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. KIHEFO 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.
This past year, CFHI opened new programs in Ghana, Tanzania, India, Uganda and the Philippines. We welcomed new staff members, collaborated with like-minded organizations like Better Volunteering, Better Care and Network of WHO Intern Alumni, and presented at conferences across the US. Here's a look back at our many accomplishments in 2015.
This blog was written by Caity Jackson, Co-Founder & Communications, Women in Global Health and Director of European Engagement, CFHI. It summarizes Panel 4 from the GHLS 2015 Symposium titled Young Global Leaders Reflect – How Will I Shape the SDGs? It was originally published on Global Health Council's Young Global Leaders Blog on November 23, 2015.
The 2015 Global Health Landscape Symposium’s final panel, ‘Young Global Leaders Reflect: How will I shape the SDGs,’ challenged today’s leaders to institutionalize young peoples’ involvement in the Sustainable Development Goals (SDGs). Three themes guided the discussion, including recognizing the important role the enormous population of youth have in ushering in these goals, ensuring young voices are heard in these discussions and invited to the decision-making tables, and encouraging true collaboration at all levels, with a focus on capacity-building and training in this skill for young leaders.
Moderated by Kyle Peterson of FSG, the stage was alive with ideas and energy as all the panelists considered on their own experiences as young leaders and what they see as the role they can play in the SDGs. Sahil Angelo from the Center for Strategic and International Studies (CSIS) started out the discussion focusing on the immense number of young people in the world – almost 2 billion between the ages of 10 and 24. This is in-part due to the successes of past global health efforts, but as a community, we have not really considered or planned for the implications of these strides. What does 2 million young people (and rising) mean in the context of the SDGs? Nowhere in the “Means of Implementation” section of the SDGs’ text does it mention that youth would be the ones to usher them in.
Many panelists commented on the comprehensiveness of the goals and saw them as tangible objectives that address the root causes of inequity in health outcomes, even as a chance to do it ‘right this time’, referring to the previous Millennium Development Goals (MDGs). Yet in terms of young leader involvement, Oliver Anene of the New York City Department of Health commented that young leaders need to be invited to the decision-making table and their voices need to be heard – especially since they are currently on the receiving side of the policies created by today’s leaders. Anne Heerdegen of the Global Health Fellows program echoed this thought, commenting on how young leaders should be invited to speak at conferences and events alongside their experienced colleagues.
CFHI would like to thank Hema Pandey for her 10 years of outstanding service with CFHI! Since joining as India Coordinator in July 2005, Hema has grown into the role of India Director while leading CFHI’s growing presence in India. Today, there are 8 thriving programs in India, located throughout the country and offering a variety of health topics to meet participant interests. Hema has played an integral role in program development by establishing and maintaining strong partnerships with a wide and diverse network of health professionals and NGOs in India. Her professional interests include rural and urban healthcare, water and sanitation, gender, and social development. She holds a Bachelors in Business and Commerce from Kurukshera University and a PG Diploma in Fashion Design from the International Institute of Fashion Technology.
Hema explains that her work with CFHI is always exciting, and that she learns something new from every student she encounters. Working with CFHI has been a learning process, and every student adds to her understanding of different cultures and worldviews, including perspectives on health and health care systems. Since working with CFHI, she shares that “instead of looking straight, I’ve started to look in all directions for answers. I am still learning with every student, so it’s as enjoyable as it was on day one.”
Hema represented CFHI at the Forum on the Empowerment of Women at the United Nations in New York in September 2010, and experience that she says was “The highlight of (my) 10 years at CFHI.” At the conference, she spoke alongside CFHI’s Executive Director, Dr. Jessica Evert, on a panel that highlighted their experiences working and leading in male dominated professions. Hema spoke about her successes using a collaborative approach to get the work done. Hema also represented CFHI at the 5th International Symposium on Service-Learning at Stellenbosch University in Cape Town, South Africa in 2013.
Hema is very appreciative of the years she has spent with CFHI, giving her the opportunity to improve herself while improving the communities around her. She reflects that her role as India Director allows her a path to help so many people. Hema is very supportive of her local staff and as an individual, she receives immense satisfaction when connecting grassroot organizations with aspiring students. She explains that this is her way of giving something back to society at large.
Robin Young, Assistant Director Africa & India, shares, "Hema is a force of energy and vision for CFHI's programs in India. She has built our engagement in India into what it is today- 8 strong programs with 2 more coming very soon- each offering a unique perspective on health and public health, from maternal and child health, to traditional medicine, to chronic disease and palliative care. Here's to ten more years!"
By Robin Young, CFHI Assistant Director, Africa and Asia
I just returned from a month-long site visit to India, where I delved deep into CFHI’s 8 programs in that most captivating of countries. It was a whirlwind journey that took me from a small village clinic in the foothills of the Himalayas, to a bustling OB/GYN unit in a hospital in Pune, to the home of an 80 year-old woman receiving palliative care from a team of nurses and doctors in the Southern state of Kerala.
India is a dazzling, intense place. With a population of 1.25 billion people, the scale of its cities; the ease with which so many people co-exist, struggle, and thrive; and the fascinating public health challenges, triumphs, and pitfalls, are enough to make any visitor want to stay much longer than a month.
But one month in India is enough to take in plenty of new information about health and medicine in a country that has so much to teach us. CFHI’s India programs offer an array of topic areas, clinical rotations, and geographical settings to choose from—there is truly something for everyone. Each of our programs is grounded in deep and longstanding local partnerships and a commitment to ethical practice—two key components that guarantee a rich and unique experience for CFHI scholars.
Under the leadership of CFHI’s India Director, Hema Pandey, we are finalizing exciting new partnerships and integrating program enhancements that will make our programs in India even stronger and more impactful. Here’s a sneak peek at a few of the exciting developments you can expect from CFHI’s programs in India:
In Delhi, we are finalizing a new research program that will welcome students with an interest in completing research in India on a variety of topics in global health, biomedicine, and beyond.
In Mumbai, we are opening a new program that offers students an up-close look into hospital medicine and infectious disease in this glittering, world-class city. Observe hospital medicine in urban and rural settings and learn about infectious diseases in a variety of locations, from outpatient clinics to small, family-run practices, to non-governmental organizations.
Also in Delhi, our “Public Health Delivery Innovations and Community Medicine" program will have an increased focus on three themes, around which all rotations and non-governmental organizations will center: water and sanitation, social services safety net, and programs for marginalized populations. As always, this program will provide an inspiring and eye-opening look into public and community health efforts in Delhi, working with populations ranging from young children who are addicted to drugs to women formerly considered “untouchable” who now prepare crafts and food for their communities.
All India participants can expect expanded pre-departure training and orientation in the form of webinars, question and answer sessions, and more. A recent addition to CFHI’s pre-departure training is Aperian Global’s online cultural intelligence tool, GlobeSmart, which provides detailed information on how to engage effectively with people from India and around the world. Competencies based on the new roadmap for global health training will frame each program and articulate the learning outcomes that you can expect to come away with after participation in our programs.
CFHI’s programs in India are the best way to come and experience the magic of India while immersing yourself in the intricacies of the health system and the social determinants of health in this fascinating country. Having just visited these programs myself, I am already excited for my next visit!
Hello everyone! I have thoroughly enjoyed my first week in Cape Coast and my third week in Ghana. Since I last wrote, I spent all of last week in the Pediatric department, except on Friday, when I worked in the Emergency Department. I have seen children with various conditions, like type I diabetes, bronchopneumonia, cerebral palsy, among others. The pace in Cape Coast is quite different than that of Accra, but I am enjoying more teaching and time spent with house officers and medical students. I also met some others from other NGO organizations that are volunteering in the hospital, and we ended up all going to Kakum this weekend, which I will discuss later.
On Tuesday, there was a morning talk about the management of preterm and low birth-weight infants. It was very interesting to get this lecture and then later in the week a lecture on the morbidity and mortality in the NICU. It is crucial to review those cases and reflect upon management to see if there is anything to improve upon in the future. Of note, there is a rate of 14.5% preterm births in Ghana in 2012, versus a 10% rate in the United States for comparison. Of the 111,500 preterm births in Ghana, the mortality rate was 7800. Often, in low-income countries, those born at 32 weeks or earlier often die, whereas they survive in more developed countries. The two themes that stuck out in prevention of mortality and management of very ill neonates is the need for infection control, including cord care, as well as close preterm follow up.
On Wednesday, I spent time going over the High Dependency Unit charts and then got a tour of the NICU with Dr. Bukarie. It was very interesting and eye-opening to see how they treat tiny babies without ventilator support or CPAP. They have the machines, but lack compressed air and continuous oxygen built into the walls, therefore, they treat the children with oxygen by nasal cannula. Also, there are 3 working incubators and otherwise used a heat lamp. We discussed how there might be potential with this sleeping bag looking device that is like an incubator. I am going to look into it further and see if I can get some donated or funded for Cape Coast’s teaching hospital. It is the simple things that make a huge difference in the outcome of neonates, especially preventing hypothermia in premature infants. I also have spare glucometers from diabetes camp this summer, so I will make sure at least two meters and strips go to Cape Coast and two to the Malnutrition ward at Princess Marie Louise in Accra.
Greetings from Denver! My mind is racing with excitement and ideas after spending the past three days with fellow family physicians passionate about global health at the American Academy of Family Physicians (AAFP) Global Health Workshop at the Grand Hyatt in Denver, Colorado. The organizers did a fantastic job establishing several tracks and special sessions that ran throughout the conference—General Plenary Sessions, Global Expansion of Family Medicine, Reflections in Global Health, Global Health Lecture Series, Focus on Research, Case Studies in Program Design, Ideas Worth Sharing and Facilitated Discussions. I had the opportunity to present at the Ideas Worth Sharing session, condensing two years of work in El Salvador into a 7-minute presentation. It was rapid fire. There were also two poster presentation sessions, of which I was fortunate enough to have my shipboard influenza outbreak case featured. The best part about the workshop was the intimate size of the group, allowing for collaborative discussions, mentor-mentee interactions, and sharing of stories. This is what the future of Global Health depends on—relationships. The opening plenary speaker, William Ventres, MD spoke about the work of global family medicine being one of creating, developing, and sustaining relationships. The other plenary speaker whose words resonated for me was Lynn Eckhert, MD who encouraged all of us to “tell the story” of global family medicine. Our lives are full of stories around the globe, and by sharing it defines us, and allows others to learn and gain appreciation. As faculty in charge of developing a global health track at Fort Belvoir Community Hospital Family Medicine residency, I found it incredibly helpful to go to sessions focusing on global health curriculum development. The number of medical schools and family medicine residency programs with “global health” tracks is growing substantially. We also learned how to do journal clubs more effectively, as well as ethical approaches to Global Health engagements. One of the challenges in global health education is that competencies have not been standardized yet, making it difficult to determine a learners level of proficiency with global health. It was exciting to see the work that Jessica Evert, MD, Executive Director of CFHI, is doing to achieve this. She referenced her recent publication in the Annals of Global Health with the Consortium of Universities for Global Health (CUGH) that proposes four levels of Global Health competency. Global Family Medicine is a relatively young field, and it was an honor to be in the midst of those forging its path. As stewards of global health we are making progress toward a more connected and healthier world. I’m already looking forward to next year!
by Caity Jackson, CFHI Director of European Engagement
The European Association for International Education (EAIE) conference held in Glasgow last week was a great start to CFHI’s Autumn European activities. It was also my first time attending an international education conference of that size and scope and it was exciting to be amongst the hustle and bustle of hundreds of institutions, partners and participants that had flocked together from all corners of the world.
The EAIE is a non-profit, member-led organization serving individuals actively involved in the internationalization of their institutions through a combination of training, conferences and knowledge acquisition and sharing. Their annual conferences welcome over 5,000 international higher education professionals and this year saw these participants coming from over 90 different countries.
There was an excellent opening speech by the dynamic Baroness Helena Kennedy, QC,which struck a chord with me about the movement education sees these days. Not only are there students who are completing their full degrees abroad, but there is constant movement between regions for short courses, specialized training and immersion education. It is becoming the norm and I think it speaks to how the world has become a community and how our aims and objectives align no matter where in the world we live.
That being said, disparities still exist in stark contrasts and for us to truly be educated in a subject in our globalized world, we have to experience these contrasts first hand. There is nothing like having your hands deep (literally or metaphorically) in the complexities of what you have studied in textbooks to drive home a message and increase knowledge retention. I left the auditorium after Baroness Helena Kennedy’s speech mulling over her message about being enablers for education and allowing students to have mobility to obtain the knowledge they desire. The classroom truly is global now more than ever and students should be encouraged to broaden their horizons and reach out to the knowledge they know will enhance their education. I think that if we are to be true global citizens, we must all strive to include a little ‘international’ to our classroom.
Child Family Health International (CFHI) provides community-based Global Health Education Programs for students and institutions. Our unique model fosters reciprocal partnerships and empowerment in local communities, transforming perspectives about self, healing and global citizenship.
Q. Tell us about the CFHI program you participated in.
I participated in Sexual Health as a Human Right: Ecuador’s Unique Model. I spent one month in Quito and was placed with Fundación Equidad, a LGBTQ health and human rights organization. This program stood out to me because it was not clinical, but rather community-based. Though I’m in medical school already, I chose this program because I believe that practicing socially just medicine requires an understanding of the social, political, and economic forces that underpin communities. Volunteering with Equidad was a great way to gain insight into the activism and health-related challenges that LGBTQ people face in Quito. As a volunteer, I helped them organize their database of people who had received their services, such as HIV counseling and testing, human rights training, and safe sex education. I also participated in their staff meetings, helped them prepare for Orgullo (Pride), and was the photographer for one of their events.
Q. What were your goals going in to the program? How did CFHI help you in achieving those?
Because I will serve Spanish-speaking populations as a physician, one of my main goals was to learn Spanish. Being able to speak Spanish is not only a practical skill, but in my opinion reflects a greater gesture of respect and solidarity with patients. CFHI helped me do this in part by setting me up with a wonderful host family. My abuela had hosted students for 18 years, and every night she would cook us a delicious meal. We would chat about everything from Caso Cerrado, a hilarious TV show, to current events and politics. I was grateful for her desire to teach and to take good care of us. In the process, I realized that a lot of communication is about confidence. You can’t be afraid to speak, to fail, and to be present in the room.
Q. Who was the most inspiring person you met on the program?
Efrain Soria is the Director of Equidad, and it was great to be able to work with him so closely. He was not only approachable, kind, and welcoming, but also clearly an effective leader. I was able to gain a glimpse into his leadership style during meetings in both informal and formal settings. By doing some research for Equidad, I learned that his voice matters in Ecuador--popular newspapers often quote him, for example. In doing so, he advocates for his work and amplifies the voice of the LGBTQ community. It was beautiful to see Efrain lead with such fearless calm and grace.
Q. Did the CFHI program influence your career path? If so, how?
Because I’m already in medical school, I have stopped debating my career path and have instead begun to think about how to be the best doctor I can be. For me, part of that involves sustaining my passion for human rights, and fighting for marginalized and underrepresented people. One requirement of being a physician ally is learning how to honor the way my patients wish to identify themselves in terms of their gender and sexuality. When Equidad counsels people on HIV, for example, they complete a very thorough interview that honors the language that the LGBTQ community in Quito prefers to use to describe themselves. Seeing how this works was valuable for me. As a medical student, I am learning how to communicate in a way that allows my patients to feel safe, discuss their medical problems freely with me, and define their own identities.
Q. What are you doing now?
I’m about to begin my second year of medical school at Albert Einstein College of Medicine in the Bronx. For the rest of the summer, I’m working on a very interesting research project with Dr. Johanna Daily in her lab at Einstein. It’s a longitudinal study that examines the immunological and clinical dynamics of mild malaria in a rural population in Malawi. Other than that, I’m reading lots of books, working on my photography, and loving summer in New York.
Q. Do you have any advice for students who are thinking about applying or about to go on a program?
Before you go, look at your motivations for going on this program with honesty and ask yourself lots of questions. What do you hope to learn? What can you realistically learn? What might you be able to contribute? What is the space that you’re taking up by entering this country and what are the implications of your presence? Doing global work is ethically complex and can be problematic. But it can also further collaborative movements for social justice when done with critical mindfulness.
In a practical sense, define specific goals and have clear conversations with your supervisors from the very beginning. This will help you achieve tangible, shared goals. Lastly, be open-minded, respectful, and spontaneous. Do your best to connect with local people in addition to your host family, whether it be your barista or your taxi driver. They are secret reservoirs of some of the best stories.
Special thanks to CFHI alumna Olivia Low to authoring this guest post.
Sounds of interaction, excitement, cultural exchange, and a mix of English and Spanish could be heard from Hotel 55’s top floor balcony in Puerto Escondido, a lively coastal town in southern
Mexico that lures surf enthusiasts from every corner of the world. However, Hotel 55 was bustling the final week of July not for those seeking the thrill of Playa Zicatela’s ferocious waves, but for an annual midwifery training that provides essential continuing education for parteras tradicionales or traditional midwives serving their communities throughout the state of Oaxaca.
The project, now in its 6th year, is critical to the health and well being of pregnant women and their families throughout Oaxaca. Over the course of 4 activity-packed and eventful days, a training mandated by the Oaxacan Ministry of Health is carried out in collaboration with Child Family Health International (CFHI), a group of ambitious medical students from Northwestern University Feinberg School of Medicine who are members of the institution’s Alliance for International Development (NUAID), and local health professionals, including Dra. Isabel Saucedo, an employee of the Reproductive Health Office of Jurisdicción 4 and CFHI’s Medical Director in Puerto Escondido. Dra. Saucedo is a local champion for bridging the gap between the local healthcare system and traditional midwives, and has shown great perseverance and commitment to ensuring this project takes place year after year.
Themes covered were safe birth techniques, recognition of obstetric emergencies, and addressing newborn distress. The Oaxacan Ministry of Health builds upon each year’s training and seeks quality improvement to establish consistency and correctness with prenatal guidance, fertility advice, family planning, and birth attendance.
This year’s training incorporated an interesting component that complimented the materials provided throughout the project. Hesperian Foundation’s award-winning Safe Birth App was introduced to a select group of midwives using low-cost computer tablets. This app was created for low literacy audiences and has been piloted in several midwife cohorts in Latin America with great success. Working in tandem, CFHI and Hesperian will continue to track the response and impact of the application and the use of the tablets on the health of local communities.
Due to limited public funding, CFHI and NUAID have joined forces to provide generous donations to breathe life into the project for the past several years. The joining of hands is what makes this project unique and generates an impact that is far reaching. Traditional midwives are highly respected members of their communities and women often seek out their services at least twice during their pregnancy. Therefore, the reproductive health of Oaxacan communities, especially those in dangerously remote locations, is vastly improved. The opportunity for the midwives to sharpen their skills, foster relationships with members of the formal healthcare system, and engage with foreign medical students is invaluable to their careers and their livelihoods. Lastly, the medical students from Northwestern University thrive off of the cultural exchange and the opportunity to contribute to a meaningful grassroots project and greatly improve their Spanish language skills. First year medical student Kyle Yoo explains, “Overall, I felt like I was really doing something. I was fully engaged. Without CFHI, I don’t believe I would have this opportunity otherwise to interact with the community and learn in the way I did.”
Puerto Escondido’s intense heat presented no match for the enthusiasm of the 30 midwives who traveled from various parts of Oaxaca, many of whom were eager to join the training for another consecutive year and to proudly represent their communities.
Each year, thousands of pre-med students around the country will begin to stress and pore over their medical school applications, writing and re-writing personal statements, reaching out to mentors for letters of recommendation, logging endless hour of community service and shadowing experience, and burying their noses in textbook after textbook studying for the dreaded Medical College Admission Test (MCAT). If you haven’t heard already, things have changed for the MCAT, which now is 3 hours longer and includes sections on sociology and psychology. “Being a good doctor is about more than scientific knowledge. It also requires an understanding of people," observes Darrel G. Kirch, M.D., President and CEO of the Association of American Medical Colleges (AAMC). "By balancing the MCAT exam’s focus on the natural sciences with a new section on the psychological, social, and biological foundations of behavior, the new exam will better prepare students to build strong knowledge of the socio-cultural and behavioral determinants of health.” It’s about time that the MCAT caught up with what is truly vital in medicine today. Our doctors today need to understand these aspects just as much as they need the basic sciences, and finally, it’s beginning to hit them at the pre-med level.
As a pre-med student, I remember loving the sciences, but that’s not why I became a doctor. I wanted to understand suffering, to really get to the bottom of why patients of different backgrounds and social status were having such drastic difference in health outcomes. Not only that, I wanted to know why this was happening all around the world. When I got the opportunity to work with Child Family Health International, a non-profit organization that partners with international healthcare providers, it changed the direction my future took. I participated in CFHI’s program, Tropical Medicine and Community-Based Care on the Coast of Mexico, based in the southern state of Oaxaca. Oaxaca is one of the poorest states in Mexico with the largest concentration of indigenous populations. Working with 10 other medical students, we worked closely with the local midwives, physicians, and women in the community to understand their experiences and needs with regard to family planning, sexual health, and maternal health. Using this information, we assisted the local health team in developing and delivering a four-day training for roughly forty traditional midwives from across the state of Oaxaca. I will never forget what it was like to sit down and listen to the midwives’ experiences of providing maternal and child health care in this setting, and the opportunity we had to work with them in their efforts to improve the health of their community. What struck me most about CFHI’s approach was that they work to empower local communities and really take “service-learning” and “partnership” to heart. The focus was not providing a service, but partnering with local organizations and offering the skills and training in an ethical way. After this experience, I continued to have multiple global experiences throughout Central America. By the time I finished medical school, I would not have taken back any of these experiences for anything. I had a better knowledge about communication barriers between physicians and patients, cost burden of disease, importance of relying on physical exam over technological tests, and treating patients as a whole, not just their illness.
Now, as a shiny new family medicine intern, currently working at a hospital where nearly 100% of the population is underserved, I’ve made a pledge to myself to never lose that empathetic side of medicine. I challenge the pre-meds and medical students of today to do the same: Get out there! Yes, learn the basics, but don’t overdo it. Be a real person, spend time outside medicine, get out into the community and the rest of the world and really, truly try to understand where disease comes from and how your patients live their everyday lives outside your clinic. Even the new MCAT wants you to.
Q. Tell us about the CFHI program you participated in.
I had the pleasure of participating in CFHI’s program, Realities of Health Access & Inequities in Oaxaca, Mexico in April 2005 just before starting my first year of medical school. The program’s intent was for students to experience the differences between the Mexican culture of medicine and their home country. This was facilitated by weekly rotations (much the same as U.S. 3rd and 4th year medical school rotations) in various clinical settings such as tertiary hospitals, community hospitals, and a variety of outpatient clinics (pediatrics, general practice, women’s health etc).
Q. What were your goals going into the program? How did CFHI help you in achieving those?
Early in my medical training I came in contact with many Hispanic patients, many of whom traced their ancestry to Mexico. I knew the American medical culture very well, but knew next to nothing about the Mexican culture. Recognizing this as a large gap in my medical knowledge, my goal was to absorb as much Mexican culture knowledge as possible, in particular, the culture of medicine. CFHI’s program in Mexico was well thought-out and goal-orientated right from the start. From the home-stays that allowed me to assimilate into the Mexican family home life to the daily Medical-Spanish classes to the weekly lectures given by Mexican doctors, CFHI’s program helped me increase my cultural knowledge in the brief time that I was there.
Q. What were the overall highlights of your CFHI experience?
THE FOOD! I had no idea the culinary expertise that existed in Oaxaca. Every street side café offered the opportunity to take in the Mexican street life with some amazing prepared dishes. Going to the farmer’s markets with my host family was also a great way to experience Oaxacan community life and learn about how the food was prepared.
Q. Who was the most inspiring person you met on the program?
One of the patients I was following in a poor public tertiary hospital, who was about my age, was sadly injured in a motor vehicle accident, leaving him a quadriplegic and on a ventilator. During the week I was following him a nighttime storm had knocked out the electricity and the hospital generator failed. Our team in pitch blackness took turns hand bagging him until our hands got tired. I can’t begin to imagine how scared he might have been that night, relying on us to provide him each breath. It was quite inspiring to witness his mental toughness and I grew quite attached to him and continued to visit him even though I had moved on to my next rotation.
Q. Did the CFHI program influence your career path? If so, how?
Definitely, as a new physician just out of my pediatric residency I had many options for a first job. I could work in a busy private practice office and make a good salary, but that just didn’t appeal to me. I knew right here in the U.S. there was a large population of people who were over-looked and needed medical attention, especially undocumented immigrants from Mexico and the homeless population. Since finishing residency I have always sought positions that serve these populations.
Q. What are you doing now?
I have quite an interesting job. I work as a general pediatrician on a 35-foot medical R.V. that travels around downtown Phoenix, AZ providing free medical care to the city’s shelters and homeless population. The medical R.V has two exam rooms, a small lab where I can draw blood, and even a small pharmacy where I can distribute medications. The program runs out of the Phoenix Children’s Hospital’s Home Youth Outreach program.
Q. Do you have any advice for students who are thinking about applying or about to go on a program?
Without a question it is a MUST do! No matter where you end up practicing medicine you’re going to come into contact with patients from a completely different cultural background. The U.S. and other Western countries continue to become more culturally diverse so having an ounce of cultural knowledge really goes a long way. Spending a month abroad in a program like CFHI’s will definitely increase your cultural awareness and make you a better healthcare provider. Plus it’s a lot of fun!!!
Special thanks to Dr. Gary Kirkilas, Vice Chair of CFHI’s Alumni Advisory Board, for allowing us to interview him for this post.
Across our planet we find it’s diversity that unites and binds us. It’s even the motto of the European Union, and is something to be celebrated by all. For if it weren’t for diverse perspectives and innovative ideas, we wouldn’t be exploring the universe, travelling on planes, or even tweeting our opinions on social media. Imagine a world lacking the multilateral United Nations organizations such as the World Health Organization (WHO), for whom diversity and equal voice are founding principles.
Today as throughout its history, WHO plays a vital role in not only improving the health of communities, but also strengthening the capacity of Member States to do so too. Child Family Health International (CFHI) shares this commitment, as demonstrated through its community-based Global Health Education Programs and Community Health Projects. Such work carries great responsibility, so the opportunity for young trainees in global public health to contribute towards these goals is a valuable experience. This is achieved in part through the highly popular WHO Headquarters internship program, which sees around 600 participants every year.
As a former intern, I can attest to the knowledge and experience that I have gained as a result of working at WHO-HQ. However, as I looked around amongst my bright colleagues and friends, one thing became clear: WHO lacks geographic diversity amongst its interns. In 2013, more than 80% of interns came from high income countries. The cost of living in Geneva is amongst the highest in the world, and WHO interns are unpaid, suggesting it’s the financial cost that holds back many candidates from low- and middle- income countries.
Every year WHO allocates large portions of its budget towards increasing countries’ capacity to respond to health needs including severe ones such as the humanitarian crisis in Syria or the Ebola emergency in West Africa. Yet, regrettably, to my knowledge WHO does not set aside funds to help young people from the often most affected countries to engage in the policy development work at WHO that may affect them. Diversity is key to a functioning international health system, so why aren’t global health agencies reflecting this where it matters most, in training the next generation?
This is why the Network of WHO Intern Alumni (NWIA), an international group of former WHO interns, is working with nonprofit organizations, global health professionals, and current WHO-HQ Interns to support two capable candidates from low- and middle- income countries who are accepted at WHO-HQ to participate in its internship program. Like NWIA, CFHI is committed to developing and ensuring the diversity of the next generation of Global Health leaders. The intended initiative is analogous to CFHI’s Diversity Scholarship Program, which supports underrepresented students to participate in global health focused study abroad opportunities.
We’ll support two accepted interns, and film their professional experiences in Geneva to produce a documentary. We have all witnessed the benefits of this opportunity, and believe it should be extended to our peers across the world irrespective of their geographic or income background. Help us make this case heard by donating to and sharing our campaign here.
Alex Cheng, Sydney, Australia
Former WHO Intern Board Vice-President
Intern, Communications Department, World Health Organization Headquarters, 2015
Both programs have been a tremendous success in their first year, attracting students from various disciplines eager to learn about public health challenges in Uganda and socioeconomic factors that influence health. Here, learning opportunities are abundant. CFHI Global Health Scholars are welcomed into KIHEFO’s family of medical officers, nurses, social workers, counselors, and other team members who are the heart and soul of these programs. Through clinical rotations, rural outreach visits, and public health initiatives, CFHI Global Health Scholars learn about the prevention and treatment of malnutrition in children, gain an understanding of the importance of partnering with traditional healers, and explore methods of growing a diversity of foods closer to people’s homes.
In June 2014, CFHI Global Health Scholars assisted with a Nutrition & Women's Health Survey in the rural community of Rubira in Southwestern Uganda. With the help of a translator, they interviewed over 70 families in an effort to gather information about health status. This important work helped CFHI's local partner, KIHEFO, identify households struggling with malnutrition and infectious diseases. This experience proved to be a memorable learning opportunity for students like Amanda Gailey, who wrote, “This week has been very full and educational. I have enjoyed getting to know some of the people here and learning about their everyday circumstances. I feel like this is the best way to help others—by learning from them and trying to better understand their needs."
In the past year, we’ve also seen tremendous growth in locally-led community health projects, like the Rabbit Breeding & Training Center. This center is implementing rabbits as a sustainable source of protein and income for rural families in the Kabale District. Since its inception, the project has grown from 120 rabbits to over 3,000 rabbits housed at 5 centers throughout Kabale District, the most recent opening in Kyanamira this past month. Recently, we also celebrated the opening of the Maternal & Child Hospital in Kabale-town, which will serve as a labor and delivery center and help decrease the burden on over-crowded public facilities.
We are grateful for our flourishing partnership with KIHEFO, who never cease to inspire us with their dedication and vision. We could not be more proud of all that we've accomplished together this past year and excited for the synergy that lies ahead.
Visit our website to learn more about CFHI’s Global Health Education Programs in Uganda.
When I moved to Washington, D.C. two years ago, I anticipated a lot of buzz around global health, but coming from the intimate public health community in Portland, Oregon, I could have never imagined something as grand as The Future of Global Health (TFGH) event.
This annual event is sponsored by Global Health Council and the Global Health Fellows Program II and is specifically branded as an un-conference because of the unique format: small group conversations led by senior global health professionals that are intended to create dialogue and foster networking. Different hubs around the event space each have a theme (i.e. Accelerating Innovation & Impact; Gender & the Global Health Arena; Measurement & Metrics; Healthy Mothers Healthy Babies; Pandemic Preparedness, etc).
Having attended the same event in 2014, I knew how to navigate the hubs a little better this year—coming prepared with thoughtful questions to fuel conversation and packing extra business cards to exchange. My current work at the George Washington University Milken Institute School of Public Health is not directly linked to global health challenges, so the TFGH event was a welcomed occasion to talk about some of the things I’m most interested in and aiming for in my professional development, specifically: impact evaluations, increasing health workforce capacity, and gender sensitivity in the post-2015 sustainable development goals.
This year the event also offered one-on-one mentoring sessions in ten minute blocks, with an impressive lineup of global health professionals that represented a breadth of sectors engaged in global health activities: private consultants, non-profit organizations, government agencies, and academic researchers. The mentoring blocks seemed to be a big hit – I was lucky enough to snag an opening at the very end – and though the mentor I was paired with wasn’t a great fit, it gave me the chance to reflect and talk about my experience with CFHI. I’m an alumna of CFHI's South Africa programs (2010), and was deeply impressed with the organization’s values and approach to global health education. Although the mentor was seasoned with years of experience, she didn’t quite grasp the difference between humanitarian work and a broader global (public) health framework. It was in this encounter that I felt truly grateful for the very grounding influence of CFHI in my training. Moreover, I felt confident in articulating to the mentor that this model of learning involved examining and understanding contextual factors that influence health and shape health disparities; and that the reciprocal partnerships with communities creates more equitable and sustainable change. Again, a little preparation beforehand goes a long way in this setting, to identify an appropriate mentor and have specific questions for their guidance or opinion. Like many things I’ve come to learn about living in D.C., the opportunity of TFGH is what you make of it—it’s no place to be shy! For myself, this can be an intimidating envronment, so coordinating with a friend or colleague instead of going solo is a good option. And if you brave it again, like I did, odds are that you find you’re in good company after all!
Other annual and notable global health events to take advantage of if you live in the greater D.C. area:
In December 2014, I left the comforts of San Francisco to take part in the Public Health & Community Medicine in India program through Child Family Health International (CFHI). During my 4 weeks in northern India, I had the opportunity to engage with and learn from various non-governmental organizations that are tackling public health challenges like injection drug use, sanitation, and prostitution. For the first week, we worked with a WHO-recognized organization in Chandigardh that focuses on women and children's health care. One of my fondest memories from this experience was being able to interact with the female sex workers that this NGO helps. I had the opportunity to sit down and talk with Aditi*, who told me how her hardships from back home forced her to become a sex worker in order to keep her children in school. Listening to Aditi's story really put my life into perspective. Aditi, who is a mom, sister, wife, and daughter, was literally sacrificing her own body for the sake of her children, something only a strong individual would be able to do. I couldn't help or stop Aditi from being a sex worker, however what I could do was be someone she could talk to, someone who would listen to her, even if only for a short amount of time. It was an exchange of hellos, an exchange of respect, and an exchange of appreciation that I could give Aditi, and ironically, in the end, what she gave me. This experience taught me that it is impossible to understand a public health issue like prostitution without understanding the human beings whom it affects.
When I embarked on this experience, it had been 6 years since my last visit to India. The transformation I saw in the country was phenomenal. I noticed improvements in infrastructure and cultural changes. Years ago, the topics of HIV/AIDS or sex workers were very taboo. No one liked to acknowledge any health risks and the government wasn’t doing much to spread awareness of such issues. Visiting the country now and witnessing the many programs the government has implemented within each state was inspirational. Programs such as NACO have made such a difference in the lives of countless people across northern India by providing necessary services and supplies to lead a healthier and safer lifestyle. Apart from HIV/AIDS, I also witnessed changes in the caste system in India. In this system, “untouchables” are deemed to be the lowest caste because of their occupation of being scavengers (individuals who clean up human waste from homes due to lack of toilets). This program gave us the opportunity to work with a UN-recognized social service organization based in Delhi that is committed to getting rid of the untouchables caste by creating a toilet complex system to implement in villages across the country.
Being an Indian-American, I was able to appreciate India in a manner I never had before. I had always heard about various problems in India, whether it was about the spread of HIV/AIDS or the controversial caste system, but I always felt helpless living more than 8,000 miles away. Through CFHI, I was lucky enough to meet people like Aditi, and listen to their stories to understand what really is going on in the world outside of our own bubble in America. Often times, I have heard my very own friends and family who are Indian-American comment on how “backwards” India is in terms of development and simple progressive ideology about issues pertaining to HIV/AIDS. By experiencing India first hand, I now have the knowledge and experience to educate my friends and family and help them be more aware of important public health issues. Reading and hearing the news about India is one thing, but actually being within India’s space and engaging with the people of that country helps put these issues in perspective.
As a senior graduating college soon, I am at the crossroads where I have to choose what I want to pursue for the rest of my life. After my 4 weeks in India, I realized that this trip wasn’t coming to an end for me, it was just the beginning. CFHI not only gave me clarity, but also a sense of direction. The CFHI program solidified my decision to pursue a career in the field of public health. Prior to the program, I knew that I wanted to obtain my MPH, however I wasn’t clear on what specialty to emphasize in. This trip exposed me to the world of global health and made me realize that it would be the perfect field within public health for me. CFHI not only helped me fall in Iove with India again, but it also helped give me a sense of purpose that I perhaps would not have found without this trip.
*Name has been changed to respect privacy.
Special thanks to our guest blogger, CFHI alumna Deepa Mistry, for authoring this post.
As experts in this approach, CFHI welcomes our alumni to contribute to our global health efforts in a new and influential way. CFHI is now accepting applications for its inaugural Alumni Advisory Board (AAB). Through the AAB, CFHI alumni will help shape our organization’s advocacy, education and development efforts, as well as the impact that CFHI Global Health Scholars have long after they return from their international programs.
The Alumni Advisory Board provides a structure to facilitate alumni interaction with CFHI, including soliciting alumni opinions and input, mobilizing alumni on CFHI's behalf, encouraging intra-alumnus mentoring, and providing alumni an opportunity to stay involved in global health and CFHI in a formal/professional development fashion.
The AAB is 12 members with diverse professional background at varying stages of their career. The board will increase collaboration between CFHI alumni, staff and international partners—all committed to advancing CFHI’s mission and building the next generation of global health leaders.
AAB members will engage and benefit from the experience in various ways. For CFHI alumni in the early stages of their career, the board will provide an opportunity to build leadership skills, network with like-minded students and professionals, and further build their global health experience. AAB members who are further along in their careers can lend their expertise, mentor other CFHI alumni, or serve in a senior leadership role on the board. The AAB will enable our alumni to build on the cross-cultural relationships that were created during their CFHI experience and apply that knowledge to their personal and professional endeavors.
CFHI is seeking a diverse pool of applicants for the Alumni Advisory Board of a variety of professional fields, education levels, and backgrounds. In addition, CFHI welcomes all skills including graphic design, social media, event planning, etc. AAB members will be a voice for their CFHI host community, therefore applicants will be chosen from CFHI’s 7 country sites—Argentina, Ecuador, Bolivia, India, Mexico, South Africa and Uganda.
Applications for CFHI’s inaugural Alumni Advisory Board are due by April 1st and can be filled out here. A committee consisting of CFHI Staff and Board of Directors will select AAB members for the 2015-2017 term by June 2015.
Q. How did you hear about CFHI? What attracted you to the Uganda program?
I heard about CFHI through the study abroad program at Northern Arizona University. CFHI was highly recommended to me. It had always been a passion of mine to volunteer in Africa and experience the culture there—that is what attracted me to the Uganda program.
Q. What were your goals going in to the program? How did CFHI help you in achieving those?
My goals going into the program were really to gain knowledge—whether that be medical or healthcare knowledge, or knowledge of a different culture and how people live, eat, dance, work, etc. in a country completely foreign to me. CFHI helped me accomplish these goals. Their partner organization in Kabale has some very special staff members who were willing to teach me so much. They allowed me to ask any question, explained everything about the people of Uganda and their culture, and made me feel very comfortable.
Q. How did the program impact you?
The program impacted me greatly. It solidified my goals of wanting to go into a healthcare career because I learned how much I love working with patients. I also feel more worldly. I now know so much about a country in Africa where very few Americans travel to. I know about the people, the food, the music, and the languages of Uganda. I saw how amazing the people that live there are, how simply they live, and how much they enjoy life no matter how hard it is. The people there inspired me to live my life like them and to never take anything you have for granted.
Q. What were the highlights of your experience?
I have so many highlights of my time in Uganda. One highlight would be heading down to the clinic everyday, excited to see the staff and looking forward to what I was going to learn or see that day. The relationships that I established with the staff are another highlight. We had amazing conversations and always had so much fun. Other highlights include traveling to villages for outreaches to treat people who could not make it to the main clinic in Kabale, hiking the Muhavura Volcano in Kisoro, and going on a safari in Queen Elizabeth National Park.
Q. How has the program changed your perception of health?
I now understand the diversity of health. Health in Uganda is very different than health in America, yet there are many similarities. There are diseases unique to East Africa that I was able to see and study. There are also differences in the way people are treated and diagnosed for these conditions. The diagnostic tests in Uganda are much more limited, therefore many cases are not solved. Certain conditions and diseases that are treated easily in America are not easily treated in Uganda and are sometimes fatal because people do not have the money to pay for healthcare services or because they wait until that last minute to get checked out.
Q. Who was the most inspiring person you met on the program?
The most inspiring person I met was Allen. He is a medical officer who works under Dr. Anguyo at the KIHEFO clinic and he is the preceptor who I shadowed. He has such a passion to help and treat others. The clinic is very understaffed and Allen wants to go back to school to become more qualified in certain areas such as radiology, so that he can help the clinic even more. While he treated patients, he was so patient and always took the time to explain things to me. Overall, he was a great teacher and such a passionate healthcare worker.
Q. How has your worldview changed?
I knew so little of Uganda and even the continent of Africa before my trip. Africa is not at all like what is portrayed of it on the news. Obviously there are parts with war, disease, and extreme poverty, but there are also amazing things about Africa that I was able to see. I no longer associate one country of Africa with the whole continent. Each country is unique.
Special thanks to Alana D'Onofrio for allowing us to interview her for this post.
For those who have participated in a service-learning trip abroad, you understand how life changing it can be. Visiting and learning from a community and culture different from your own can affect you in deep and meaningful ways. But programs and experiences vary widely. Some may claim opportunities for personal and professional growth, yet transparency and best practices are not always the reality on the ground. Also undermining quality, few programs provide true long-term benefits to the host community. One way that medical service-learning trips, or global health electives, can ensure quality is by applying a competency-based framework.
What is competency-based education?
Competency-based education (CBE) is not new, but the concept is receiving renewed attention in many fields, including global health and medical education. One distinguishing feature of CBE is that it begins with the end in mind. This means that the first priority when creating a competency-based curriculum is identifying the desired characteristics and qualities of a competent graduate. Once these characteristics are defined, they are broken down into building blocks, called competencies, which students master as they move through the curriculum. Unlike traditional education, competencies do not have to be course-specific or based on a specific number of course hours; instead, they integrate everything that the student is learning at a given time and build upon each other throughout their schooling. The amount of time required to master the knowledge, skills, and attitudes necessary to achieve each competency may vary, but competence must be demonstrated before students are able to progress in the curriculum.
The beauty of CBE is that it is fluid and flexible, promoting critical application of the course material with a focus on what students should be able to do, as opposed to a singular emphasis on knowledge. The ability of CBE to produce graduates who are competent professionals has made the approach increasingly popular among various health fields. In fact, The Association of Schools and Programs of Public Health (ASPPH), the Accreditation Council for Graduate Medical Education (ACGME), and the Canadian Medical Education Directives for Specialists (CanMEDS) have all developed core competencies for their programs.
It is easy to understand why GHEs are increasing in popularity. GHEs provide benefits to students, improving cultural competence, strengthen clinical skills, and increased appreciation for prevention and providing care to the underserved. However, opportunities for growth are not always guaranteed as they are based entirely on program quality. Unfortunately, little effort has gone into determining the structure and educational objectives for GHEs. One way to ensure GHEs meet the needs of students and host communities is to apply a competency-based framework built around the health needs of the host community. Even though most GHEs take place in low and middle-income countries (LMICs), current global health competencies are primarily developed by professionals from high-income countries and little research has explored the effects of GHEs on local communities. In order to develop positive, reciprocal relationships with host communities, colleagues in LMICs need to be engaged in conversation to identify local health priorities and relevant competencies to address them. Students thinking about participating in a GHE can promote responsible global health education by choosing a program or organization, such as Child Family Health International, that has strong international partnerships and is dedicated to protecting the interests of host communities.
Global health electives that promote cross-cultural partnerships and emphasize competencies addressing the health needs of the local community can provide incredible opportunities for personal and professional growth, while simultaneously offering benefits to the host community.
Special thanks to CFHI Intern, EmilyDecember Latham, for authoring this blog.
On June 26th, I collaborated on a workshop entitled “Beyond the Basics: Advising Students on Health Experiences Abroad,” led by Child Family Health International (CFHI) Executive Director Dr. Jessica Evert and Tricia Todd, MPH, Assistant Director of the University of Minnesota Health Careers Center. The workshop coincided with the National Association of Advisors for the Health Professions (NAAHP) Annual Conference, held this year in San Francisco. Advisors arrived at CFHI’s San Francisco headquarters in to a full house with over 20 attendees representing 15 different colleges and universities. Small Liberal Arts colleges from Maine were particularly well represented, with advisors from Bates, Bowdoin, and Colby College in attendance.
As a grad student of International Education Management, I was interested to observe the backgrounds represented amongst the attendees. Some were faculty in science departments, some staff from career development offices, and others from programs specifically geared towards global health. What everyone had in common was knowledge of issues relating to advising pre-health students, and all expressed worries regarding the growth of an “industry” to meet the rapidly growing demand from students seeking health-training programs abroad.
Health Students Doing Too Much, Too Soon - How to Choose Reputable Programs
The issue of the commodification of education abroad, which I was familiar with from graduate courses, took on greater significance when discussing health-related programs where issues of medical ethics and patient safety come into play. In such cases, not only are students being sold an education abroad “experience", but unethical program providers tell students that they will be able to perform clinical work that exceeds their training and “change the world” through their work, effectively putting patients’ lives at risk.
Advisors were eager to discuss strategies for guiding students towards reputable programs and avoiding companies and experiences where students are encouraged to “do too much, too soon.” Case studies were presented, based on actual incidents from the field. Some were particularly alarming: undergraduates delivering babies, students conducting hospital rounds unsupervised, even instances of students scrubbing in for surgery! Unfortunately many students are under the erroneous impression that participating in this type of hands-on clinical experience will give them a leg-up in the competitive world of medical, nursing or other health professions school admissions. Part of the messaging to pre-health professions students therefore needs to focus on how performing clinical duties beyond what they are authorized to do here in the U.S. is highly unethical, and could jeopardize their own careers.
Before the evening was over, Dr. Evert, playing the roll of the advisor, and I, playing the part of a well meaning (but naïve) pre-med student, acted out an all too common scenario for the group. Fortunately, in our fictional advising session the student wasreceptive to ideas. The advisor convinces the student to re-examine motivations for wanting to go abroad, and suggests the right questions to ask when choosing a global health education program. The role-play emphasized the many tools available for students to examine their motivations for taking part in a health experience abroad. I think advisors in attendance left the CFHI - UMN Health Careers Workshop with new resources, a feeling of community, and a better sense of how to guide students to help them make better decisions for their global health education.
Special thanks to our guest blogger, CFHI Intern Alex Nichol, for authoring this post.