The study period was 3/11- 3/12 and we have spent the past year plus clarifying and interpreting the data. This program has made a significant impact in at least 12 out of 14 areas studied. These areas are the most important intervention areas to save lives in very poor settings. Just last month, we received more specific data from a colleague at Johns Hopkins University, who plugged our data into a tool (LIST) that converts behavioral data into the percentage of lives saved in an area based on the intervention. The net impact of our pro- gram is to reduce the death rate of kids in the area by 9-11%. To be fair, some of this reduction (~half) is due to larger macroeconomic changes that are reducing Uganda’s child mortality rates nationally. We also had significant problems keeping the knowledge within the study Intervention areas, accounting for dramatic improvements in the control areas. The bottom line, however, is that we have demonstrated, via the scientific gold standard of the controlled trial, that our program works very well and is making a clear difference for those in the communities we serve. We expect even better results in the next trial when protected water sources and cook stoves are added in.
Protected Water Source Program Scales Up
Since last year, we have engaged local villages to build protected water sources that turn contaminated drinking holes into clean drinking water. Our studies show that the process of re-routing this water through a series of clay, sand, porous rock and then out a clean pipe makes the water fifty times cleaner! This means that kids are far less likely to contract diarrheal illness, which is the second leading killer of kids in Uganda.
It truly does take a village to build these protected water sources. We supply the know-how and the materials, but we work with the villagers every step of the way in this process. They build it, so they own it, and will take care of it. We recently hired additional staff to increase production from building one new source every other month to building one new source every month. Currently, we have 10 functioning protected water sources serving close to 600 households and over 3,200 people. Over the next year, we look to at least double this capacity. Part of this expansion will honor our longtime friend and board member,
Ministry Asks Omni Med to Train Rest of Mukono
Over the past five years, we have become the largest organization train- ing VHTs in Mukono district, just east of Kampala and north of Lake Victoria. This year, we finished all of Mukono South, which includes Ntenjeru, Nakisunga, and the islands of Lake Victoria. Given our success training and maintaining VHTs in Mukono South, Uganda’s Ministry of Health has asked us to train the rest of the Mukono District, from Mukono TC north to Sieta-Namunganga. We are honored by this request, and are sketching out a 5 year plan to do so. We have started training VHTs in Mukono Town, with over 100 trained this fall. But we have a long way to go: 1100 trained, and roughly 2800 to go. Training VHTs is labor intensive and very expensive, but the VHTs’ passion, dedication, and impact makes it truly worthwhile.
In 2012, we trained an additional 350 VHTs, bringing our total now to 916 VHTs. By late spring of 2013, we will have trained over 1000 VHTs! We have only 132 VHTs left to train before completing training in Mukono South, a large district just east of Kampala. Since each VHT brings preventive and basic primary health care to 30 households with an average of 6 people per household, we have thus far impacted directly 168,880 people through this program at a cost of only 33 cents per person impacted.
During the past year, we held scores of focus groups and quarterly meetings, maintaining our previously trained VHTs. Last summer, we printed up over 3,000 laminated “VHT Guide to Healthy Homes,” which contains twelve important preventive health measures every family can follow. They include pictures and easy to follow instructions in the local language, Lugandan, on water purification, nutrition, bed nets, how to make oral rehydration solutions, prevent AIDS, get vaccinations, and why to breast feed, among others. We have thus far handed out 2,260 through home visits by our staff and volunteers. This direct teaching is invaluable and life-saving.
We sent 10 volunteers to train and maintain community health workers in Uganda this year. This group included 2 attending physicians, 2 medical residents, and 9 medical students, all going for 1-2 month stays. They were, Dr Alan Penman (U Mississippi), Dr John O’Brien (U Washington), Drs Sarosh Janjua and Nancy Restighini (St Elizabeth’s Medical Center). Medical students included Austin Wesevich (Washington University), Daniel Mays (GWU), Anne Nichols (GWU), Caitlin Sherman (GWU), Kaitlin Blackard (U Virginia), and Elise Turner (U Virginia).
We completed our randomized controlled trial, demonstrating efficacy of our approach. Kudos to all who contributed, Ben Lough, Zac Tabb, Edison Mwrozi, Edward Mwebe, John Lubanga, and the medical students who painstakingly retraced much of the study’s steps this past summer, helping us to clarify and understand our results: Danny Mays, Austin Wesevich, Anne Nichols, and Caitlin Sherman. We have received considerable help in this work from researchers from Washington University’s Center for Social Change.
Some updates from our Community Empowerment in Health Program, Uganda:
One of our student volunteers, Kate McGrail, spearheaded an initiative to build protected water sources for local villagers. Edward Mwebe, John Lubanga, and local villagers spent a week in September constructing a water source that brings drinkable water to villagers who relied previously on contaminated water. We constructed our second site in December, 2011, and plan to construct one new site each quarter, with site selection targeting the best performing VHTs whose villages have the poorest quality water. Each site costs over $500 to construct, but will no doubt save many lives.
We have trained 650 VHTs thus far. Since each VHT brings preventive and basic primary health care to 30 households with an average of 6 people per household, we have been able to impact 117,000 people directly through this program.
Our randomized, prospective trail measuring the impact of this program will conclude in the spring of 2012. This will be one of the first trials ever conducted measuring the impact of a service program on the health of the rural poor in Africa. We have other research initiatives underway.
We are expanding the number of universities in our program. Since our start, we have sent medical, public health, dental, and other allied health students from the following universities: Tufts, Dartmouth, UCSF, Duke, U. of Missouri at Kansas City, George Washington, Harvard, American University, U. Massachusetts, along with several medical residents & a P.A. from St. Elizabeth's, three senior physicians, and a registered nurse. We plan to send at least 20 more volunteers in 2012.
On November 16, 2010, Omni Med was recognized by the U.S. Center for Citizen Diplomacy for our selection as a “Top Ten Best Practice Program” by the International Voluntary Service Task Force. The U.S. Summit for Global Citizen Diplomacy in Washington, D.C. presented the award to Omni Med for its contributions to Service World, a legislative corollary to the Edward M. Kennedy Serve America Act of 2009. This proposed legislation, called the Sargent Shriver International Service Act, would dramatically increase the number of US citizens serving abroad. Omni Med crafted the Global Health Service Corps component. Please see the pdf version of the brochure for details.
7.26.2010: United States Peace Corps Uganda Country Director Ted Mooney committed to a long-term partnership with Omni Med and the Uganda Ministry of Health in the Community Empowerment in Health Program in Mukono, Uganda. The Peace Corps will commit two-year volunteers to expanding and sustaining the program throughout Uganda.
Caritas Network President Dr. Ralph de la Tore committed to a global health track at Caritas St. Elizabeth's Medical Center, with a prime focus of the Community Empowerment in Health Program, Uganda. Dr. O'Neil will serve as the global health track program director.
Omni Med would like to announce its support for ServiceWorld: Strategies for the Future of International Volunteer Service. Service World is a plan "to build a culture of international volunteer service." Omni Med contributed to the creation of the ServiceWorld plan, in particular by championing the cause of a Global Health Service Corps. With the 50th anniversary of the Peace Corp fast approaching, we hope to see legislative and executive action in line with the recommendations proposed by Service World.
Omni Med's Uganda Program has become the focus of our current efforts. At present, we have sent 15 volunteers to Uganda, and by the end of the summer we will have trained about 400 local community health workers. We are seeking additional health volunteers for teh program, typically one month in duration in Ntenjeru, Mukono District, Uganda.
The Omni Med Database of Global Health Service Opportunities is placed online and searchable as part of the Center for Global Health Service. Thanks to support from Salesforce.com, the Helen Steiner Rice Fund, Union Institute & University, and the Academy of Medicine of Cincinnati.
American Medical Association announces publication of two books on global health disparities and volunteer service Awakening Hippocrates: A Primer on Health, Poverty and Global Service; and A Practical Guide to Global Health Service. Both books written by Dr Edward O'Neil Jr and published by the American Medical Association, Chicago.