Most U.S. medical schools have programs in international health, but there is a need to find ways to make students (particularly those with little clinical experience) more effective volunteers in international settings. The Department of Family Medicine at the University of Miami School of Medicine developed a program to help prepare students for international work and to ensure that the work they do makes a difference. Over the past four years, this program, Project Medishare, has sent groups of students to Haiti to conduct health fairs. Students prepare all year for their voluntary trips, which take place during the spring and summer breaks; they learn about Haiti's history, culture, language, and health problems. They also raise funds and donations of medicine and supplies. The health fairs, which are one-day events in orphanages and villages, emphasize patient education and preventive medicine. The success of the fairs is evaluated using testimonials from Haitian officials and patients, students' journals, and data collected by the students. Factors critical to Project Medishare's success include (1) having a "critical mass" of culturally and linguistically competent students and faculty; (2) collaboration with local authorities and providers; (3) advance preparation; and (4) using lessons learned from each event to improve the next.

Main problem background: Acute lower respiratory illness is the most common cause of death among children less than 5 years of age in Haiti. Because children with Sickle Cell Disease (SCD) have a very high risk of contracting invasive pneumococcal infection which may lead to bacteremia and pneumonia, childhood mortality among children with SCD will be significantly higher if they are not diagnosed and receive penicillin prophylaxis and appropriate immunizations. Currently, Pneumococcal 13-valent Conjugate Vaccine (PCV13) is not routinely given to any children in Haiti. Importance:The institution of newborn screening and the routine administration of PCV13 in Haiti should decline the mortality of all children, and in particular the mortality of children with SCD. New finding insights:There is no newborn screening program in Haiti. Limited data suggest that 1 in 173 children born in Haiti will have SCD. We will implement a newborn screening program in Cap Haitïen, the second largest city in Haiti, with the purpose of identifying the children with SCD, and assuring they are vaccinated with PCV 13 and receive penicillin prophylaxis. Our hypothesis is that children who are identified through newborn screening with SCD will have a lower mortality rate compared to national statistics. Conclusions:Newborn screening coupled with PCV13 and penicillin prophylaxis will reduce the mortality of infants with SCD as compared to national infant death statistics in Haiti.