Bringing Care Worldwide
The only way we can advance medicine is by seeing the bigger picture. It’s easy to get pigeonholed on focusing on what’s happening in our local area , but to be better providers we have to see the breadth and spectrum of diseases that are out there.Amer Al-Nimr, MD
For Amer Al-Nimr, MD, a pediatric gastroenterologist, a reason he joined the Children's Hospital at Dartmouth-Hitchcock (CHaD) team is because of its altruistic work.
"Dartmouth-Hitchcock and Dartmouth College have always played a leading role in global health and global health education. Many physicians and nurses have been really active both in the local community and the global community," Al-Nimr says. "It’s all a part of our culture of caring. The only way we can advance medicine is by seeing the bigger picture. It’s easy to get pigeonholed on focusing on what’s happening in our local area , but to be better providers we have to see the breadth and spectrum of diseases that are out there."
Al-Nimr, who came to CHaD in 2015, previously worked at Rainbow Babies & Children’s Hospital in Cleveland, OH, the oldest pediatric global health track in the nation. He was the director of their global health program from 2010 to 2015, and at CHaD he is now spearheading the Global Child Health Program—a program aimed at streamlining the global health efforts providers are working on within CHaD, introducing a global health curriculum for the pediatric residents, and to strengthen and expand physician and student bilateral exchange.
Before he came to CHaD, Al-Nimr says there was extensive global health activity happening here—either organizationally or individually—and many providers were working within their own grants and research. CHaD faculty has been active in many countries including Rwanda, Tanzania, Haiti, Nicaragua and Kosovo. In speaking to Keith Loud, MD, MSc, chair, Pediatrics and director of CHaD, Al-Nimr says they wanted to figure out a way to bring everyone together so "the right hand knows what the left hand is doing." A faculty Global Health Interest group was quickly established and meets six times a year for activity coordination and knowledge sharing.
Recent trip to Jordan
Al-Nimr has been regularly visiting Jordan, a small country in the heart of the Middle East, and is setting up a Memorandum of Understanding with Mutah University’s Faculty of Medicine and CHaD.
"We are working with the Jordanian Ministry of Planning and International Cooperation to establish a clinic administered by D-H and Mutah University inside the Syrian refugee camp at Azraq," he says. "We are also planning a ‘twinning’ project between the Upper Valley Middle Schools and under-served Jordanian public schools in cooperation with the Royal Health Awareness Society."
Al-Nimr is collaborating with researchers at Mutah University to study the prevalence of celiac disease in high risk populations in Southern Jordan and in the Syrian refugee camp at Azraq. The aim is to help come up with a framework for the Jordanian health services and the United Nations High Commission for Refugees to monitor and treat identified children. Al-Nimr is also studying the prevalence of functional gastrointestinal disorders in refugee Syrian schoolchildren. He was invited to give a Grand Rounds presentation at Mutah University focusing on these projects and was presented an honorary shield from the Dean of Faculty of Medicine, Dr. Hani Al Hamaideh.
A personal interest in global health for children
Al-Nimr’s personal interest in global health for children can be divided in two ways: global health education for pediatric residents and caring for the Syrian refugees in Jordan. As someone native to the Middle East, Al-Nimr has taken an interest in the Syrian refugees since the crisis started in 2011. He travels there three to four times a year to do this work.
"In 2012, there was an alarming rise in refugees coming in to Jordan and they were divided between urban refugees and the refugees in camps. My main focus is the refugees in camps," he says. "What started as a medical interest turned into a social interest; I began to see how a camp grows, how temporary camps and structures become permanent and what happens to children born in these camps."
He says he has witnessed the Za’atari camp grow from a small camp with 3,000-5,000 residents to almost 180,000 residents living in horrible conditions. The camp has since become smaller and more manageable—now at around 80,000 residents.
"And I’ve seen everything in between—riots, demonstrations, changes in food distribution, introduction of schools and safe places for children, and shelter changing from tents to semi-permanent structures and caravans," Al-Nimr says.
In a different camp, Azraq, Al-Nimr is actively trying to set up a recurrent gastrointestinal clinic with a focus on celiac disease screening. He is trying to identify an algorithm to be introduced to the United Nations High Commission for Refugees, World Program and Unicef in Jordan to screen high-risk populations for celiac disease and establish a proper nutrition, feeding and monitoring program.
"Celiac disease is an underappreciated refugee -health issue in Jordan, Lebanon and the Middle East; apparently .5 to 1 percent of the Jordanian/Syrian population has it. So far, I’m not seeing a clear algorithm from the United Nations High Commission on Refugees (UNHCR) on how to identify and treat this population, because they’ve never had to deal with it before," Al-Nimr says.
Global health education
This year, we are introducing the first year of a three year Global Health Curriculum for pediatric residents at CHaD. It will include didactic and interactive lectures by specialists in the field as well as simulation sessions and workshops geared toward low resource settings.
"We are investing in our residents. We all care about making our world better, and I think that’s something really special about CHaD."