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.

Ethical Dilemmas in Global Internships: Lessons from the GIC 2016

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by Robin Young
Assistant Director, Africa and Asia

“The first year that the Northeastern Students came to the Tunaweza Children’s Centre in Uganda, it was wonderful!” shares Titi Pamela Kakonge, founder of the Centre, which offers a range of therapies for children with disabilities. “But then they left, and all the local parents withdrew their children from our school. They thought that since the Mzungus (white people) had gone, the program was over.”

The vacuum left by the departing students was gaping, despite the fact that the Centre was led and staffed by a robust local team. After that, Ms. Kakonge and Northeastern University worked together to find ways to ensure that the community saw the local staff as the leaders and the teachers, not vice versa. Today the Centre runs year-round, successfully receiving interns from Northeastern and other institutions, with clear local leadership and well-defined job descriptions for the physical and speech therapy interns.

I heard Ms. Kakonge speak at the Global Internship Conference in Boston earlier in June, at a session titled “Tunaweza Children’s Centre- We Can: An Interprofessional, International Partnership with Northeastern University’s Bouvé College of Health Sciences.”  Ms. Kakonge founded the Centre while searching for adequate care and services for her daughter who was born with disabilities. The challenge that she highlighted above has been well documented.

Pamela Roy, Farzana Karim-Haji, and Robert Gough call this the ‘revolving door’ nature of exchange between students and hosts, and propose several ideas for host communities to address this ethical dilemma, all of which Northeastern is now utilizing. They suggest making certain that students are sufficiently prepared for the experience, taking steps to ensure that host community needs are truly being met through the internship, and equipping students to listen, observe, and learn from the host community.

During their session at the GIC, Roy, Kaim-Haji, and Gough, drawing on their experiences at Aga Khan University, Western University, and the Consultancy for Global Higher Education, highlighted a new, open-access resource they have developed, titled “Building Ethical Global Engagement with Host Communities: North-South Collaborations for Mutual Learning and Benefit.” In it, they compile recent findings and summarize the ethical dilemmas that challenge all of us who engage in North-South Global Internships, including mobility inequality (in which students from the north have more access to the south in terms of professional development and career opportunities than vice versa); exploitation of the host community as research participants; and unethical marketingand advertisement to promote global internships, to name a few. The resource offers definitions of these dilemmas and offers a series of recommendations that can help all of us in the field to improve our global internship offerings.

At CFHI, we’re always thinking about how to offer internships that, to quote a recent publication on short-term global health experiences, “Optimize community benefit and learner experience.” From where we stand, an internship should only take place if we can ensure that it benefits, within an ethical framework, our partners around the world, as well as the intern.  We do this by engaging in fair trade learning practices, ensuring that our partners are fairly compensated for their work and have substantial leadership and input into all internships and programming; by requiring our participants and interns to complete the Global Ambassadors for Patient Safety modules, preparing them to engage in ethical medical practice that prioritizes patient safety at all times; and by inserting interns into existing healthcare and social service systems, with local leaders who focus on assets rather than deficits in their communities. I had the opportunity to share some of these resources during a session at the GIC alongside Moira Mannix Votel, Associate Co-op Coordinator & Director of Cooperative Education at Northeastern University’s Bouve College Cooperative Education.

At CFHI, we strive to close the ‘revolving door’ referred to earlier.  It is important to us to create leaders for the future who understand a larger view of the world beyond their own.  We are continuously pushed and encouraged by the input of our colleagues in this field and look forward to moving this conversation forward at any opportunity.


Rorobinyoungphotobin joined the CFHI team in 2015. As Assistant Director, Africa and Asia, she provides program management and support for CFHI’s programs, helping to ensure program safety and quality, best practices in international education, and strong institutional and global partnerships. Robin’s professional background includes extensive work in international education, global health, and asset-based development. Robin holds an MBA from Florida International University and a BA in Sociology/Anthropology with a minor in Ethnic Studies from Lewis and Clark College. She completed a course at the Summer Institute for Intercultural Communication, helping to inform her interest in increasing intercultural competency in global work and education, and subsequently co-authored the Cultural Detective Dominican Republic series. Robin received a Fulbright Fellowship grant in 2007 and spent a year researching gender-based violence in the Dominican Republic, where she ended up living for nearly 5 years. Robin is passionate about supporting thoughtful, ethical and asset-based strategies to address health disparities and support underserved communities. She lives in the Bay Area and loves backpacking, riding her bike, and spending time with family and friends.

 

A Recap of CFHI’s Time at PEGASUS 2016

Pegasus-logo

CFHI was proud to send their Program Coordinator, Lyndsey Brahm, to the 2016 PEGASUS Conference that took place in Toronto over May 13th to 15th.  PEGASUS is an acronym derived from the conference’s three main themes of peace, global health and sustainability. Leaders, change-makers, professionals and students from multiple disciplines convened to share their expertise in research, education, field experiences, advocacy and policy in order to address unacceptable levels of poor health nationally and internationally.

CFHI hosted a workshop on asset-based community development (ABCD) and introduced our vision into how recognizing assets within a community as opposed to what is lacking can prove to be a successful global engagement approach and can lead to communities feeling more empowered. CFHI has numerous partnerships throughout ten different countries and prides itself on fostering sustainable relationships and not being “fair weather friends.” We want the communities we work with to take ownership of their own development and to be enthusiastic about sharing their expertise with our global health scholars who come seeking new perspectives in health and medicine, outside of their own system.

Program Coordinator, Lyndsey Brahm asserts, “We want people to challenge their way of thinking and to see past what may initially appear as image2chaos and devastation; to lend time towards learning about innovative ideas already in place and community strengths that are critical to overcoming health challenges that persist within their community.”

A buzz was in the air as this thought-stimulating conference carried on throughout the weekend. One presentation that stood out from our perspective belonged to Matt DeCamp, Assistant Professor at the Johns Hopkins Berman Institute of Bioethics and in the Johns Hopkins Division of General Internal Medicine. He spoke on the subject of global health ethics, encouraging students and trainees to go abroad for longer, and the development of appropriate pre-departure materials. He shared his experience about a global health trip he undertook as a medical student at Duke University, where he faced challenges cultural differences and was exposed to human rights. He remembers feeling unequipped and under prepared to deal with such circumstances. He now contributes to the development of adequate pre-departure materials for those seeking an international health experience and runs focus groups for returnees at Johns Hopkins University.  CFHI recently gave a webinar on this very subject.  Which is available by clicking here.

CFHI was excited to be a sponsor for this year’s PEGASUS conference.. It is a valuable space for CFHI and others within the field to challenge one another and generate new ideas, actions and policies to improve the health and well being of the world’s citizens, whether on a small or large scale. The commitment is fierce.

The Joys of Motherhood: Sharing CFHI’s Impacts with my Children

Mother’s Day post by Jessica Evert, MD, CFHI Executive Director

It’s been said that “having kids- the responsibility of rearing good, kind, ethical, responsible human beings- is the biggest job anyone can embark on” (Maria Shriver). The challenge of mothering is monumental, yet there are precious pieces of this world that aid us in the journey. For me, one of those pieces is Child Family Health International (CFHI). IMG_7937 Jess & the kids

Through my involvement with and support of CFHI, my daughter has come to learn about a world beyond her imagination and comfort zone. I have been able to support mothers in 10 countries; community leaders who are passionate about making those struggling in their midst better off; and young people who are embarking on a transformative experience abroad that will raise their consciousness of global citizenship and make them feel a “a little softer about places that are not as economically well off,” as one CFHI Medical Director put it.

The day in and day out of mothering is a frequently overwhelming cacophony of whining, laughter, hugs, and shrugs. There are moments that intersperse our daily routine and allow us to expand our children’s worldview. These moments make us feel like super mamas. Through CFHI I am able to be the mother I want to be for my children and the children of the world.

Although my financial support of CFHI is modest, it is steady. Through this steady giving to CFHI, I am confident I am contributing to a better world. Through modeling generosity for my children, I am confident I am shaping the kind, ethical, responsible humans that I hope they will become.

International Women’s Day 2016: Celebrating CFHI’s Inspirational Women in Global Health

CFHI is proud to have worked with many talented and empowered women in global heath, who are inspiring change in their local communities. Please join us in celebrating some of these truly remarkable women.

Isabel SaucedoDr. Isabel Saucedo
CFHI Medical Director Puerto Escondido, Mexico
Dr. Isabel Saucedo has been a vociferous champion of women’s reproductive health throughout her medical career. A consummate health professional and mother of two, Dr. Saucedo manages domestic violence training programs for women, as well as maternal care. She was also the catalyst for kick starting the Traditional Midwives Training program in Oaxaca, set up in collaboration with the local Ministry of Health. We are grateful to have her as a partner and friend and wish to see her continue her work in the local community.

Hema PandeyHema Pandey
CFHI India Director
Hema recently celebrated her 10-year anniversary with CFHI, and what a journey it has been. She has been instrumental in expanding CFHI’s programs across India, and today she manages 8 thriving programs that address health topics such as maternal and child health, traditional medicine, chronic disease, and palliative care. She has worked tirelessly to gain the respect of her peers and excel in what is a highly male-dominated profession. We are very fortunate to have worked with Hema throughout the years – and here’s to ten more years to come.

Cecila UribeDr. Cecilia Uribe
CFHI Medical Director La Paz, Bolivia
A dedicated pediatrician, Dr. Cecilia Uribe has been committed to serving the underserved women and children in her local community. Observing an unfortunate trend in La Paz for single mothers to fall into a vicious cycle of poverty, Dr. Uribe responded by creating a safe haven for young mothers. The Young Mother’s Empowerment Center (EMJ) is a place of hope where these women can get back on their feet through easy access to education, vocational training, and child-care. Dr. Uribe has left an indelible mark on the well being of her community and we are so proud of her achievements.

Susana AlvearDr. Susana Alvear
CFHI Medical Director Quito, Ecuador
Dr. Susana Alvear is a family physician from Quito who has dedicated her life to improving the local healthcare system in Ecuador and creating equitable access to healthcare, especially in poor, underserved communities. As a CFHI partner, she has been a staunch advocate of empowering local medical professionals, and giving them the training and resources they need to better serve their people. We are truly inspired by Dr. Alvear’s passion for helping those who suffer extreme poverty, discrimination, hunger, and illness and we hope that you are too.

Avril Whate 2 (1)Avril Whate
CFHI Medical Director Cape Town, South Africa
Avril Whate is a Nurse Practitioner who supervises one of CFHI’s most popular programs in Cape Town, South Africa. She has been with CFHI since 2004, has worked with the Provincial Health Department for over 20 years, and remains a strong advocate of public health programs. Avril makes a tremendous effort to ensure that our students have a fulfilling experience during their time in Cape Town, and enjoys learning about global health concerns and their impacts on the community. We have really enjoyed working with Avril, and her commitment to our students and health programs is truly admirable.

Magaly ChavezDr. Magaly Chavez
CFHI Medical Director Oaxaca City, Mexico
Raised in a small rural town in Oaxaca, Mexico, Magaly cherished the seemingly impossible dream of one day becoming a female physician. However, through hard work and perseverance, she went on to become the first doctor in her family, as well as the first female doctor in her hometown. Today, Dr. Magaly Chavez manages CFHI’s Health Access and Inequities program in Oaxaca. Dr. Magaly’s strength and determination serve as an inspiration to so many women so are striving to achieve gender parity in male dominated societies and professions.

 

Hasta pronto, Córdoba

Sophia Alvarado is a pre-medical student at Diablo Valley College and a member of the American Medical Student Association (AMSA). Sophia received a scholarship to participate in CFHI’s Global Health Intensive Program, Hospital Medicine in Latin America, in January 2016. The following is an excerpt from her blog. This post was originally published on January 15, 2016.

IMG_8938Everyday in the hospital was a new and fun experience for me and I am so happy that I decided to come to Córdoba and participate in the Hospital Medicine program through CFHI. I have had the opportunity to see and learn things now that back home I might not have seen until the end of medical school or even until residency. All the people I got to meet and talk to have been so great and helpful. Overall, my time in the hospital surpassed all my expectations and I hope that I can come back soon.

I want to say thank you to everyone at CFHI in California and everyone at ICC and the Hospital de Urgencies here in Córdoba. This experience was so amazing and I will cherish the time that I have had here for the rest of my life. Leaving Argentina is really bittersweet but this is definitely not the last time that I will travel to this amazing place. Again, thank you to everyone involved in this program – words cannot fully express how much I have enjoyed my time here and how truly sad I am to go.

Read more from Sophia’s blog at http://californiatocordoba.blogspot.com/.

 

Traditional Healer

Courtney James is a Senior Resident in Baton Rouge, LA and a member of the American Medical Women’s Association (AMWA). Courtney received a scholarship to participate in CFHI’s program Exploring HIV & Maternal/Child Health in Kabale, Uganda in November 2015. The following is an excerpt from her blog “CFHI Uganda Experience.” This post was originally published on December 29, 2015. 

I visited the Traditional Healer during my stay. You can’t fully understand health in Kabale without discussing the Traditional Healer’s role. I believe they quoted a percentage of about 90% of Ugandan natives have utilized the traditional healer at some point in their lifetime. The healer is sought for a multitude of ailments such as malnutrition, allergies, arthritis, GI issues, sexual dysfunction (hahaha). He has so many different herbal remedies that he prescribes for each issue.

img_42551KIHEFO has respectfully bridged a partnership with the healer in hopes that the two entities can coexist without disregarding the other. KIHEFO has provided education to the healer regarding complex cases that should be referred for medical intervention, especially Malnutrition. So many people believe that malnutrition is due to a curse and therefore they seek the healer’s herbal remedies in hopes of curing the child. This is very dangerous and unfortunately some families seek medical treatment when things are severe. Since KIFEHO has started communicating with him the healer does sometimes refuse to treat complex cases and KIHEFO has seen a reduction in the severe cases that present to the Nutrition center.

Read more from Courtney’s blog at https://cjglobalhealth.wordpress.com/.