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 than many of my peers about communication barriers between physician 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.
“Global health education is at a crossroad. The landmark Commission on Education of Health Professionals for the 21st Century highlighted the substantial disparities in health education worldwide and proposed reforms to enable all health professionals to “participate in patient and population-centered health systems as members of locally responsive and globally connected teams”.
This quote was taken from the Lancet article entitled 'Equitable access for global health internships: insights and strategies at WHO headquarters.' The Lancet Global Health article highlights the need for broadly accessible global health internships--- ones that allow for exposure to community-engaged programs by students from a variety of socioeconomic and professional school backgrounds. The barriers to access to global health educational opportunities are real and require the global health education community to embrace novel approaches, alliances, and funding mechanisms.
CFHI global health interns with local physician in Ecuador.
Child Family Health International- CFHI a leader in global health education programs for over 20 years, is mindful of these barriers. As a nonprofit running global health internships that advocate for ethics and social responsibility, we recognize there are significant costs associated with global health internships and provide fair compensation to local communities and professional mentors that shape the intern experience through their time, energy and expertise. This follows best practice guidelines set out by the Working Group on Ethics Guidelines for Global Health Training (WEIGHT). However, program fees needed to provide resources for host communities and to support and educate interns can be a barrier to equitable access to reach beyond students from resource-rich backgrounds.
Like the WHO, CFHI utilizes scholarships in an effort to seek out candidates that may have greater financial need, limited opportunity to travel abroad, and those whose are under-represented in our programs. Scholarships and funding initiatives such as these are key to making real strides in south-to-south participation in global health internships and reducing their exclusivity as the domain of the wealthy. In addition, CFHI provides a crowdfunding platform to make it easier for students to raise funds through friends, family, mentors, and wider social media networks. Crowdfunding is growing, and is a powerful tool that should be considered by WHO and other global health internship providers.
“For sustainable improvements in internship access and improved global health education, academic and professional institutions need to partner with the public sector and foundations, donors, and governments to channel resources to achieve this aim. However, the scale of this task necessitates the involvement of multiple stakeholders. Who else will step up and contribute to a growing movement towards equitable access for training, educational, and networking opportunities in global health? And who should lead this transition and monitor its success?”
The article is ‘right on’ with its call to arms. If global health education programs and internships to not focus on equity, access and diversity, we risk perpetuating the same power imbalances and disparities that the global health community strives to eliminate. Child Family Health International commends WHO and the Lancet article authors for highlighting this issue and remedying it with action and advocacy.
How can we ensure that more students have access to global health and other professional and international internships? Comment on the Lancet blog or tell CFHI what you think below!
“Where are you from?” is often the hardest question for me to answer. Do I give the short answer, the long answer, or settle for “it’s complicated” like a provocative Facebook relationship status? Yet that dilemma is a small price to pay for all I’ve gained through experiences living and traveling around the world.
A study from the journal of Social Psychological & Personality Science found that those who engage in multicultural and international environments are more likely to be offered jobs. At surface value, this comes as no surprise; in any arena these days—school, job, socially, or otherwise—it is beneficial to set yourself apart, and “multicultural experiences,” are a great way to do so. But simply accumulating stamps in your passport is not enough. In an article on the study, David Livermore writes “If business travelers spend their time at international hotels and offices; and if study abroad students spend their free time on Skype and Facebook, travel may have little positive benefit for improving CQ (cultural intelligence) and career opportunities.” Travel creates a possibility for transformation through exposure to new cultures and ways of life. But it is easy to pass up that opportunity and flock toward familiarity instead, to head to a Starbucks in a foreign country or find solace from strange surroundings amongst fellow visitors.
The Transformation: How You Engage
Transformative travel requires openness. As more and more and more people seek programmed multicultural experiences— study abroad, volunteering, or simply sightseeing—it is important to evaluate your own goals and the goals of the organization. Responsible international travel necessitates embracing the discomfort and challenges of unfamiliarity, and also willingness to let go of your own authority: to follow the leadership of the locals and see the positive aspects of a community rather than perceived negatives. To me, the most striking overseas experiences have involved connecting with people through common humanness despite apparent differences. These experiences, not traveling itself, are transformative.
I was drawn to work with Child Family Health International (CFHI) because their global health programs promote an immersive experience through community-based projects and perspectives. Interning here and learning about CFHI programs over the past month has made me reflect on my own international experiences. I was born in the U.S. but since age nine I have lived abroad in different countries with my family. Though I have spent much of my life overseas, some who go abroad for shorter periods of time have had more intensive and challenging cultural experiences than mine. It can be easy to entrench yourself in an expat community and become complacent about pushing beyond that.
The study suggests benefits of international travel for your career; I don’t see my experiences overseas as having made me marketable, though I can’t complain if that is a byproduct. Rather, I see travel as the defining aspect of my life that has provided more unique challenges and rewards than anything else. CFHI’s motto encourages students to “Let the world change you,” instead of trying to change the world. It has and will continue to change me throughout my life. And maybe even get me some jobs too.
Special thanks to our guest blogger and CFHI Summer Intern Karoline Walter for authoring this post.
Internationalized Medical Education: How do we develop competency-based education and realize its full potential? UN-recognized NGO Child Family Health International (CFHI) has been running global health education programs for over 20 years. We have seen a lot along the way since our beginnings in a small garage in the San Francisco Bay Area.
Global Health and Study Abroad See Upward Trends
Fast forward to 2014. Global health has become a buzzword, conjuring up images of Bill and Melinda Gates projects and Partners in Health initiatives. Once a field that rallied for press, global health is receiving increasing limelight. Take a look on the Kaiser Family Foundation webinar on U.S. spending towards global health initiatives or the entire Center for Global Development event devoted to discussing Best Buys in Global Health. Global health teaching in undergrad and medical curricula is also increasing and the 2013 Open Doors Report on International Educational Exchange, states study abroad by U.S. based students is steadily increasing and is at an all time high. The Association of American Medical Colleges data demonstrates that 35% of US medical students participate in international experiences. Spurred by increased participation, global health education is evolving from a phenomenon of one-off volunteer experiences to a field of educational theory and practice, shaping the world’s next generation of healthcare providers with skills demanded by an increasingly inter-connected world.
Looking at Competencies in Medical Education & How Students Engage
A study in the journal Academic Medicine shows the structure of global health programs, the degree to which they are imbedded in local health care systems, and having a capacity-building agenda, affects what students learn. In an era where competency-based education is dominating pedagogy in medical education, we must leverage the richness of global health experiences to meet accreditation standards and competency-based outcomes. Like studies have shown and CFHI’s 7,000 alumni can attest, global health exposure and international experiences make for better practitioners and global citizens. CFHI’s approach leverages asset-based engagement and encourages students to “Let the World Change YOU.”
As we strive to meet demand and look at the nuances of programming, we must continue to examine students’ international experiences. This month thousands of international educators will gather at the NAFSA conference and discuss these topics at the Colloquium on Internationalizing Education for the Health Professions. Here and on our own we must consider key questions—what competencies does a globalized health practitioner need? What competencies are nurtured during global health programs? How do we wed international global health and what is taking place in our own back yards? Just as important, not all global health experiences are created equal. As educators and leaders in the field, we must advocate for socially responsible and ethically sound approaches to placing students in health settings abroad.
I descended upon the city through drizzle in true Seattle fashion, the Olympic Mountains revealing themselves in the distance. A local next to me argued against Seattle’s reputation for unyielding damp weather and boasted that the previous four days were dry and full of sunshine.
Rain or shine Seattle was brimming with energy and dialogue, as The University of Washington hosted the 11th Annual Western Regional International Health Conference (WRIHC) April 4-6, themed “Uncensored: Gender, Sexuality, & Social Movements in Global Health.” The largest student lead conference in the nation, nearly 600 attendees from around the country and the globe joined the dialogue around gender and sexuality, topics too often stigmatized and neglected. I was there as an alumna of three different Child Family Health International (CFHI) global health education programs, representing CFHI amongst an army of global health enthusiasts.
Jessica Stern, Executive Director of International Gay and Lesbian Human Rights Commission (IGLHRC), boldly declared, “It is not an option to silence sexuality. It’s everyone’s business to talk about these issues and more importantly, we need to talk about the sex we actually have, not the sex we pretend to have.”
The conference kicked off with a fiery presentation by keynote speaker Stella Nyanzi, PhD. A native to Uganda and a seasoned medical anthropologist, Dr. Nyanzi has worked extensively on youth sexuality and sexual and reproductive health issues in East Africa and contributed notable social science research and academic literature surrounding these topics. She encouraged the audience to not waste any time and to ‘uncensor’ gender, sexuality and social movements --the hardcore issues. She wasn’t kidding and even stunned the audience with the use of curse words, repeatedly followed by, “Pardon me, but I thought this conference was uncensored?” The diverse crowd immediately took to her, listening intently as she urged all in attendance to mobilize against issues that, whether we realize it or not, are relevant to us all.
Simply being in that room meant we were all comrades in the struggle for global health no matter what our focus, being that gender and sexuality permeate all aspects of health. Don’t forget, she sternly reminded us, that health transcends the mere absence of disease. “Become radical in a radical way and stop doing business as usual. Global health is about the global North and South. Arrive in foreign lands with a teachable spirit and empower everyone involved.”
Those with a teachable spirit can learn more about sexual and reproductive health issues touched upon during the WRIHC event. CFHI’s Sexual Health as a Human Right: Ecuador’s Unique Model in Quito, Ecuador affords understanding of sexual and reproductive health issues in Ecuador, the first Latin American country to guarantee sexual rights in the constitution despite a conservative societal context. Participants learn and help devise and execute educational and outreach strategies to take out into the community.
Going forward it’s imperative to continue ‘uncensoring’ topics, such as sexuality and gender. Jessica Stern from IGLHRC reminded us, “Sexuality is not just homosexuality. We all have sexual identities and sexual health is a human right.” Carlton Rounds, Founder of Volunteer Positive, urged the crowd to “lead with your stigma.”
Thanks to three time CFHI alumna Lyndsey Brahm for authoring this blog post.
Nothing makes for fodder amongst academics and medial professionals like definitions. In the case of global health there are more than a few. One definition was put forth for the Executive Board of the Consortium of Universities for Global Health (CUGH) by Jeffrey Koplan, MD, MPH, a physician, author and academic. Another definition, offering a challenge to the often idealized concept, was proposed by a physician from the Global South as “a concept fabricated by developed countries to explain what is regular practice in developing nations.” During this, the 19th annual National Public Health Week, let’s consider the definition of global health that appeared in The Lancet, “Global Health is Public Health.”
Students in Ecuador Attending a Reproductive Health Information Fair
Abroad, physicians and other practitioners in resource-restricted settings act simultaneously as caregivers for both individual patients and populations as a whole. The marriage of public health, clinical medicine, and health systems is cost-effective, pragmatic, and successful. Slowly the US is catching on, as primary care physicians start to look at their patients, not only individually, but also as panels with certain disease profiles that can be monitored for population-based perspectives. Similarly, experts have called on medical schools to be accountable to their communities in the Social Accountability of Medical Education movement, suggesting schools success cannot be measured without considering impacts on their own community’s health status.
Discovering Public Health in International Experiences
As head of Child Family Health International(CFHI), students interested in CFHI’s Global Health Education Programs often approach me and ask “What programs are focused on public health?” or conversely, “I want a program solely focused on clinical medicine, not public health.” What they soon learn upon beginning their CFHI experience, however, is the important reality that in many low and middle-income countries the lines between public health and biomedicine are very much blurred. This is largely out of necessity demanded by sparse or finite resources, as well as evidence-based and systems approaches to health.
International experiences focused on global health such as CFHI’s have so many proven benefits—studies have shown increased cultural competency, better understanding of caring for people with limited supplies, and a nurturing of lifetime dedication to underserved care. Importantly, they also increase board scores in public health. So, rather than asking “how can I find an international experience focused on public health?” consider the question, “how can I find the public health in my international experience?”
How have you found the public health in your international experiences? Let us know in the comments below.
Just a few weeks ago, in partnership with CFHI, Winnie and James Chang of Palo Alto, California hosted an event celebrating the recent opening of The Center for Empowerment of Young Mothers (EMJ) in Bolivia. The Changs are spearheading fundraising and donations for this project based in Bolivia working to empower young mothers.
Bolivia is one of the poorest countries in Latin America and the education system is often underdeveloped. In addition, the rate of sexual violence is extremely high; 7 out of 10 female teenagers are assaulted. Many of these young women become pregnant, some as young as 14 or 15. To combat these issues and provide support to young mothers, the EMJ Center was created. It operates a facility in El Alto, Bolivia, staffed by doctors, nurses, administrators and volunteers and provides help to young women from all socio-economic backgrounds. In South America, young mothers are often impoverished, socially isolated, and have little education. Understanding the importance of education and improving their self-esteem is key to mobilizing change. Because South American women are usually in charge of the family, they play a very important role in society. The EMJ Center in partnership with CFHI works through education and empowerment so these women will positively affect Bolivian society at large.
EMJ provides daycare services for more than 20 mothers, recreational activities for children and moms, and are launching a fair where mothers are able to sell crafts and handiwork they have created. Mothers at the center were interested in learning about family planning, so EMJ provides education on these issues as well as women’s rights and gender issues.
CFHI and the EMJ Center are physically far away from one other, yet they strive for the same goal - to empower women.
You can help this great cause and do your part to further United Nations MDG 3 and women’s empowerment by donating to support the EMJ Center.
Newsflash! This week’s headlines report a new humanitarian organization ‘Doctors Without Licenses’ will start providing substandard care by putting together a group of “decertified physicians, pre-medical undergraduates, and ‘people just interested in the human body’.” The organization states it will be sending their staff to conflict zones and underserved areas to incorrectly provide medical care.
Image from The Onion satirical article
This news was reported in The Onion, a satirical weekly publication, so it is, of course, facetious. The sad truth is that it refers to a very real phenomenon.
Voluntourism and Medical Voluntourism – Repercussions
Searching ‘voluntourism’ on Google, one finds a number of hits for organizations that set up volunteer opportunities for well-meaning individuals to work in underserved communities. Medical voluntourism refers to doing medical care within these communities; these volunteers can be physicians, nurses, residents, medical students and a growing number of organizations offer hands-on opportunities for pre-medical students, as well. More and more research as well as anecdotal reports state that these short term volunteer trips do more harm than good to the local community. (If you’re interested in a great contrast between voluntourism and global health—this article is a must read. The volunteers may be providing direct patient care, giving medications, and doing procedures. In cases where the volunteer has no formal training, and would not be allowed to do the same in their home countries, this type of care is unethical whether or not the results are disastrous. Even for those who are trained and skilled, the lack of knowledge of local infrastructure, drug formularies, culture, language and historical frameworks can actually lead ‘good’ actions to having negative consequences.
Solutions and Social Responsibility
Proposed solutions vary as the scope of the problem is large and not fully realized. However, organizations such as Child Family Health International - CFHI, try to decrease harm by giving students the opportunity to immerse within the culture, focus on broad global health competencies, observe native health care providers who are dedicated to their communities long-term health. This prevents the student from being a short-term ‘band-aid’ health worker or trying to get patient care experience that they are not licensed to undertake. The students are able to understand health concerns in other countries while minimizing possible harmful outcomes.
Voluntourism is most likely here to stay, however the importance of finding ways to reduce harm while giving the local community the help it requires is an ongoing challenge.
Thanks to our guest blogger, Aditi Joshi MD, ER Physician and Former President IFMSA-USA for authoring this post.
February 20th is World Social Justice Day. We would like to take this day to highlight one of our partners who has been working to achieve social justice. Dr. Rajagopal has been helping to reform the Hospice and Palliative Care laws in India through his organization, Pallium India.Through both personal visits to patients, and by building a strong system of doctors across the nation, Dr. Rajagopal has highly improved the state of Palliative and Hospice Care in India. Access to Morphine and Pain Killers is an enormous problem in India because of previous problems with morphine addictions. India has the highest amount of victims for mouth cancer, and it is estimated that less than 3% of cancer patients get proper pain relief. (1)
Dr. Raj conducting a home visit, Trivandrum Southern India
Fortunately, laws in India have been changed. Now, a policy has been set so that in Kerala, doctors with at least 6 weeks of training, such as Dr. Rajagopal, can prescribe morphine for palliative care. (2) The rule was introduced in June 1998 in Trivandrum, the capital city of the state of Kerala. Since then, the central government has recommended this new rule to all the states in India. The idea of easier access to morphine and other pain relieving drugs was initially recommended by organizations and committees such as WHO Collaborating Center for Policy and Communications in Cancer Care (Wisconsin, USA). The Center is currently attempting to simplify complicated state narcotic regulations to further improve the availability of opioid analgesics.
Through his organization, Pallium India, Dr. Rajagopal strives to provide Palliative and Hospice care to those that need it. Not only does Pallium India provide medical care to patients, but the organization also provides resources such as food and sewing machines to the patient’s family to help them get back on their feet. CFHI has partnered with Dr. Rajagopal to launch the Palliative Care In Southern India Program in Trivandrum, India that centers around Hospice and Palliative care. The CFHI participants involved in the program are given the opportunity to visit the patients and experience first hand how patients are treated and managed. Pallium India and CFHI have worked together to reform India's Hospice and Palliative Care system.
“Over the past decade, the number of American students in health fields going abroad has nearly tripled, with many opting for programs that take them out of the classroom and into clinics and hospitals. But as participation has increased, so, too, have educators’ concerns.
Far too often, experts say, students are providing patient care—conducting examinations, suturing wounds, even delivering babies—for which they have little or no training. Indeed, as competition intensifies for medical-school slots, some students may actually be going overseas for hands-on experience they could not get in the United States, in hopes of giving their applications a competitive edge.”
As the field of global health continues to grow, so too are programs and options available to health students of all fields, often promising opportunities to “help” and engage in hands-on experience beyond their training, skill level, or licensure. From the beginning CFHI has used an asset-based approach for engaging with communities abroad, and encouraging students to “Let the world change YOU.” In this way we position participants of Global Health Education Programs to learn, reflect, and realize that many times the most powerful impact they have in their role abroad is to form connections and relationships with local expert physicians and patients that will serve them in their future careers, as well as learn about the multitude of health determinants and complex global realities that underlie global health challenges. We’d like to extend a big thank you to the Chronicle of Higher Education for helping us spread the word and advocate for social responsibility in health and medical education.
What do you think should be students’ role in health settings abroad? How can students balance enthusiasm for learning while respecting ethical boundaries in clinical settings? Let us know your thoughts in the comments section below.
CFHI's Newest Programs in East Africa: Be Part of “An Activated Community” in Southwest Uganda
It is exciting when CFHI finds a partner so well aligned with its values of addressing broad determinants of health, engaging communities to help themselves, and strengthening local capacity for health care and community activation. The Kigezi Healthcare Foundation (KIHEFO), a non-profit organization operating in Kabale, Uganda, is fighting disease, poverty, and ignorance by creating “An Activated Community.” In partnership with KIHEFO, CFHI’s new Uganda programs HIV & Maternal/Child Health and Nutrition, Food Security & Sustainable Agriculture offer students from all academic backgrounds a firsthand learning experience addressing health, poverty, and education.
Uganda is a country in Sub-Saharan East Africa facing many serious health problems and challenges, including high rates of maternal mortality (only 30% of women give birth in a health facility), HIV and child malnutrition. There is a shortage of medical professionals working in Uganda, along with equipment and medications. With the majority of the population living in rural villages and earning around less than $2 a day while subsistence farming, access to healthcare services is a severe challenge.
KIHEFO’s mission is to fight disease, poverty and ignorance in an integrated, sustainable manner. This means not only delivering healthcare, but helping communities deliver themselves out of poverty and reducing the problems causing sickness and disease. The team is large, “an activated community” made up of staff, former-patients and supporters worldwide mobilizing their communities for improved health and economic well-being.
CFHI Student’s Role in Uganda
Through CFHI, students from all academic backgrounds and levels have the opportunity to work closely to learn first-hand about child and maternal health, HIV, malnutrition prevention and rehabilitation, food security, sustainable agriculture, empowerment of women’s groups, micro-credit savings and community mobilization.
Students observe and learn from healthcare professionals working at the General Clinic, at the HIV/AIDS Clinic learn from counselors and former HIV positive patients about testing and counseling HIV+ patients, and participate in a monthly HIV outreach.
At the Nutrition & Rehabilitation Centre, students learn from social workers and nurses about preventing and rehabilitating malnourished children, and participate in nutrition assessments to measure patient’s growth and progress. Additionally, students learn about sustainable agriculture practices, including permaculture, and the importance of crop diversification and growing food closer to home.
KIHEFO believes there is no single cause of disease, much like there is no single solution. Mirroring the CFHI approach they believe initiatives must be integrated, community-based and sustainable. Join CFHI’s Uganda Programs to learn from the people behind the “community activated” model for improving health and livelihoods.