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University of Notre Dame
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International Development Fellow Promotes “Good Medicine”

Mary Hendriksen • November 2014

One year ago, Patrick Salemme ’14 was proudly holding an acceptance letter to medical school—the culmination of years of dedication and a careful process of discernment. An Arts and Letters anthropology and pre-health major, Salemme had completed a rigorous pre-med curriculum as well as two medical internships—one in Puebla, Mexico during his junior semester abroad and one the following summer in Peru through the Kellogg Institute for International Studies.

As thrilled as he was at that moment, something seemed missing.

“I knew I wanted to have more of an impact on the world,” he recalls, “and for that impact to be right now.”

A Year in the Field with a Kellogg Partner Organization

Patrick SalemmeA few days later, Salemme opened an email from Kellogg Associate Director Holly Rivers about the launch of the Institute’s own International Development Fellowships (IDFs). In a unique initiative designed to provide new graduates the opportunity to work in the critically important field of international development, fellows are awarded a one-year placement with such organizations as Partners In Health (PIH) or the Association of Volunteers in International Service (AVSI).

“I knew immediately that an international development fellowship—specifically, one with PIH affiliate Compañeros En Salud (CES) in rural Mexico—would be a perfect fit for me,” Salemme says.

“My ultimate goal is to become a physician who helps communities throughout the world develop effective and sustainable healthcare systems—ones that are actually used by the people they are meant to serve. That is precisely the PIH/CES mission.”

Advancing the Accompaniment Model of Health Care in Rural Mexico

Awarded the IDF fellowship, Salemme deferred medical school and began working in June in Chiapas, a mountainous, coffee-farming region where more than half the residents live below the poverty line. PIH/CES has been active in the region since 2011, fulfilling its goal of providing high-quality health care through a model that envisions health care workers walking “side by side” with residents rather than directing them.

Salemme’s first assignment was to expand and train a centerpiece of the PIH/CES plan: community health workers.

Known as acompañantes, these are local women who make weekly visits to fellow residents diagnosed with chronic diseases, particularly hypertension (which affects one out of three adults in Chiapas), diabetes, epilepsy, and depression. They offer the education and support that help keep these conditions under control between monthly physician checkups—by answering questions, providing information about the specific condition, checking to see if patients are adhering to medication schedules, and offering friendly advice on diet and exercise. 

Salemme has trained acompañantes in one community and is assisting with furthering their education in three additional communities. He is also monitoring the effectiveness of the acompañante initiative by helping to design medical record forms that the women complete about their patients and creating a database to store the information and create reports.

A second assignment is monitoring and evaluating the quality of care in clinics staffed by PIH/CES physicians—first-year residents or pasantes who are fulfilling the Mexican requirement of a year of service. Salemme oversees a database that tracks PIH/CES interactions with patients with chronic health needs, ensuring that if patients with diabetes have not kept their appointments, for example, the pasante or supervisor can seek them out. A third task is serving as volunteer coordinator for both US and Mexican health workers.

“I am so impressed at the number of people who have heard about our care and choose it over more far-flung options,” Salemme says after four months in Chiapas. “This shows the power of good medicine . . .and speaks volumes about the quality of the PIH/CES model.”

Serious Work for Serious Students

As rewarding as the work has been, Salemme has had some difficult moments.

“This has been the first time ever I have experienced culture shock,” he says. “While studying in Mexico and interning in Peru, there were always other Americans nearby to speak English with at the end of the day. Now, I speak only Spanish, and I am entirely immersed in the life of Chiapas.”

Throughout the fellowship, Salemme keeps close ties with Kellogg. Executive Director Steve Reifenberg, who was instrumental in setting up the fellowship with PIH/CES, traveled to Chiapas in late June to help establish Salemme in the area. Rivers offers counsel through frequent phone conversations.

“That Patrick elected to defer medical school to pursue this experience speaks to its value,” Rivers notes. “The International Development Fellowships are serious projects for serious students. The recipients learn much more than is possible in a summer internship. They have the opportunity—and are given the responsibility—to contribute to an initiative in a long-term way.”

Salemme is fully aware of his responsibility—and his opportunity.

“Global health initiatives are only successful if they incorporate worldviews and social systems already in place. I’m truly learning to accompany people with a disease or affliction—to show compassion—rather than merely telling them what to do. This is the lesson I will take forward into medical school and in my career in global health.”

Olivia SchneiderSecond International Development Fellow in Uganda

Olivia Schneider ’14, a political science major with minors in business economics and international development studies, was named an International Development Fellow at the same time as Salemme. She is working in Uganda with the Association of Volunteers in International Service (AVSI), helping to implement the USAID-funded SCORE project, which aims to improve the well-being of critically vulnerable children and their families by increasing household income, food security, and access to legal services.

The partnerships with both AVSI and Partners in Health build on a major initiative of the Kellogg Institute to understand the role of human dignity in development.

Applications for the coming year’s International Development Fellowships are due Friday, January 30, 2015. More information here.


 

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