Winter 2019

PAs Go Global

Physician assistant students are getting a new worldview, thanks to a clinical rotation in South Africa.

By Laura Ferguson

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School of Medicine student Elizabeth Huebner at the entrance to Kopanong Hospital. Photo courtesy of Jennifer Nunes (PA Program)

When Jennifer Nunes, MG19 (MPH/PA), first heard about a pilot clinical rotation for Tufts physician assistant students at South Africa’s University of Witwatersrand, she jumped at the chance. “South Africa was exciting to me because my interest is in infectious disease—especially HIV— and I knew I could learn more clinically by being there,” she said.

For eight weeks starting in August 2018, two Tufts students, Nunes and Elizabeth Huebner, MG19 (MPH/ PA), participated in clinical rotations at both the rural Kopanong Hospital in Vereeniging, and the more urban Chris Hani Baragwanath Hospital in Johannesburg. In exchange, two third-year clinical associate students from the University of Witwatersrand (Wits, for short) worked with patients at Tufts Medical Center for four weeks.

Nunes now looks back on the experience abroad as “one of the most incredible things I’ve ever done in my life,” she said. “I fell in love with the challenges and with the people.”

That’s encouraging feedback for the physician assistant program, which will graduate its first cohort of combined MPH/PA- degree students this spring. “It’s exciting,” said Beth Buyea, program director and an assistant professor of public health and community medicine. “Though we’re young, we’re innovative and paying attention not only to our own immediate needs, but to global needs as well.”

Tufts faculty connections with Wits established a bridge between the two schools. There are considerable differences to span: In the United States, physician assistant education dates to 1965, while in South Africa, the comparable clinical associate program began just a decade ago. But this contrast, Buyea said, offered students the opportunity to deepen their understanding of the profession.

“We wanted our students to see how similar they are in their work, but also to show them the distinct challenges health professionals face in their respective countries,” she said. For the Tufts students, that included being immersed in South Africa’s fight against the HIV epidemic. The South African students, in turn, “really wanted to see how the PA program is used in medicine,” Buyea said. “They got a sense of what the future could hold for them.”

Rhode Island native Nunes said that once Huebner and she arrived in South Africa, “we hit the ground running,” as they worked in multiple departments during the day and often took on an emergency shift in the evenings. The students encountered a wide range of conditions, including illnesses not often seen in the U.S., such as malaria, advanced neurosyphilis, Stevens-Johnson syndrome, and HIV complications such as cryptococcal meningitis.

“We were helping one patient after another, after another,” Nunes said, “especially in the inpatient wards, which were almost always full, and in the emergency department, where there were lines out the door. It forced me to be resourceful and to think outside the box.”

Based on first-year success, the clinical rotation exchange program is slated to continue in 2019, with two students participating from each university and the possibility of future expansion.

“We recognize that international, hands-on experiences are increasingly part of student expectations and aspirations,” said Buyea, who credits a partnership with Fernando Ona, clinical associate professor of public health and community medicine, and support from Joyce Sackey, dean for multicultural affairs and global health, and Aviva Must, dean of public health, in getting the program off the ground. “We will continue to work hard to make sure our PA and MPH/PA students have these extraordinary opportunities.”

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