They will then return to their academic institutions with additional funding and ongoing virtual Stanford faculty mentorship to conduct a yearlong clinical improvement project focused on the skills they acquired. SASH is funded through an independent educational grant from Pfizer and managed by CIGH, in partnership with the Stanford Center for Continuing Medical Education.

“SASH is unique in its ability to fund the home institution of the scholar upon his or her return to ensure ongoing support of the implementation of health improvement projects,” says Director of the Stanford Center for Innovation in Global Health Michele Barry, MD.

This program builds on CIGH’s longstanding and successful Stanford/Yale Global Health Scholars program, which sends U.S. trainees to partner sites in low- and middle-income countries to train and work alongside local clinicians. 

“We are excited to reciprocate the learning and insights our scholars have gained over the years by now hosting African physicians at Stanford, advancing global health equity through true bidirectional partnerships,” says Barry. “We also look forward to learning from our visiting scholars.”

During the first round of recruitment in early 2024, nearly 450 physicians from 28 African countries applied for the first two of four cohorts. The 13 fellows selected for these first cohorts will arrive in January and April 2025.

“This demonstrates an overwhelming need for programs like SASH, not just on the African continent but in other low-resource settings around the world,” says Barry, adding that she hopes to see increased funding and support for programs like these.

Eastside and the Diversity Council used these town halls as a chance to foster connection, understanding, and improved health for the whole community.

Collaborating in New Directions

Fortunately, since the pandemic has subsided, this collaborative relationship has evolved in new directions. Now, Eastside and the Diversity Council host career sessions for students at the high school to learn about careers in the health sciences and to seek mentorship opportunities. These sessions continue to lead to new opportunities for the students, the school, and Stanford.

“We had a larger panel session. It was amazing,” remembers Williams. “We expanded our group. We had their incoming freshman class. We had PACCM faculty, some of our fellows, some internal medicine residents, some medical students, some RNs, some PA, respiratory therapists – a huge panel. Really, it sparked an interest in the students.”

These new sessions have also had small-group conversations, CPR instruction with manikins, and a mixture of discussion and hands-on activities. Such changes to this partnership align well with Eastside’s mission, which has expanded from preparing students for college to supporting their alumni through college and into professional careers.

“We are eager to introduce our students to a variety of career paths, expanding their horizons and showing them what is possible,” Bischof says. “The opportunity to partner with Stanford has been tremendous.”

Devastating to Local Communities

From Sri Lanka to the Salinas Valley, the impacts of this mysterious kidney disease are devastating for the patient, their family, and their community. 

“Life changes overnight when you give patients a diagnosis,” says Gopal Krishna, MD, a nephrologist with Central Coast Nephrology who grew up in a region of India that has become a hot spot for CKDu. 

Krishna believes that up to 20% of his patients have been affected by the illness. He’s now partnering with Anand and Contreras by providing them access to interview patients on dialysis.

Anand, who also directs Stanford Medicine’s Center for Tubulointerstitial Kidney Disease, is motivated by the stories of those impacted. In Sri Lanka, she says, farmers have committed suicide to prevent their families from suffering the financial burden of treatment. In other cases, children left school early, or mothers left the home, to work.

“Progressive kidney disease in a working-age person impoverishes families and robs them of a loved one,” she says.

A Puzzle Spread Across Time

Despite the impact, few nephrologists, patients, and community members in Central California are aware of this condition, and an understanding of causes and solutions remains elusive.

Because the disease is difficult to detect in its early stages, researchers struggle to understand which exposures in a person’s life may have contributed to their illness. Compounding this, many impacted communities lack sufficient epidemiological data and research capacity to investigate the condition.

“It’s a puzzle that is very difficult to piece together – a puzzle not only with many pieces, but pieces spread across time,” says Anand.

Strenuous activity in extreme heat is one highly suspected risk factor – and a growing one in light of climate change, says Anand. Other possible contributors include drinking water contaminated by pesticides or naturally occurring elements, silica exposure from the burning of certain crops, and infection by viral diseases.

As a Clovis Community College and UC San Diego graduate who hopes to attend medical school, Banda says that this experience is motivating him to become a doctor capable of engendering trust in his patients.

‘Hope to Find Solutions’

While researchers hope to better understand the causes of CKDu, their ultimate goal is prevention across borders.

Meanwhile, researchers are collaborating with universities in Central California, as well as local farmworker rights organizations, to develop a project focused on protecting at-risk workers – particularly as rising temperatures put laborers at greater risk.

Krishna hopes the initiative can help catch or prevent the disease before it reaches its terrible end stage for many of his prospective patients. 

“As we begin to recognize and appreciate that this entity exists,” he says, “I think there is a lot of hope to find solutions.”

Universal Enthusiasm

Another Global Health Track resident, Savannah Karmen-Tuohy, MD, has found the NAGHMC medical students inspirational. “The enthusiasm with which they do their pre-work and how prepared they are … is truly unparalleled,” she says. They are learning and working in the absence of much of the technology taken for granted in the U.S. Forget CT scans and other expensive diagnostic technology; they don’t even have reliable or affordable internet access. “We are adjusting each session as we go and have a debrief call before and after with members of the NGO and the on-site faculty to think about how to work best during these sessions. That’s exciting from an educator’s perspective.”

The enthusiasm is as bidirectional as the learning. In a letter of thanks to Stanford University, the participating NAGHMC students wrote, “These lectures have been invaluable in expanding our knowledge and understanding of various medical conditions and their treatment. The case studies presented in these lectures have provided us with a deeper insight into the practical aspects of medicine and have equipped us with the necessary skills to approach similar cases in a clinical setting. The real-life scenarios discussed have helped us develop critical thinking and problem-solving abilities that are essential for a successful medical career. The expertise and professionalism of the instructors who have conducted these lectures are truly commendable.”

“I can’t go to the hospital now. I have a math test tomorrow!”

That was Sofia Laiton’s reaction to her father’s insistence that he take her to seek care immediately for her worsening inflammatory bowel disease (IBD) symptoms. She was 15 then and had recently been diagnosed with Crohn’s disease (a type of IBD). “In my junior year in high school, I had every symptom in the book: fatigue, blood loss, weight loss – it was scary,” she recalls. 

Her father took her to Valley Children’s Hospital in Madera, California, a part of the Stanford Health Care system. What she thought would be an overnight stay turned into a 10-day admission for tests and treatment of an infection.

“I was in my worst condition back then,” she says. She was taking several medications, including monthly infusions of infliximab, an anti-inflammatory medication. “But over time I’ve come to see IBD as a journey. I couldn’t run to the finish line, but I could live a stable life by adapting and defining a new normal for me.”

In 2022, when Laiton was 21, her pediatric gastroenterologist suggested that she transition to adult care at Stanford Health Care. That was when she participated in the Pediatric-to-Adult IBD Transition Program and became a patient in the adult gastroenterology division.

Since the IBD Pediatric-to-Adult Transition Program was launched in 2020, more than 35 IBD patients, including Sofia Laiton, have made a smooth transition from pediatric to adult care, under the leadership of Keyashian and Rachel Bensen, MD, a clinical associate professor of gastroenterology at Stanford Medicine Children’s Health.

The need for this kind of support arises from some key differences between pediatric and adult healthcare delivery:

• Pediatric care is family-centered, with parents serving as decision makers on behalf of the patient. Adult care is focused on the individual patient who acts on his or her own behalf.

• Pediatric care is often multidisciplinary and team-based; adult care is usually driven by a single provider who taps into subspecialty care as needed.

Now, the joint visit creates a true transition. Patients are free to have a final check-in after the adult visit with the pediatric social worker before becoming a full-fledged adult patient.

Laiton, now 23, graduated from the University of California, Davis, in 2022. She works in a high school as a student assistance specialist. She still needs medication to manage her condition, but with Keyashian’s help she’s down to one infusion every six weeks and no oral medications. Her Crohn’s disease is in remission.

Patient Feedback Is Positive

The frontier has been opened for establishing this program as the standard. Now, physicians are considering how to analyze available data to demonstrate outcomes and effectiveness of this way of providing care. 

“I love this program,” declares Keyashian. “It’s what I’d want for my own kid.” 

Designed for a Positive Patient Experience

While not every patient who goes to the emergency room needs to be admitted to the hospital, those who come to the Stanford Emergency Department and require inpatient care for certain types of issues now don’t have to wait for a hospital bed. Instead, they can be quickly transported to the Stanford Health Care Patient Care Unit at Sequoia via ambulance.

Notes Ahuja, who oversaw the clinical buildout of the unit, “We are aiming for a seamless experience for our patients. The unit is staffed by Department of Medicine hospitalists, Stanford Health Care nurses, and other key personnel. Patients have either a private room or a large, shared room that looks just like one they’d have at Stanford Hospital.” The Stanford Health Care Patient Care Unit at Sequoia has 12 private rooms and six shared rooms, all more spacious than comparable rooms at the Stanford campus.

“An additional benefit is that this unit opens up beds on the Stanford campus for patients with more complex and highly specialized conditions who could only get their care at Stanford Hospital,” Ahuja explains.

As medical director of the new unit, Lew designed the new workflow for the offsite location, hired a team of on-site hospitalists, and was the first physician to see patients there. He continues to oversee clinical care to ensure that patients receive Stanford-level quality. 

A Novel Approach to Specialty Care

The unit draws from a roster of Department of Medicine specialists from endocrinology, nephrology, infectious diseases, and cardiovascular medicine, who are available to consult with patients virtually via a wall-mounted large-screen TV and a camera. 

“We learned during COVID that there are times when virtual interaction is as good as or better than in-person interaction,” says Christopher Sharp, MD, chief medical informatics officer, whose team supported the integration of digital technology into the Sequoia unit. “This is an exciting model that allows us to extend specialty care outside of the Stanford campus by ‘beaming in’ specialists.”

Ron Li, MD, medical informatics director for digital health, designed the virtual consult workflow and helped specialty clinicians learn how to best use the technology to care for patients. As a board-certified informaticist, Li specializes in using technology to improve the care of hospitalized patients.

Stanford has previously used the virtual consult model to bring high-quality specialty care to affiliate hospitals and clinics – in some cases expanding access to specialty care 24/7. Telehealth has proved to be reliable and agreeable to patients. “The expertise and care we bring to patients is at the core of our mission,” says Sharp, “and by being digitally driven, we’re able to scale the reach of this expertise across Stanford Health Care sites.”