Category Archives: Local Experts

Partera Influence on Health and Culture in Mexico | A Personal Story

This piece was written and contributed by CFHI participant Carmen Simmons, who was a Medical Student at Meharry Medical College when she participated in the Women’s Reproductive Health program in Puerto Escondido, Mexico in 2018.

When first arriving at the Centro de Salud, I have to admit I was proud of myself. I had managed to find the right colectivo in a mountainous countryside in the quaint town of Río Grande. After exchanging various “Buenos Dias”, I made my way over to partera, traditional midwife, Señora Lucia Zaguilan Mayoral.

At our first meeting, Sra. Lucia patiently listened to my never-ending questions in – let’s be honest – broken Spanish. When she spoke I struggled with the speed of her words. After some compromise on both of our parts, we found a tempo that worked for us to communicate.

Sra. Lucia calls Colonial Villa De Tututepec home and is a Rio Grande native. She has been attending births since she was 13 years old (today she is 63). Coming from a long line of parteras, she started learning as her grandmother’s apprentice. To this day, her family is filled with an impressive variety of healthcare workers.

She has attended conservatively well over 5,000 births. INCLUDING HER OWN CHILD’S! Yes, that’s right, she delivered her own son. She recounted the story to me while laughing at its ridiculousness. In her last days of pregnancy, she was in the kitchen cooking when her contractions started getting too close for comfort. She can’t exactly remember why no one was home, but nonetheless she had her abundant knowledge of births to comfort her. As calm as anyone could be while delivering her own child, Sra. Lucia guided her son toward the light of life. She even cut the cord herself! By the time her family came back home, they were greeted by a nursing newborn.

During the partera training I was able to witness, Lucia reflected on the immense amount of knowledge her grandmother bestowed onto her. This particular partera training is an annual training co-facilitated by Child Family Health International, local staff and a group of Northwestern students in partnership with the Oaxacan Ministry of Health. As a young girl, Lucia learned many techniques from her grandmother including monitoring her patient’s hair, skin, and eye color and the various methods of moving a baby into the correct position for delivery.

At the partera training, I immediately noticed that all of the women were 60 years or older. I asked her what she thought had changed in the last 20-30 years since she began practicing as a partera to account for this . She comments that she, and others, have noticed a change in attitude with the younger generation. She states that “most young women (under 35) are scared of anything to do with childbirth. Many want cesareans now. And the others are too afraid to learn to be a partera.” The sociopolitical context on the increasing cesarean rate in Mexico is interesting in itself. Approximately 39% of all hospital births in the state of Oaxaca were cesarean births. The World Health Organization states when the cesarean rate goes above 10%, there is no evidence that mortality rates improve.

During my time with Lucia and other parteras, I learned of the integral role that Parteras play in women’s health in Mexico although it seems to be an aging profession. I also learned about the scarcity of resources (financial, equipment, etc.) that the parteras face and overcome daily in their work. I fear that communities will not truly understand the immense importance of their role until there are very few left. My hope is we don’t wait until then, and find a way to revitalize younger generations to strengthen the tradition and empower the existing parteras.  

Mabuhay: The Philippines During National Women’s Month

by Ally English
Program Manager, Africa and Asia

Mubuhay!  

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

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

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

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

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

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

National Women’s Month

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

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

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

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

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

How does a month celebrating women translate to health?

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

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

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

How do locals celebrate women’s month?

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

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

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

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

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

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

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

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

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

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

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

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

CFHI Impacts: How Local Communities are Transformed

By Lyndsey Brahm
Program Coordinator

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

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

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

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

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

Midwife Training in Oaxaca, Mexico

Midwife Training in Oaxaca, Mexico

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

Ethical Dilemmas in Global Internships: Lessons from the GIC 2016

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by Robin Young
Assistant Director, Africa and Asia

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

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

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

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

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

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

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


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

 

CFHI Unveils Inaugural Alumni Advisory Board

Over the past 23 years, Child Family Health International (CFHI) has transformed over 8,000 participants’ lives through our Global Health Education Programs in 7 countries. CFHI Global Health Scholars experience competency-based education and asset-based community development, while contributing to the transformational ways that CFHI’s partners address health and healing.

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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.

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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.

For more information, please contact alumni@cfhi.org.

Travel vs. Transformation: Career Impacts

Travel and Cultural Intelligence

“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.CFHIMapWhite

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.

Beyond International Women’s Day

Women’s Empowerment Beyond International Women’s Day

International Women’s Day, also known as United Nations Day for Women’s Rights and International Peace was March 8th.  Child Family Health International (CFHI) firmly believes, however, that we must reflect more than once a year on women’s empowerment, progress made, and steps we can take as individuals and organizations to push this initiative forward.  In fact, front and center in CFHI’s tagline we highlight the importance of this as part of our everyday mission: Transformative Global Health Education and Community Empowerment.  This includes working towards UN Millennium Goal 3 – Promote Gender Equality and Empower Women.UN Millennium Goal 3 Photo

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.

Help support young mothers in Bolivia: http://www.emjcenter.org/donate/.

 

Thanks to guest bloggers Alexandria Tso and Nayanika Kapoor for contributing in part to this article.

CFHI Salutes Medical Director Dr. Raj on World Social Justice Day

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

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.

(1), (2) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573467/

 

-Special thanks to guest bloggers Alexandria Tso and Nayanika Kapoor for contributing this article.

CFHI vs. Brigades: Defining “Helping” in Healthcare Abroad

A Doctor Walks Into a Community..

For healthcare professionals or those on that path, it’s tempting to drop into a community abroad and start treating patients.  The stark realities of poverty, lack of resources, and unaddressed illness provides an often disturbing (and therefore motivational) contrast to our Western frame of reference.  We are often shocked and saddened.  As a consequence, we want to help.

An important question arises however, when we are students or even when we are credentialed professionals visiting a faraway community, what’s the best way to help?

Two Approaches to Global Health aamcacademicmed

An article profiling Child Family Health International – CFHI’s Global Health Education Programs in the current online edition of the Association of American Medical Colleges’ journal Academic Medicine contrasts two interpretations of ‘helping.’  The article contrasts CFHI’s program structure to that of brigades.  Brigades are short-term (often lasting one or two weeks) international activities that set-up clinics in parallel to or completely outside of existing health systems.  These temporary establishments are meant to see many patients in a short period of time. Commonly, medications, often drug samples, are brought down from the home country of volunteers and dolled out to patients.

The students writing the article draw an important contrast between the two definitions of ‘helping’ represented by CFHI Programs and brigades.  Brigades aim to ‘help’ by directly treating patients using Western physicians and students.  But they do so often at the expense of follow-up and continuity of care.  Brigades define ‘help’ in a very immediate sense.  Contrastingly, CFHI defines helping as empowering local communities and using Western funds to develop and elevate the stature of the native health care workforce.  CFHI positions local physicians, nurses, and community members as local experts, in a unique role to teach outsiders about their approach and insight. CFHI  believes they are the sustainable solutions to global health challenges.

Humility and Knowledge Key

CFHI Student with Local Doctor, India

CFHI Student with Local Doctor, India

CFHI’s definition of helping is perhaps more humble, believing we need to first respect and attempt to understand the complexities that underlie global health challenges, rather than trying to address these challenges with immediate auxiliary patient care.  This admiration of local health care providers and the goal of first comprehending the complexities of global health disparities is fundamental to shaping the collaborative global health leaders of the future.  Before we try to change a reality, we must begin to understand it.  This understanding is afforded by CFHI’s Global Health Education Programs.

How it All Began: The Early Days of CFHI

The Early Days of CFHI Featured at San Francisco Film Festivalfilmfest

This past July the documentary film “The Most Distant Places” was featured amongst others at the Bay Area Global Health Film Festival. This story, directed by Mike Seely, is depicted from the perspective of Ecuadorian doctor Dr. Edgar Rodas, then a medical school Dean in Cuenca, Ecuador. The film chronicled the importance of constructing a mobile surgical clinic and the team involved in bringing mobile care to remote communities in Ecuador.

The film festival was organized to shed light on a critical message in need of a strong voice: access to the most basic surgical care is a human right, not a luxury. Dr. Rodas shared his story and expressed an unwavering commitment to his fellow Ecuadorians. As the film came to an end and the audience allowed the weight of the story to settle, he delicately reminded everyone that every effort produces a result. These efforts would eventually result in CFHI- Child Family Health International as we know it today.

A Chance Meeting

A young Evaleen Jones, in Ecuador.

A young Evaleen Jones (right), in Ecuador.

As I sat across the table from Dr. Evaleen Jones, CFHI’s Founder and President, I marveled that even after twenty-one years, she tells the story of CFHI’s beginning with energy and excitement. She reminisced about her time in Ecuador as a third year medical student at Stanford University School of Medicine. At the time, Stanford University did not readily offer International Health opportunities abroad with a student focus. To best serve patients living in densely populated Latino communities within the Bay Area, Evaleen knew that Spanish language and cultural competencies were essential. And so, with only a modest amount of money she embarked on her first adventure abroad.

Once in Ecuador, Evaleen’s efforts to connect with local physicians led her to Dr. Edgar Rodas, the doctor who would be featured in the Distant Places film many years later.  She came to know him as a simple man who exuded a deep-seeded commitment to the well-being of his fellow countrymen.  As a surgeon he rejected the notion that a person cannot have an operation simply because they don’t have enough money. Regardless of the enormity of such an undertaking, he felt the status quo would not suffice.

As chronicled in the film, Dr. Rodas’ goal was to build a mobile surgical clinic. Evaleen, sensing the strength of his presence and understanding the value of his quest, jumped in headfirst and agreed to return to the States to arrange funding for construction of the mobile clinic.  According to Evaleen, “There are some people who you can sense very quickly are special individuals.” Even after only a week of knowing Dr. Rodas, she allowed her instincts to propel her forward.

CFHI Begins

The start of her fourth year in medical school Evaleen hit the ground running. Every conceivable connection was utilized- donations of all kinds– designing and constructing a surgical clinic, shipping the mobile unit. Evaleen’s fearlessness in asking gave her the edge that ultimately convinced others to help. Each someone told her “absolutely not Evaleen, this is impossible,” it motivated her to continue.

It was during this time that CFHI came to life. Approaching potential small-logo2_pngdonors as a recognized NGO lead to greater success. Evaleen had also not lost sight of her original intentions: CFHI was to be a platform to provide medical students (and later students of varying fields interested in health) with learning opportunities abroad, and to increase language and cultural competencies. Dr. Jones states again and again that the world is a classroom and students should pay for the privilege of learning.  Uniquely CFHI, she also saw that students could be a sustainable source of support for locally-run health care efforts that don’t breed reliance on Western ‘aid.’ While placed in the global classroom, students are encouraged to open their minds and listen well, and let the world change them. Even with the passing of time, Dr. Rodas and Dr. Evaleen Jones remain faithful to their belief that, “It has always been about the people, not the projects.”

 

–Lyndsey Brahm

Special thanks to CFHI alumna and volunteer Lyndsey Brahm for her work on this post.  Lyndsey will be attending the University of Copenhagen, School of Global Health in 2014.

Have some ideas and interested in blogging for CFHI?  Email info(at)cfhi.org for details.

Exploring the “Family” in Child Family Health International

You may have heard people refer to CFHI and those involved in the organization as part of a global family.  Our ‘family’ is made up of wonderful volunteers, health care providers, devoted  staff (stateside and abroad), as well as the fastest growing part of our family– more than 7,000 CFHI alumni and counting!India-Hands  We have been growing our family and projects for over 20 years.

CFHI is not only a global family, but we serve families.  Two projects that come to mind when I think about how our work affects families are projects that target the long-distance trucking industry in India and the illegal sex workers that support this industry.

In India, young men, and boys barely out of school, travel the highway system connecting the most distant corners.  The work is hard, the hours long, and the travel dangerous on the over-crowded highways connecting coast to coast.  While away from home for 2-6 months at a time, many truck drivers engage in sexual activities with prostitutes.  Two National Aids Control Organization (NACO)-based foundations that target this population are the Society for the Promotion of Youth and Masses (SPYM) and SWACH (Survival for Women and Children Foundation).

Actors performing skit on STD awareness at truck stop in New Delhi, India.

Actors performing skit on STD awareness at truck stop in New Delhi, India.

Both do amazing outreach and fieldwork with peer educators, some once truckers themselves. They captivate the young audience by performing skits (see photo, right), playing card games, leading monthly health camps, and offering the men free hair cuts and shaves while they talk about safe sex.  SWATCH peer educators target the high-risk female sex workers~ often widowed women (some still in their teens) who have been forced into sex work to support their children. Their main activities include teaching why condom use is important, the importance of regular HIV testing and resources are available if they test HIV positive.  They even teach the woman how to put on a condom on men in the dark by demonstrating how to put a condom on a model blind-folded!  Challenges ahead include rehabilitation training for the sex workers.

The family in Child Family Health International is both our global family of staff and local health care providers that make CFHI Global Health Education Programs the amazing experiences they are, and the network of folks, our alumni, who have been touched by CFHI’s transformative programs, as well as the families served by CFHI programs and reinvestment in host communities.

 

International Women’s Day- A Story From CFHI India

alwar2Evaleen Jones, MD is the founder of Child Family Health International (CFHI) and Clinical Faculty at the Stanford University School of Medicine.  Today, on International Women’s Day we feature an experience from her recent visit to CFHI partner sites in India, and a story from a woman she met while there.  Her story  carries the message of community empowerment that CFHI embodies.

January 31.  Today we visited Continue reading

CFHI: Asset-Based Community Engagement

Child Family Health International (CFHI) at 20 years old continues to be the gold-standard in forward thinking and innovative frameworks in global health education.  CFHI provides community-basedsmall-logo2_png education alongside local professionals via clinical and public health experiences for students and those interested in learning more about medicine and health-related fields, with more than 20 programs in 6 countries.  Programs cover a variety of topics from maternal health to palliative care.

What Makes CFHI Different?

After all these years CFHI remains unique, continuing to challenge paradigms in global health and advocating for local communities. CFHI partners with communities that are considered low-resource and underserved by global financial standards.  Rather than focusing on what is lacking, however, CFHI helps to identify community strengths, ingenuity, and passion.  In close collaboration with local teams, CFHI creates programs and funds community health projects identified and carried out by local teams. This practice is based on the asset-based community development approach, formalized at Northwestern University.  The CFHI approach positions local health practitioners and patients as the ‘local experts’—presenting global health realities through authentic experiences that help shape and transform young people who are interested in global health, equity, and global citizenship.

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

Not Just Talking the Talk, But Walking the Walk

Importantly, CFHI is a staunch proponent of compensation for local community contributions and practicing financial justice.  Uniquely CFHI, 50% or more of student program fees go directly to the communities they will be visiting, benefiting the local economy at large and specifically undeserved health systems.  CFHI is an active affiliate of Consortium of Universities for Global Health, United Nations ECOSOC and has authored literature about global health educational curriculum development at undergraduate and graduate levels.   CFHI encourages students to “Let the World Change You” in preparation for being a part of socially responsible, sustainable change they wish to see in the world.

How Can We Think Globally & Act Locally?

Phrases like “Think Global, Act Local” and “Global Health is Local Health” are catchy, but it’s sometimes difficult to figure out what they really mean. Continue reading

CFHI Featured at AAFP Global Health Workshop

Child Family Health International’s  Quito, Ecuador Medical Director Dra. Susana Alvear and Global Medical Director Dr. Jessica Evert were featured in the closing keynote address of the 9th Annual AAFP Global Health Workshop.  Nearly 300 attendees from 25 countries attended to share ideas, evidence, and inspiration on topics ranging from global health education at US institutions to the proliferation of family medicine around the world to the ethical challenges of global engagements.

Drs. Alvear and Evert presented on the realization of ethical aspirations- breaking down ethical concepts into practical topics and tangible actions.  The presentation was warmly received.  Dr. Dan Ostergaard,  AAFP’s Vice President for Health of the Public and Interprofessional Activities emphasized the application of CFHI’s motto “Let the World Change You” for all trainees, faculty, and physicians active in global health.  He also emphasized the concept drilled home by Drs. Alvear and Evert that we should really speak of “Toward Equity” rather than “Equity” itself given the gross disparities around the world.  Drs. Evert and Alvear emphasized the ability of institutions and individuals from developed countries to highlight the value of assets in developing country contexts—for example, richness of culture, strong traditional medicine practices, resourcefulness, rather than emphasizing the disparities of financial resources in order to ‘level the playing field,’ a concept originating from CFHI’s former Executive Director, Steve Schmidbauer.

Great respect and admiration were expressed for CFHI’s leadership, program structure, and partnership model.

Trends in Global Health Education: UT Health Science Center, San Antonio

UT Health Science Center, San Antonio Houses Global Health in the Center for Ethics

It’s interesting to consider where a university or medical school chooses to house their Global Health efforts and how this affects the focus and framework of global health activities.  Continue reading

Students Asking Difficult Questions on Global Health Engagement and Development

During the Western Regional International Health Conference I had the privilege of lunching with a group of inspirational and innovative undergraduate students from the University of Washington and University of British Columbia.  At University of Washington students have created the Critical Development Forum (CDF),  a think-tank creating Continue reading

CFHI Sexual Health in Ecuador Program Highlights Constitutional Priorities

In 1998 Ecuador was the first Latin American country to name reproductive and sexual health as constitutionally guaranteed human rights.  Continue reading

Celebrating 20 Years of CFHI

Happy Birthday, Child Family Health International!

2012 marks the 20th anniversary of CFHI’ s transformative Global Health Education Programs and Community Empowerment. This milestone gives us a chance to celebrate and to look back on the impact of CFHI. Continue reading