Global Health Reflections with CFHI Alum Meghan Brombach

One of the best ways to get to know CFHI is through the experiences of the students who attend our programs. Here you can find a story from Meghan Brombach, a 3rd/4th year med student from the AT Still University of Health Sciences – Chicago School of Osteopathic Medicine.

Meghan joined CFHI in Bolivia for a 4-week program in order to grow her experience of global medicine and to understand how to prevent and treat infectious disease pathology not common in North America. She was one of the CFHI AMSA Global Health Scholarship recipients.  This award is presented three times annually to outstanding students from the American Medical Student Association who are attending a CFHI program.  I recently had a conversation with Meghan about her time with CFHI and some of her reflections on her journey:

In her blog, available at https://medicinainlapazbolivia.wordpress.com/, she sums up her experience:

“I have seen extreme pain and poverty in this place. I have had days where I didn’t know what to do with what I saw but I have also had days where the beauty has overcome it and I 
have found peace in just being where I am. Within the present moment, devoid of judgement for yourself and others is truly where I believe the most fulfilling life exists and where we learn and grow most. That is also where inspiration exists to see the light and keep pushing through the overwhelming need that exists in the underserved (which is the majority) of our world. I really can’t put into words what this time in Bolivia has taught me, nor how much I have been affected by the kindness and vibrant culture I have experienced here. I leave Bolivia with a deep gratitude for all of the teachers and generous souls who have opened their hearts so widely and shared with me their Andean world.”

A CFHI Reflection for World Refugee Day

CFHI is honored to receive interns from around the world at our offices in San Francisco. This summer we have the pleasure of welcoming Amani Ruiz from Rice University. Amani is passionate about understanding health disparities and exploring how CFHI’s programs can help bring awareness to the social and environmental determinants of health globally. In recognition of World Refugee Day, Amani has written a piece highlighting the important work taking place on her campus focused on the staggering 65.6 million displaced people in the world today.

Hi everyone! I’m Amani Ramiz, a CFHI intern from Rice University.

Since Congress passed the Refugee Act of 1980, America has accepted over 3 million refugees.

For World Refugee Day, I wanted to focus on a project showcased at Rice’s Moody Center of Arts earlier this year: Olafur Eliasson’s “Green Light— An artistic workshop” and a brief history of Houston’s refugee involvement.

Olafur Eliasson’s “Green Light— An artistic workshop”

In this exhibit, local refugees and migrants from various countries, including Afghanistan, Iraq, Iran, Syria, and Cuba, united to build “Green Light” lamps from recyclable and sustainable materials. Rice University was chosen as the first location for this workshop in America, which has now expanded internationally to other countries. The workshops are site-specific, helping refugees transition to their new community.


Pictures 1&2: The green lights are sold as individual units, but can be stacked to form larger shapes.

Green light serves as a metaphorical representation of hope and purpose for refugees, who are celebrated as survivors rather than victims. According to creator Olafur Eliasson, “there is a very strong tendency to see refugees as resourceless. One of the strategies of the ‘Green light’ project is to promote the idea that refugees are also resourceful; they’re full of potential.” (1) This potential serves as encouragement for refugees as they search for work in their local communities.  Refugees are often seen as victims needing aid rather than self-sustainable. They arrive in a new country where they don’t always speak the language, often resulting in miscommunication. The persistence amidst loss and hardship is rewarded with hopes of a better future for their families and themselves. “Green light” serves a green light for refugees that they are protected now, in a country that will try to help them acclimate and follow their dreams. With multiple refugee services in Houston, refugees are provided with resources to transition smoothly into American life.

This artistic workshop is an immersive experience that goes beyond lamp creation. It includes language courses, seminars on cultural displacement, a film screening of a recent release, and initiatives accustomed for the local community. For example, Rice baseball players taught refugees about the American sport of baseball. Sharing tips and practicing pitches with the players, refugees are integrated into the local community and American life. The “Green light” also gives back to the refugee community, with proceeds benefitting local NGOs dedicated to refugee and migrant assistance. The exhibit is currently in Venice until November (2)

Houston- Refugee Center and Most Diverse City in America

The United States received 71 percent of U.N.-referred refugees between 2010 and 2014. Houston welcomes more refugees than any other city in the country. Houston alone welcomes about 25 of every 1,000 refugees, which is more than most nations. If Greater Houston were a country, it would rank fourth in the world for refugee resettlement (3).

Houston began a refugee resettlement program in the 1970s, resettling 200,000 Vietnamese migrants after the Vietnam War (4).  Since then, Houston has welcomed refugees from more than 40 countries.

With Houston’s sustained efforts for refugee resettlement, Rice University was the perfect location for “Green light” in America. The refugee community comes from diverse backgrounds from different countries, time periods, and struggles. Hence, the refugee resettlement is what makes America great. It produces a blend of culture and traditions, the melting pot that America has always been famous for.

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Sources:

  1. http://news.rice.edu/2017/03/27/olafur-eliassons-green-light-welcomes-refugees-to-houston-and-rices-moody-center-for-the-arts/
  2. http://theartnewspaper.com/news/eliasson-s-green-light-to-welcome-refugees-in-venice-and-houston/
  3. http://www.houstonchronicle.com/local/gray-matters/article/The-refugee-who-welcomes-the-refugees-6468958.php?t=5f776781bd438d9cbb&cmpid=email-premium
  4. http://www.sbnation.com/2017/2/1/14473536/super-bowl-2017-houston-refugees-trump-travel-ban

Mabuhay: The Philippines During National Women’s Month

by Ally English
Program Manager, Africa and Asia

Mubuhay!  

As I stood waiting for the bus, I finally found a moment to observe the organized chaos of downtown: honking cars swallowed by traffic, old, grandiose Catholic churches, and the Tagalog language effortlessly melting with English. Amidst the hustle and bustle of this vibrant city, I feel a wave of peace and relaxation.

I continue to wait, gazing down the road, until suddenly my eyes lock on a long, multi-colored jeep that looks as though it has been refurbished from World War II. I soon find out that indeed, it has, and the bus-jeep hybrid rolls past me at a speed slightly faster than a lazy jog. The peculiar vehicle is not at fault for its lack of motivation; the bustling traffic and heat of downtown Manila causes even the most type A personalities to take the back seat…if there is one.

The “jeepney” rolls to a halt and dozens of school children clad in navy uniforms pour out the back with their parents. I gaze at the top of the vehicle and realize that at least twenty young Filipino men with beaming smiles had propped themselves up on the open roof. “Eighteen seats” becomes an irrelevant form of measure, and the most popular method of transportation now proudly holds at least 40 passengers.

I let my gaze fall back to the overfilled streets, and I notice an outstretched arm raised above the splatter of traffic, and a subtle, casual wave.

I see Dr. Joel Buenaventura, CFHI’s warm and passionate Medical Director, emerge from the crowd.

“Ally! Good morning po, and welcome to your second day in the Philippines!”

National Women’s Month

I was lucky enough to visit the Philippines during March. This was a pivotal time of year to visit this vast country of over 7,000 islands, as local Filipinos graciously gathered to celebrate a group of empowering people which has long fought against the repercussions of marginalization worldwide: women.

This March marked the 29th National Women’s Month of the Philippines.

A month traditionally catered towards raising awareness, this year’s focus aimed to turn understanding into action with the theme: “WE Make Change Work for Women.”

The “WE”: Women’s Empowerment. The “Make Change Work”: symbolically abbreviated as MCW, better known in Filipino culture as the Magna Carta of Women, a decades old women’s rights mandate with the goal to end gender discrimination once and for all, and it appears to be working.

In 2011, the Gender Parity Index (GPI) for elementary school enrollment climbed to 1.03, indicating that 103 girls for every 100 boys had enrolled in elementary education. Women excelled in basic literacy and numerical skills, ahead of men by three and four percentage points in each category, respectively.

How does a month celebrating women translate to health?

A demographic health survey conducted by the World Health Organization (WHO) indicated that over 60 percent of women in 2013 delivered their babies in a health facility, either at a rural barangay health station, clinic, or hospital. In comparison, the number of women who gave birth in a health facility a decade prior staggered at under 40 percent. A higher number of women giving birth in health centers allows for a consistent monitoring system throughout pregnancy, less complications during childbirth, and consequently, lower infant and maternal mortality rates.

Additionally, the percentage of women who had access to post-natal care within two days after delivery jumped from 25 percent in 2003 to 65 percent in 2013.

Throughout my site visit, I even uncovered that according to local Municipal Health Officers, there are just as many female physicians as there are male physicians, and that men and women have equal opportunities to pursue careers as nurses, midwives, and doctors.

How do locals celebrate women’s month?

They celebrate with beauty pageants, dancing, coconut festivals, health lectures on self-breast exams, and…pap smears; but not using the same Western methodologies to which many women are accustomed.

During my visit on Quezon, Quezon island, I spent one full, enriching day at a barangay health station (BHS) 45 minutes outside of central Quezon. It was the third farthest BHS from the town center, and took a series of windy dirt paths, muddy rivers, and village crossings to arrive there.

I shadowed Mika, a young, passionate, and knowledgeable nurse who conducted a cervical cancer prevention lecture for the local women from the surrounding village.

While the lecture took place in Tagalog, I followed along with the accompanying images and roaring, knee-slapping laughter of the women as they curiously asked questions and bonded with fellow female friends about this (exciting) new topic.

The second half of the lecture reiterated the importance of cervical cancer screenings, and the women proudly and confidently lined up for a check-up.

Traditional pap smears involve gently scraping the cervix and examining the cells for abnormal growth, testing for the presence of precancerous or cancerous cells.

In low resource settings, studies have found that visual inspection with acetic acid (VIA) is pivotal in assessing the presence of cervical cancer, and results are relatively consistent with conventional analyses. Cervical cancer can be a preventable disease, and VIA is an alternative, low-cost test widely implemented throughout BHS’s in the Philippines.

The women lined the barangay ready for their exams, entered into the system by writing out their names and date of birth, and obtained their cervical cancer screening through VIA.

The reward? Banana-que, of course. Much like barbeque, banana-que is a ubiquitous street food in the Philippines and a famous form of mouthwatering skewered fried banana with brown sugar coating.

We dove head first into plates of banana-que before saying our goodbyes and parting ways.

Women’s month provided a welcoming avenue to address important and sensitive women’s health topics that are otherwise often difficult to discuss. My short time in the Philippines embodied a warm, empowering comradery that I deeply miss since my departure.

This blog details the “Remote Island Medicine Program” in the Philippines.  Learn more about this program and others at www.cfhi.org/all-programs.

CFHI’s place in the 2030 Agenda

By Lyndsey Brahm
Program Operations Manager

There is a certain energy that is felt walking through the doors of the United Nations (UN) in New York City. It’s inspiring being surrounded by so much diversity, in a place where cultures collide for the common good.

As a long time partner of the United Nations Economic and Social Council (UN ECOSOC), Child Family Health International (CFHI) had the honor of being invited to the 2017 Partnership Forum  to engage in the promotion of opportunities to increase prosperity and sustainable development for all. The forum’s theme was “taking action to improve lives”. CFHI has long been a part of this movement and is recognized for its unique approach to community engagement, prioritizing local empowerment through ownership and recognition of expertise, and utilizing an asset-based approach, which draws attention to strengths within the community rather than weaknesses.

Mrs. Mary Robinson, former President of Ireland and High Commissioner for Human Rights, stressed in her keynote speech that, “we cannot achieve anything without partnership. It simply won’t happen.” In conversation amongst foreign diplomats and UN members, the importance of inclusive, bold and innovative partnerships was discussed in order to strive for resilient infrastructure and to honor the Sustainable Development Goals (SDGs), with special regard to vulnerable countries and a changing climate.

CFHI seeks to bridge the gap between the global north and south through sustainable partnerships that allow for communities to take ownership over their own development and to provide a means for those with great promise to remain within and dedicated to their communities. CFHI’s global health education programs highlight local expertise and encourage program participants to understand and value what it means to be a guest in a community other than their own. This approach has the power to shape future collaboration for the better and instills hope in achieving important global initiatives, such as the SDGs.

Toward Planetary Health

By Anne-Gaëlle Jacquin

What could a phycologist (an algae researcher) possibly do at CFHI? If you type this query into an Internet browser, it will probably ask “Do you mean psychologist?“ The link between global health and algae doesn’t seem obvious at first but there are definitely some common threads, specifically around sustainability.

I am a marine biologist. When I was in grad school, there was a daily barrage of news about the unprecedented scale of environmental and ecological damage  to our planet. While working on my PhD in algal biotechnology, what struck me was how algae had so much potential to help mitigate some of our sustainability challenges. Inspired by this, I founded The Algonauts Project in 2010 to chronicle algae innovations for sustainability. I met with more than 150 specialists, whom I call Algonauts, living in over 17 countries. These Algonauts are scientists, entrepreneurs, NGOs, fishermen, farmers and inventors. They develop applications with algae which help with food production, wastewater treatment, environmentally friendly aquaculture, CO2 offset, biomaterials, new medicines and many more innovations. To help spread their knowledge and enthusiasm about algae, I document these innovations and the stories of the Algonauts at www.algonauts.org.

When Dr. Evert, CFHI’s Executive Director, told me about the concepts of Planetary Health and One Health, I wasn’t familiar with them. In the subsequent weeks, the more I learned about these concepts, the more I found myself jumping with the excitement of a breakthrough!

Over the last few years, a common theme has emerged in sustainability science: to reach universal objectives of sustainability and address the complexities of global problems, there is a clear need for transdisciplinarity approaches and an integration of knowledge from experience and from science. The archetypal convention of separating natural and social science in academia had conducted in an incomplete understanding of nature-society interactions and the integrated dynamics of the ‘Earth system’ as a whole.

And often times, in such transdisciplinary work, weaving a compelling narrative across complex disciplines isn’t always possible.

This is where the concepts of Planetary Health and One Health make so much sense – they offer a powerful bridge between very different disciplines – health of the human population and the health of our environment, including animal health. This emphasis on the human health consequences of the degradation of natural systems throws into sharp relief the urgency and fragility of our current situation, and emphasizes that the health of one can not be examined without examining the other.

The concept of Planetary Health, recently formalized through the launch of a new journal, The Lancet Planetary Health, is defined as the achievement of the highest standard of health, wellbeing and equity worldwide. It encompasses a wide spectrum of disciplines for investigating not only the effects of environmental change on human health but also the human systems (political, economic, social) that govern these effects.

One Health recognizes human, animal and environmental health as interconnected and particularly emphasizes the interdisciplinary collaboration between human and veterinary medicine.

CFHI has long been committed to the promotion of Planetary Health and One Health and the diversity of its nearly 40 programs offer students and faculty the possibility to explore these transdisciplinary and integrated approaches and to acquire an intercultural literacy which is also fundamental for sustainability.

Offerings include the “Community Medicine from Rainforest to Coast” program in Ecuador, where students gain exposure to rural and community medicine in both rural and urban settings, exploring chronic, acute, and infectious and tropical diseases. The program provides anthropological insight into indigenous communities by learning the unique worldview of the Shuar tribe and their uses for traditional medicinal plants combined with spiritual practices. In this program, students will learn from local experts about a wide range of environmental disciplines (botany, animal husbandry, forestry, entomology) and the sociocultural and political aspects of jungle preservation.

In Kabale, Uganda, with CFHI’s “Nutrition, Food Security, & Sustainable Agriculture” program, students learn about veterinary approaches developed in the Rabbit Breeding and Training Center in Kabale, exploring how proper care and hygiene for raising rabbits are the grassroots for integrated economic, social and health improvements. Students also learn about ground-breaking integrated approaches for improving food security and nutrition. From primary care clinic to rural communities, students observe and contribute to the implementation of practical solutions in health, farming and education and the positive impact of these programs on maternal and child health.

You can explore CFHI’s offerings in Planetary and One Health here: CFHI Planetary Heath & One Health Initiative

Looking at sustainability through the lens of global health has been a very enriching experience, opening lots of new prospects. I can foresee algae in some of them and can’t wait to explore them further!
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Anne-Gaëlle is a marine biologist from Plogoff, a village in Brittany at the Western tip of Europe where the ocean is all around! In this end/beginning of the land, there is wilderness, quiet, wonderful lights and powerful storms. Anne is fascinated by nature, the universe and life as a whole, from the complexity of cellular mechanisms to human societies. She obtained her PhD from the University of Western Brittany in France and afterwards she felt the need to look at the bigger picture.  She saw that microalgae and seaweeds are fundamental in ecosystems and could play an even bigger role in the future for sustainability. After her PhD, when the reputation of algae was very negative due to green tides, she started a journey around the world to share the wonders of algae.  Learn more about her project at www.algonauts.org

How the World Changed Me in Argentina

One of the best ways to get to know CFHI is through the experiences of the students who attend our programs.  Below is a story from Southern California student, Daniel Sarkissian.
About Daniel
I am a third year neuroscience major at UCLA. I currently do clinical research at the Neuromodulation Division of the Semel Institute of Neuroscience and Human Behavior and volunteer at the UCLA hospital as a Care Extender. After graduation, I plan to take a gap year, during which I will apply to medical schools across the United States. Going into medicine has always been my life goal, and when my biology professor told me about this program and how I would gain valuable clinical exposure, I knew this was meant for me.
Why he chose CFHI
I chose the Hospital Medicine program in Córdoba, Argentina because I wanted to gain clinical exposure shadowing surgical procedures and to explore the beautiful sight s in Argentina. My experience of volunteering at the emergency room is what made me strive to attend this CFHI program, as I wanted to expand my knowledge of global health, how hospitals are run in other parts of the world, and to enhance my Spanish skills. Southern California has a large population of Spanish speaking people, which is also why I chose to go to Argentina, as I would be forced to get out of my comfort zone and speak Spanish on a daily basis. When I first began volunteering at the emergency room at the local hospital in Glendale, CA, one of my notable experiences was translating Armenian, as that is my native language. Seeing this language barrier is also why I decided to go to Argentina, as I would improve my Spanish skills and have a larger outreach to people who do not speak English. The Spanish lessons, both the one on one and the group session, greatly improved my Spanish communication skills. My experience with the Hospital Medicine program in Córdoba was at the Hospital Pediatrico del Niño Jesus, where I gained experience in general pediatric care, surgical procedure, and radiology. I observed over 30 surgical procedures which taught me more about different disabilities and conditions while learning about human anatomy underlying each procedure. I departed Argentina with improved Spanish skills, a greater understanding of their healthcare system and a greater drive to pursue my medical career in surgery.
Reflection on what’s next
The four weeks I spent in Córdoba were undoubtedly the most enlightening four weeks of my life. The general pediatrics unit taught me where to check with a stethoscope for various conditions. When I was shadowing surgeries, some doctors responded to questions and explained the procedure. After seeing all these surgeries and how big an impact each surgery has on the patients’ lives, it reinforced my ambition to become a surgeon. This experience also drove my lifelong ambition to work with Doctors Without Borders, to further broaden my understanding of other cultures and deliver healthcare to all of those who need it. CFHI gave me the opportunity to fully immerse myself in the surgical field and this experience of learning medicine in a totally different culture is invaluable to my future.

Getting One Step Closer to a Unified Global Health Curriculum


The term “Global Health” can be an all encompassing, and sometimes, vague term.  Individuals from the fields of public health, medicine, and more have all defined this term in different ways.  That is why when the Consortium of Universities for Global health convened in 2008, one of the items that members called for was to define the field of global health and standardize required curricula and competencies for the emerging discipline.

We are excited to announce that, as of this week, we are one step closer in providing that definition as the Global Health Competencies Sub-committee of CUGH released a new toolkit that brings together resources from a wide array of subjects and authors in the field of global health.  All this under the leadership of CFHI and our Executive Director, Dr. Jessica Evert.  Thank you for this great effort across dozens of institutions and fields!

Referred to as the CUGH Global Health Competencies toolkit, the resource is designed to help Global Health faculty build curricula and competencies that may stretch beyond their immediate area of expertise.  As the field of Global Health grows in its maturity as an academic field, we here at CFHI are proud to be at the vanguard.

 

Emerging Best Practices for Training Residents in Global Health

By Dr. Jessica Evert
Executive Director, CFHI

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As trainees are more and more senior (think resident physicians compared to pre-health undergraduate students), the questions around the content of their global health training, particularly in clinical settings, are more complex. As residents or young faculty we have more clinical skills and expertise, but does that mean we should use international opportunities to focus on clinical care? Is clinical care as a primary focus of global health activities a sustainable endeavor? What happens when we leave and our clinical skills leave with us? As Michelle Morse pointed out in 2014, residents undertaking global health training and service activities requires a new mind-set (read her great commentary: http://www.pih.org/blog/dr.-michelle-morse-a-new-mindset-for-global-health-training). Its no longer acceptable or desirable for resident physicians from High-Income Countries to use large volume patient opportunities in Low and Middle Income Countries to bolster their clinical encounters or surgical case requirements. We have to do better. Even though residents are still in ‘training’ they have skills that can contribute to the capacity of resource-limited health settings, and often these capacities have little to do with directly providing clinical care to patients.

A new article in the Journal of General Internal Medicine walks residency programs through a thought process on how to create opportunities for residents to engage in global health. The approach is based on four fundamental questions.

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Who are you teaching?

How are you teaching?

What are the goals of your Global Health program?

What are your resources?

The last question is an important one. While many programs aspire to build a wide breadth of opportunities in global health for trainees and faculty, the administrative support can be lacking. For programs with limited resources, it is suggested that partnering with an organization, such as Child Family Health International, as an ‘extender’ of the personnel, relationships, quality improvement, and curriculum necessary to provide thoughtful and impactful global health education and engagement. Residency programs grappling with the opportunities and challenges presented by Global Health are well served by this new publication and the thought process it outlines. Here’s to developing the fundamentals and collaboration necessary for safe and impactful global health training and service!

CFHI Impacts: How Local Communities are Transformed

By Lyndsey Brahm
Program Coordinator

Child Family Health International (CFHI) has always prided itself on fostering honorable and long-lasting relationships with its international partner communities. Communities feel empowered and confident that their partnership with CFHI will contribute substantially to their developmental goals and will pave the way for a promising future. CFHI uses several mechanisms to support its partner communities: global health education programs, research and advocacy, and community health projects.

CFHI Community Health Projects build and reinforce the importance of passion within resource-restricted communities. They use an asset-based community engagement approach that focuses on strengths rather than needs and weaknesses. These projects help to bring solidarity, financial support, material support, and exposure to innovative ideas that are led by local health care workers, community leaders, and other native change agents, thus building local capacity, skills, and fueling passion to create a better tomorrow.

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CFHI is currently supporting seven community health projects within five countries, in addition to professional development opportunities that arise for CFHI partners. In July 2016, Dr. Geoffrey Anguyo and Martin Ngabirano, our local partners in Kabale, Uganda, attended the 21st International AIDS Conference in Durban, South Africa as part of their commitment to fighting high HIV rates within southern Uganda. This opportunity not only provides momentum for their grassroots based initiatives and aims to improve the livelihood the community members, but it also sets an example for incoming CFHI participants to learn from.

The number of mothers and children attending the Young Mother’s Empowerment Center in El Alto continues to rise each year, since opening its doors in 2013. The center now provides a safe haven for six mothers and 10 children, a place where the women can access quality child care opportunities, health care services, support groups for victims of domestic violence, and advice on employment and educational opportunities. The women feel solace is having one another as support and more confident seeking out means of improving their lives and that of their children.

40 traditional midwives-parteras-attended an annual continuing education training in Puerto Escondido, Oaxaca, Mexico this past summer. This 4 day training is hosted each year by CFHI, Northwestern University Feinberg School of Medicine and the Oaxaca Ministry of Health and has been running since 2010. There is a unique energy and fervor amongst the midwives about being able to access educational tools to improve the care they provide for a high percentage of women in Oaxaca’s coastal region.

Midwife Training in Oaxaca, Mexico

Midwife Training in Oaxaca, Mexico

CFHI devotes significant time and energy to honoring the skills, expertise and commitment its international partners have to their own communities. It’s important to recognize the potential of individuals within the communities and those that have an unshakeable determination create positive and lasting change. We salute to that!

Student Spotlight: Ariel

For our newest Student Spotlight we introduce CFHI Alumni Ariel from California. In June this year Ariel chose our program Healthcare Challenges with focus on Hospital & Inpatient Medicine, HIV/AIDS and Global Health Nursing. She went to Cape Town in South Africa for 5 Weeks. A few months after her return, we asked for a short reflection on her adventure:

 

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CFHI Alumni Ariel in South Africa

A little about Ariel:

I am a third year biological sciences major at UC Davis. After graduating from Davis I want to pursue a career in health by becoming a nurse practitioner or PA. Studying abroad was one of the experiences I was most excited for when I came to college. When I heard about an internship abroad opportunity through CFHI it seemed like the perfect fit.

 

Why she chose CFHI:

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I chose CFHI for a number of important reasons to me. First, I wanted to experience living in a new country to really understand the culture and daily lives of another part of the world. I chose Cape Town because the city seemed like such a lively place with so much to do and so much history to learn about regarding Apartheid. The best way to truly get a feeling for another way of life is to immerse yourself in the country’s culture. I had never been to Africa so I was super excited to learn about a new continent and compare the healthcare challenges with the ones we face in the States. Also, volunteering at Community Day Centers and observing procedures at a pediatric hospital in Cape Town were unlike any other opportunities I had had in the past. Through CFHI, I was able to witness healthcare first hand and be a part of a typical day for physicians right in the middle of the action.

What is next for Ariel:

Taking part in a CFHI program opened my eyes to the different fields of medicine and global healthcare. Before I went to Cape Town, I thought I was set on going into nursing. After going through rounds with med students, watching surgeries, and attending lectures and tutorials, the experience influenced me to consider a PA program. Also, it confirmed my inclination that I want to work in pediatrics. I plan on becoming involved with one of the student run clinics at UC Davis to get more experience with patients. If I was given the opportunity after I become licensed, I would definitely work in a hospital in another country for a longer period of time.

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Service Learning and the Strive for Social Justice

by Robin Young
Associate Program Director, Africa and Asia

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As a nonprofit organization offering international health programs to students, is it our job to incorporate social justice into our work?

How can we bring feminist perspectives into our programming?

Does research coming out of “the Academy” in the United States apply to our partners and colleagues in the Global South?

These are the types of questions that were explored at the annual International Association for Research on Service Learning and Community Engagement (IARSLCE) conference, held in New Orleans.

IARSCLE is an international non-profit organization devoted to promoting research and discussion about service-learning and community engagement, aimed to advance understanding of scholarship from international perspectives.

At CFHI we offer service learning components in many of our programs for health students whether it is engaging with an ongoing, locally-led nutrition project in southwestern Uganda, or offering educational trainings to youth in an addiction rehabilitation center in Delhi, India. A lot of what we know about best practices in service-learning come from members of the IARSLCE community.

Mid-wife training in Port Escondido, Oaxaca, Mexico

Mid-wife training in Port Escondido, Oaxaca, Mexico

CFHI has recently played an instrumental role in bringing patient safety (and specifically, service-learning projects in which under-qualified students practice medicine beyond their level of education) into focus within the IARSLCE community, highlighting important tools such as the Global Ambassadors for Patient Safety (GAPS) modules, among others.

This year, CFHI presented a session called “From Research to Practice: Service-Learning in Healthcare Settings,” which allowed us to explore the case for general and program-specific learning competencies; explore the ethics of global health service-learning through the lens of case studies; and climb into best practices that prioritize both patient and student safety in healthcare settings abroad. As is always the case when surrounded by brilliant colleagues, it was an opportunity to share knowledge and resources and continue to think about how CFHI and other program providers can ensure that we are helping students to be prepared for their global health experiences.

Refugees and the Desire for Education

by Caity Jackson
Director of European Engagement

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Unusually hot weather welcomed me to the town where The Beatles famously made their debut. Coincidentally, the theme of the conference was ‘Imagine’, with a strong emphasis of thinking outside of the box and engaging everyone’s imaginative side in relation to European and international education.

But ‘imagining international education’ had a more serious tone this year, with the presence of sessions focusing on refugee education and how to increase inclusivity in all aspects of the recruitment, delivery, and evaluation of the educational process. How are we making international education possible for all?

This year, the EAIE conference held a track focusing on refugee education, in an attempt to address and respond to the refugee crisis in Europe. These 13 events focused on fair admission, recognition of international educational attainments, and how Germany is responding to the influx of refugees through intercultural certifications and integration programs.

Not only being represented through sessions and posters, refugee education wove itself into the opening and closing plenary of the entire conference. Kilian Kleinschmidt began his keynote address with harrowing figures: 1.2 million people have been displaced from their homes over the last year, with the total budget available for all aid, including refugees, natural disaster assistance, etc, worldwide, adding up to approximately US$20 billion. “Compare that to the money spent on real estate development and you understand why aid is the wrong concept. Aid is an arrogant concept of charity”, Killian asserted.

Photo by: Russell Watkins/Department for International Development

Photo by: Russell Watkins/Department for International Development

‘Imagining’ again that education for all is within our grasps, sessions focused on overcoming the barriers international education recruiters/marketers, administrators, and alumni coordinators face when it comes to a mobile population. How can we value our prospective and current students and erase the dollar sign universities associate them with? How can we increase diversity on campus while ensuring students have all the services they need to succeed at their fingertips? In only a few days, participants left with imaginative answers, if not even more questions to guide their work.

Diversity has always been a focus of the work that CFHI has engaged in. We imagine a world in which there are no barriers to the enriching experience cross-cultural learning can give. Our many scholarships aim to address these barriers and we are proud of the breadth of diversity in our scholarship applicants and successful candidates and we are honoured to walk side by side with our partner organizations.

Wrapping up this event that saw over 5000 professionals from over 90 countries gather in the spirit of increased global cooperation, Melissa Fleming of the United Nations High Commissioner for Refugees (UNHCR) told stories of those that our work has not reached. These stories from some of the most dire situations of the world, where the hunger to learn is beyond any of our comprehensions, was the inspirational closing we needed. Melissa began her talk with an account of her experience taking her own daughter through the steps of studying in France. She then told us about Esther, a young refugee whose main aspiration is to become a neurosurgeon. The contrast, in terms of opportunities for these two equally young and motivated women, is evident. If education offers life opportunities, why are we failing to provide this to those who need it most? As Melissa put it: “my daughter’s future is in her hands, Esther’s is in ours.”

Looking forward from the 21st AIDS Conference

By Lyndsey Brahm
Program Coordinator

AIDS 2016 began in earnest as public health officials, policy makers, civil society leaders, dr-geoffreypersons living with HIV/AIDS and others committed to ending the pandemic, converged to collectively assess the global AIDS response and to roil the assembly into accessing equity rights now, the conference theme that resonated throughout the Durban International Convention Centre for five eventful days. Those in attendance, including UN Secretary-General Ban-Ki-Moon, UN AIDS Director Michel Sidibé, KwaZulu-Natal Premier Willies Mchunu, and His Royal Highness Prince Harry, were called to redirect attention to vulnerable populations and scale up prevention and treatment for women, girls and youth.

Child Family Health International (CFHI) is a fierce advocate for local capacity building within our partner communities across the globe. One mechanism used to support this effort is through funding of professional development opportunities for our international partners. CFHI Local Medical Director in Kabale, Uganda, Dr. Geoffrey Anguyo, and Founder of Kigezi Healthcare Foundation (KIHEFO), CFHI’s partner organization in Kabale, attended the conference along with his colleague, Martin Ngabirano, Volunteer Projects Coordinator at KIHEFO.

Dr. Anguyo specializes in HIV/AIDS. In more than twenty years of practicing medicine in Uganda as a primary care physician, in private and government hospitals and through non-profit healthcare delivery, he has devoted himself to the cause and inspired his team at KIHEFO, as well as members of his local community, to join the march. Dr. Anguyo is pursuing a Doctorate of Public Health at Bath University in the United Kingdom with a specialization in HIV/AIDS.

“It was a very great opportunity for me to attend the 21st international conference on AIDS supported by CFHI. I was able to interact with many international scientists and organizations on the KIHEFO version of community engagement in managing HIV/AIDS using integrated and sustainable approaches,” remarked Dr. Anguyo.

UNAIDS (http://www.unaids.org/en/regionscountries/countries/uganda) reports that 7.1% (% of population ages 15-49) of Uganda’s population in 2015 suffered from HIV, nearly 1.5 million people, 96,000 of whom are children aged 0-14 living with HIV. 28,000 people in Uganda have died of AIDS and 660,000 children (age 0-17) were orphaned due to AIDS.

dr-geoffrey-martin“I was honored to be able to connect the leading industry decision makers and get their commitment to join our efforts to step-up public health through volunteering among others. Dr. Anguyo and I were able to learn trending research findings and targets and share KIHEFO’s renewed commitment to contribute to ending this deadly disease by 2030,” commented Martin Ngabirano, reflecting on his experience during the conference.

The conference has provided Dr. Anguyo and Martin with a unique set of tools and an expanded network within the global HIV/AIDS community to continue their efforts with renewed strength and a fresh perspective back home in southern Uganda. They plan to engage CFHI participants in these efforts, which will prove to be a valuable learning opportunity for those who take part in either of the two program tracks offered in Kabale (link to programs).

“I was involved in discussions to promote comprehensive sexuality education as a tool in decreasing HIV risk factors in adolescents and young, including creating demand for sexual reproductive health. I am now applying this knowledge to create youth groups and use peer approach to get more young people involved in decreasing HIV risk factors. We plan to engage more CFHI students in this activity to promote cross-cultural approaches in decreasing HIV risk factors in young people in the coming months,” said Dr. Anguyo.

Martin commented excitedly, “The conference has renewed my confidence in working with available resources both local (our nature and wildlife) and beyond borders, like CFHI participants, to inspire us to change our lives.”

Quality End-of-Life Care in the Face of “A Global Moral Failing”

“Modern medicine’s focus on mastering each part of the human body and the diseases that make them malfunction has generated remarkable power to sustain life. But this focus… has neglected the dying and their suffering, as if repressing a shameful secret.” (1)

Dr. Raj conducting a home visit, Trivandrum Southern India

Dr. Raj conducting a home visit, Trivandrum Southern India

This “shameful secret,” revealed in the 2015 Quality of Death Index (2), is

no secret to Dr. M. R. Rajagopal, co-author of a new piece in the Lancet that reviews the 2015 Index. As the founder and Chairman of Pallium, India, he has brought palliative care to the fore in India through education, advocacy, and service provision. Through various initiatives, he has dramatically expanded access to palliative care in India’s state of Kerala and beyond.

Dr. Rajagopal and Pallium, India, are CFHI partners and offer CFHI students the opportunity to learn firsthand about palliative care in Kerala.

Ms. Hema and Dr. Raj on home visits Pallium India

Ms. Hema and Dr. Raj on home visits

The 2015 Index findings indicate that poor countries can, under the right circumstances, offer effective palliative care. The authors point out that while most of the top scorers in terms of palliative care provision are high income countries, several low and middle income countries (for example, Mongolia and Uganda) did score much better than certain high income countries such as Russia and Saudi Arabia. Findings in the report also indicate that investment in palliative care can actually save money for healthcare systems in the long run.

Despite notable limitations in the 2015 Index (lack of a comparable instrument for validation; the fact that it excludes countries from the study which offer no palliative care services whatsoever, to name two), the authors offer this conclusion: “The 2015 Quality of Death Index is an insightful and credible effort that laudably calls attention to the woefully inadequate care for some of the neediest and most vulnerable patients across the world, those near the end of life.”

Many thanks to Eric L. Krakauer and M. R. Rajagopal for drawing attention to this critically important issue that affects millions, and will become increasingly pressing as more of the world’s population lives longer and with a higher  number of non-communicable diseases.
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  1. Eric L Krakauer, M R Rajagopal, www.thelancet.com, Vol 388, July 30, 2016, page 444
  2. Economist Intelligence Unit. 2015 Quality of Death Index: ranking palliative care across the world. https://www.eiuperspectives.economist.com/healthcare/2015-quality-death-index

CFHI Student Spotlight: Madison

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(CFHI Student, Madison, Pictured on the left)

A little about Madison:
I graduated from Washington University in St. Louis and will be starting medical school this August at Upstate Medical University. I heard about CFHI as an undergraduate when a representative from CFHI came and spoke at my school. After deciding to take a gap year between my undergraduate years and medical school, I thought a CFHI program could be a perfect way to bridge the gap between my undergraduate experience and the beginning of medical school.

Why she chose CFHI:
I chose the Primary Care and Social Medicine program in Córdoba, Argentina becauseargentina of both the location and the focus of the program. My time working in the Emergency Room during my gap year had made me acutely aware of the necessity of learning Spanish and the importance of primary care. Everyday, I saw patients who used the Emergency Room in lieu of a primary care provider, patients who were born into a system where structural violence had stripped them of access to quality preventative care. The Primary Care and Social Medicine program in Córdoba allowed me to explore primary care in another country while simultaneously improving my Spanish. The one-on-one Spanish lessons combined with complete Spanish immersion greatly improved my ability to communicate in Spanish. I left Argentina with a deeper commitment to medicine, to global health, and to communication.

Reflection on what’s next:
Screen Shot 2016-07-21 at 6.13.00 PMAs an Anthropology: Global Health and Environment major at Washington University in St. Louis, I enjoyed applying an anthropological lens to global health issues and studying the complexities of global health issues and policies played out on a local level. CFHI gave me a valuable opportunity to immerse myself in another culture and see those complexities firsthand. Ultimately, my hope is to be involved in initiatives that will reduce the number of premature babies, combat the many adversities associated with prematurity, and improve medical care for people with disabilities. I know I will take what I learned from CFHI with me as I continue along the path to become a physician and work toward those goals.

When Public Health and Clinical Health are One: Remote Island Medicine in the Philippines

by Robin Young
Assistant Director, Africa & Asia

Medical students often tell me that they are focusing so intensively on the science of health that they forget to see the person behind the pathology.

IMG_5046That won’t be a problem when you complete CFHI’s Remote Island Medicine program in the Philippines.

I recently returned from a visit to this program, and it was clear that while you are in the Philippines, every day and every moment spent interacting with patients and healthcare providers will remind you that clinical and public health are inextricably linked; that social factors so often determine health outcomes.

As a program that focuses on remote and rural healthcare, these links are intrinsic to the work, but it’s the local team that really provides the insight and reflection for CFHI’s participants in this program. The CFHI Philippines team is a group of passionately committed doctors, all of whom are currently or have in the recent past served as medical officers on remote islands. In many cases, they have served as the only doctor for miles; though they will be the first to tell you that their teams of nurses and midwives are highly skilled and serve as a critical first line of care and response for the local community. They believe firmly in the right to free, high quality healthcare for all, and they have devoted their lives to bringing that reality closer, both in the clinical setting and also by participating in advocacy work with the International People’s Health University, and the People’s Health Movement..

Before traveling to the remote islands, you’ll spend a week in Manila visiting the WHO IMG_5290offices, local NGOS, and other sites that provide context for the healthcare system in the Philippines. You’ll visit the public hospital in Manila where healthcare is meant to be freely available to all, but in reality, most people have to pay for elements of their care. In the hospital, you’ll learn how changing diet and a more sedentary lifestyle are leading to a dramatic increase in non-communicable diseases (NCDs) including diabetes and heart disease, reflecting a global trend. You’ll see the effects of public health initiatives that require breastfeeding and institutional birth. Through your local team, you’ll learn that many people at the hospital in Manila have come from far away to seek care and treatment: Sometimes, whole families make the trip to Manila, in order to support a sick relative. Often, they come all the way from one of the 7,000 islands in the Philippines.

Next, you’ll head out to your assigned island, either Quezon, Quezon, or Tablas, Romblon. In these remote settings, accessible only by boat or air, you’ll work alongside the Municipal Health Officer to learn about key public health initiatives including immunization and deworming campaigns, breastfeeding, and education to help families recognize danger signs during pregnancy. You’ll also shadow nurses as they treat patients at the health center or health station, managing everything from labor and delivery, to diabetes and heart disease, to severe trauma. You’ll experience every stop along the referral chain, learning about the possibilities and limitations of the system as you go.

By the time your wrap up your weeks on the island, you will have heard many stories that remind you of the links between clinical and public health work. You’ll see families who have to spend their small savings to travel to the mainland for treatment. You’ll observe the highly effective tuberculosis treatment centers, which are structured to help people complete their treatments (even after they feel better, and might be inclined to stop taking their medicine), and has drastically reduced TB on many islands in the Philippines. You’ll see cases that are intimately linked to the realities and the livelihoods of island life, such as farming and fishing. You’ll learn about traditional healers and beliefs, and how the healthcare system has made strides toward including traditional healers and birth attendants in its work, rather than alienating them.

I think Jennifer Harter, a recent participant in the program, summed it up best when she said: “There is a visible connection between all aspects of the healthcare system from public health at the international level (WHO) to the rural barangay health stations at the community level. I saw how each sector interacts and the roles each play. It is hard to explain, but trust me when I say it is truly fascinating.”

Celebrating the 7th Annual Traditional Midwife Training

by Lyndsey Brahm, Program Coordinator

You could feel the afternoon heat of Puerto Escondido’s tropical sun blazing through the open-air patio that overlooks a precious slice of Oaxaca’s coastline. The fans provided little relief from the thick air, nor did the ocean breeze coming off of Puerto’s infamous Playa Zicatela. But the heat and subsequent lethargy were no match for 37 practicing midwives (parteras tradicionales), 6 medical students from Northwestern University Feinberg School of Medicine, CFHI participants and staff, and clinical and public health officials from the Oaxaca Ministry of Health who joined forces for the 7th Annual Traditional Midwife Training in Puerto Escondido, Oaxaca, Mexico.

IMG_2956This CFHI community health project is a shining example of the value of reinvesting in host communities and the importance of collaboration, welcoming diversity in our interactions, and connection amongst people of different cultures; all of which represent values CFHI has long held in high regard. The curriculum for the training is prepared by the coastal region branch of the Oaxaca Ministry of Health and addresses safe birth techniques, detection of warning signs, knowing when to refer to a physician, appropriate care for a newborn, etc. The training is then delivered by Northwestern University medical students entirely in Spanish. Even though the midwives are receiving the training they are also very enthusiastic about sharing their expertise and the traditions that have maintained their virtue across generations.

It is an extraordinary opportunity for each midwife to take part in the 4-day training in Puerto Escondido, especially those traveling from remote villages of Oaxaca’s coastal region. This year 37 midwives attended, several of whom returned from previous years and quickly showed leadership within the group. The midwives are selected according to location, the goal being to invite those spanning a large geographic area, and the number of births they attend to, a statistic reported to the Ministry of Health by a practicing physician within each community. The midwives are often leaders within their communities and held in high esteem. They return to their villages and share knowledge and resources gained during the training.

DSC00107Two of the midwives braved the Oaxacan sun and traveled on foot for 4 hours to reach Puerto Escondido after catching a bus from their villages. You could see the determination on their faces to make the most of this professional development opportunity.

It is programs such as this that CFHI takes pride in supporting year after year. One that impacts the community by giving them the tools to take ownership of their own future.

CFHI Student Spotlight: Ross – Reproductive Health, Quito Ecuador

CFHI student spotlight showcases students who have been and are working in one of our many programs . This is a feature where we highlight the students’ experience, if you would like to be featured please contact CFHI’s outreach director Keaton Andreas via email Keaton@cfhi.org. 

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Ross is involved in Pace University’s Physician Assistant program. He is interested in Women’s Health, Primary care/preventative medicine, and pediatrics. He selected the Reproductive Health rotation in Quito, Ecuador, because he is around spanish speaking patients back at home and wants to be able to speak to his patients in whatever language that makes them most comfortable.

 

 

 

  1. What school did/do you go to?  Pace University’s Physician Assistant Program
  2. How did you hear about CFHI? It’s the international rotation provider my school works with.
  3. What areas are you interested in regarding medicine? Women’s Health, primary care/preventative medicine, pediatrics
  4. What program are you in and how did you determine that was the right one for you? Reproductive Health rotation in Quito Ecuador;  I selected this program based on my interest in reproductive health and my desire to improve my medical Spanish.  I live in NYC, where many patients only speak Spanish, and I want to be able to speak to my patients in whatever language makes them most comfortable.
  5. What were your expectations for the trip and how have those matched up with reality? My expectations were that the rotations would be largely observation with the opportunity to take histories and present patients in order to practice discussing patients in Spanish.  My expectations have been surpassed.  I have rotated through very different locations in OB/GYN, emergency medicine, and primary care, giving me exposure to a diversity of medical situations.  
  6. What has been the best part of your experience so far? The best part is definitely the cultural immersion, which also happens to be the most difficult part.  The discomfort of being in a totally new place is what forces you to adapt.  It is absolutely the reason my Spanish has improved so much.
  7. Who are you working with? Depending on the location, I have mostly worked with the attendings.  At one of the sites, I was matched with a resident, which was a nice opportunity, as they usually do more procedures.
  8. What is the overall goal of your program? My overall goal was to improve my medical Spanish.
  9. What is your overall goal? What do you want to accomplish through your program? Same ^ [Same answer as the previous question]
  10. What are some cultural things you have learned? The primary cultural difference I have noticed, at least medically, is that family is prioritized by patients over everything, including privacy.  This is definitely different in the U.S.  We learn that in order to get an honest history it is best to talk to the patient alone.  That is often not an option here.  It is interesting that people have such a level of comfort regarding their personal medical details, definitely surprising at times.

Photo of the Week FAQ

thumbnail_1 CFHI wants to help you share your one of a kind moments from your program! We are excited to be starting a ‘Photo of the Week’ contest where we will select a winning photo every Friday of the week. Entering your photo is simple, just tag us on Facebook and or Instagram @CFHIglobalhealth and use our hashtag #LetTheWorldChangeYou. Just take a quick look at our Social Media Ethics and our Photo Contest guidelines.

ATTENTION ALL ALUMNI: We also want you to share your past experiences with us, you are encouraged to post any past photos! Just use the hashtag #LetTheWorldChangeYou, #TBT, and tag us @CFHIglobalhealth, your photo could be featured in a Throwback Thursday post!

FAQ

How long does the POTW contest last?

The Photo of the Week contest is a summer event that CFHI is running for 8 weeks over July and August  of 2016. Individuals can tag their photos they take/took while partaking in one of CFHI’s 30+ programs. Every Friday starting July 1 – August 26, we will announce a ‘Photo of the Week’, or a photo we felt best represented CFHI’s motto of ‘Let The World Change You’!

How do I enter?

This is an online social media contest therefore you are automatically entered by posting a photo and tagging us in it instagram @CFHIglobalheath or by tagging ‘Child Family Health International’ on Facebook. You should also use the hashtag #LetTheWorldChangeYou!

Where can I post?

We will choose the POTW winner based on Instagram and Facebook posts. However, you are free to post on any social media site (Twitter, LinkedIn, etc.), just remember to tag us!

What are you looking for in a winning photo?

We want to show what it is like to be a participant in CFHI’s worldwide programs! We are looking for photos that best represent you and your program, the work you are doing, and the experience you are having. We know that there will be many interpretations of this and we are so excited to see what you come up with!

What can’t I post?

Please refer to our guidelines below for instructions on how to be a conscious photographer. You cannot post any photo that exploits or misinterprets people, places, and situations you are in. For greater detail, please refer to our Social Media Ethical guidelines here

Can I win more than once?

With over hundreds in our summer programs and 8,000+ alumni, we want to be as fair as possible and see different people from different programs each week! However, it is possible to win more than once, just not in a row. So share as many photos as you would like!

What if I want to share old pictures?

We absolutely want to see and feature alumni photos too! Just post on instagram, tag us in the photo (@CFHIglobalheath), and use the hashtags #LetTheWorldChangeYou and #TBT so we can select your photo for a throwback Thursday special mention!

Do I get a prize?

Gloating rights and a sweet congratulations card from CFHI, what more could you want! 😉 All winning photos will be used throughout our social media channels and maybe even in our future promotional material, you famous photographer, you!

Where will you feature my photo?

We will feature your photo on Instagram, Facebook, and might use it for other promotional purposes throughout the year. Each time we do, we will tag you or make sure to credit you and your great photographic skills!

  

CFHI Bolsters Staff With Advocacy Expertise

Child Family Health International is pleased to welcome Keaton Andreas as Director of Outreach.  Keaton brings to CFHI a passion for advocacy and community organizing having honed his skills as Campus Campaigns Organizer for Universities Allied for Essential Medicines. CFHI Board Chairman, Gunjan Sinha, reflects “it’s exciting to hire someone with a community-building approach to our outreach position.  Keaton’s unique point of view will allow CFHI to expand the thought leadership community that CFHI has been nurturing for nearly 25 years.”  

keaton_bio_picKeaton will expand CFHI’s advocacy training for CFHI scholars and alumni in order to meet CFHI’s mission of creating changemakers through programs that emphasize the strengths in communities abroad often noted for what they are lacking. Keaton received his Master’s in Intercultural Studies from Fuller Seminary in 2011.  Fuller Theological Seminary is one of the United States most influential institutions of its kind with over 4,000 students representing 90 different countries.