Category Archives: Local Experts

CFHI’s Model for Global Health Electives Included in Oxford University Press Publication

Oxford Handbook on Neuroethics

Oxford Handbook on Neuroethics

“Global Health Ethics is once again in the forefront of discussion with the recently published Oxford Handbook of Neuroethics chapter emphasizing the relevance of biomedical, clinical and public health ethics within the global medical and academic community.  Child Family Health International’s (CFHI) Evaleen Jones M.D., Jessica Evert M.D., Scott Loeliger M.D., and Steven Schmidbauer co-authored the chapter on the importance of establishing and sustaining an ethical framework for educational global health programs.

With growing interest in Global Health Electives among the medical and academic community, there are genuine concerns regarding equity, justice, and sustainability within underserved communities.  CFHI’s chapter discusses global citizenship via a socially responsible framework to create positive global health educational experiences for students and host communities, connecting students with local health professionals and through direct investments in local community based projects.  ”

So reads the beginning of the Press Release for CFHI issued today.  Needless to say, we are all very proud and very happy to have this recognition especially from such a noted publisher as Oxford University Press.  The portion that CFHI contributed to this chapter on Global Health Ethics is an attempt to describe our model of working in underserved communities by identifying local experts and building on the inherent strengths of the communities.  We have seen over and over again low-resource settings where amazing things are being accomplished every day in patient care due to extremely dedicated local professionals.  We see their deep commitment to serving the people and we join together with the local health professionals to design Global Heath Education Programs that are open to international students and trainees.  You can read our submission here but I want to take this opportunity to thank all our international partners who have chosen to work with us to develop this model and make it successful for the last 20 years.  No partnership is one-sided and we are deeply indebted to all the local doctors and nurses, hospital and clinic staff, local coordinators, host families, language teachers, drivers and many others who make our international programs function so well, even in some very challenging circumstances.  Our hats are off to all members of the CFHI global family –you all share in this recognition!

Read the full CFHI Press Relase and Chapter.

Empowerment Means Having a Voice

Voices of empowerment from women in rural Northern India

About an hour outside of the north Indian city of Dehradun, the terrain starts to change as you begin to enter the foothills of the Himalayas.  Paved streets give way to winding dirt roads, some seemingly carved into the incline of the mountain like the etches of a screw and only wide enough for one vehicle.  Luckily almost no one in this area has a car, so we are usually sharing the road only with the monkeys and the goats.  On this particular trip, the monsoons have not yet released India from their grip and our vehicle struggles on the loose dirt and gravel as the torrents of rain pour down.  Oddly enough, here, about as far away from an urban setting as you can get, I’m reminded of a car wash because the sheets of rain are hitting the car so hard that you can feel their force on the hood of the vehicle like the power washes you can get back home.

CFHI Logo SmallLuckily, as we reach the village of Patti, the torrents subside and we are able to disembark without getting too wet.  CFHI has supported the operation of a clinic in this area since the late 1990s –it is the base of the CFHI Rural Himalayan Global Health Immersion Program.  In the last seven years, we have trained women elected from the surrounding villages as health promoters.  Previous to these efforts, there was no organized healthcare happening in this area.  Today is a meeting of the health promoters, some having walked as many as five hours for the event (a fact that always humbles me greatly).  An initial three year training effort took women with little or no formal education and taught them the basic skills of health promotion.  Many of them come from a long line of traditional birth attendants, so they already had some experience in the area of health.  After the initial training, they have been able to monitor women throughout their entire pregnancy.  Additionally, they instruct their communities on many topics: sanitation, nutrition, immunizations, hygiene, and family planning, to name a few.

As the rain began to intensify once again, we huddled around two tables pushed together on a porch, under a metal roof, next to a rice field.  The sound of the rain caused everyone to move in closer and lean in to hear.  My many previous visits over the years have been in more extreme dry heat when we sat spread out in the shade as we

CFHI Health Promoters Meeting in the Village of Patti, Northern India

CFHI Health Promoters Meeting in the Village of Patti, Northern India

talked.  –Of course I need to stop here and say that since I have no capacity in Hindi, the CFHI India Coordinator, Ms. Hema Pandey, was gracious enough to do the translation, and her easy, relaxed, yet professional manner also contributed greatly to the level of the conversation.  Maybe it was this more close huddling, or maybe it was just the product of seven years of meeting them once or twice a year, but for whatever reason, this time the conversation took a more intimate track.  Over the years, our meetings have been about stories of the work the Health Promoters are doing, each in her own village.  I’ve always been moved by their commitment and dedication as the women are all volunteering in this role and, at times, it can occupy a lot of their time and energy.  We always talk about what they need and we try to line up successive training experiences for them.  Today, however, I somehow felt like I could ask them more about themselves.  Now, all these years into their work, I could see in them their own sense of being experienced –that they are really settling into their roles.   It also helped that there was a young 18 year old woman who had joined us for the first time, as she now wants become a Health Promoter.  The older women took her under their collective wing as she found it hard to answer any direct questions –not used to being asked her opinion.  “Don’t worry, you’ll get used to it,” was the message as all the older women laughed.  “We were all once like you,” one of them told her, “not knowing how to speak, not sure what to say … you’ll learn.”  It was also touching to see the older women buoyed in spirit by her interest.  There was more of a general feeling –not only of pride, but also of purpose, and an almost palatable sense of hope for the future in the smiles of the older women, broader than I have ever seen them before.

I asked the women what they liked most about their work.  They answered with the stories of what they have been able to do.  “And for you,” I asked, “what do YOU like about it.”  There was some discussion amongst the group. They said that they like “feeling empowered.”  “What does it mean,” I asked, “to feel empowered?”  “It means that now I can speak,” said one, motioning to the new recruit whose personal growth and self confidence the women will now each personally see to.  “It means I can teach,” said another.  “It means improvement, progress for the whole village,” said another.    This spawned a longer conversation of the feeling of satisfaction they have in seeing the results of their work.  They see women having healthier pregnancies; they see children growing up stronger and healthier.  One of the biggest changes, they report, is that now, even the men of the villages will listen to them in a way that never happened before.  The women told me that the men have come to see the women as possessing knowledge and understanding as a Health Promoter that no one else has.  What was even more remarkable than the statement itself was the body language, the tone of confidence, and the feeling of accomplishment that came through in these statements, none of which required the skills of a translator to be successfully communicated.

A Visit with The Father of Palliative Care in India

Dr. Rajagopal Dispenses  Needed Medicines and a Healthy Dose of Respect.

Pallium India

Pallium India

 

After a meeting with CFHI’s Founder, Dr. Evaleen Jones at Stanford University, Dr. Rajagopal (Dr. Raj),  the Founder of Pallium India agreed to become one of CFHI’s newest partners in India.  CFHI India Coordinator, Ms. Hema Pandey, and I had the privilege of spending three days with him in Trivandrum, Southern India as we work to develop a CFHI Global Health Immersion Program exploring Palliative Care.

As the monsoon season takes its time to come to a close, the beautiful, lush countryside around Trivandrum in Kerala –Southern India is as calming as the Trivandrum, Indiapresence of Dr. Raj to his patients. We were given the great privilege of being allowed to shadow Dr. Raj during a day of home visits to various patients of Pallium India, the nonprofit he founded.

Who is Dr.  Rajagopal

Dr. Raj is responsible for beginning the palliative care movement in India.  He tells me that while the goal of palliative care might be the same in India as it is in England, where the modern hospice movement was started, the implementation is different.  Dr. Raj feels that to simply pick up and transplant palliative care as it has been developed in the West can inadvertently have consequences that cause more suffering –when the main goal of palliative care is to reduce suffering. Dr, Raj is indeed a unique individual; he is both a visionary and a worker in the trenches.  To follow him for a day doing home visits was inspiring.  It was also a primer in how to do this kind of patient care.

Dr. Raj pointed out to me the four domains of patient care that were outlined by Cicely Saunders, the founder of the modern hospice movement.  The four interlocking domains are Physical, Emotional, Social, and Spiritual.  It is certainly a tall order for anyone to provide such comprehensive care, and to do it in low resource settings is even more challenging.

A Day in the Life– Implementing Palliative Care in India

As we drove into some of the poorest communities in Southern India, Dr. Raj and his team, a nurse, a social worker, and a driver went about their routine.  Patient files are reviewed as we travel in the van.  The size of the patient files is notable.  After Dr. Raj read the file a bit, he begins to tell us the context of the family we are about to see.  We get a succinct yet

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

Ms. Hema and Dr. Raj on home visits

thorough description of the family composition and history.  The level of detail is impressive and we even had a few questions about the family that Dr. Raj answered from the record.  I asked him when he last saw the family and he said that this was his first visit to them.  There are three other teams conducting home visits and so the family has been seen by the other teams in the past.  It is amazing to see the level of detail that is recorded from the home visit.  From these notes, other services from nutrition, to physical therapy, to social work are provided –all driven initially from the teams’ weekly or fortnightly visits.

As we arrive, Dr. Raj gives warm and respectful greetings.  He makes use of his reading of the chart right away to let the family know that he is up to speed on the situation even though this is his first time seeing them.  Telling and retelling the story can be a help, at times, for a family but to have to do it with every healthcare worker that shows up, can become a burden.

In the home visit, Dr. Raj is totally in his element.  Calm, positive, and respectful, he has a way of making the patient and the family feel that he has all the time in the world to spend with them –they have no idea that he has six more home visits to do.  His careful touch, his undivided attention, his deep listening, his affirming comments are all the epitome of what a home visit should be.  He listens and draws

Dr. Raj conducting a home visit, Trivandrum Southern India

Dr. Raj conducting a home visit, Trivandrum Southern India

out information to help him tweak the treatment plan based on what has happened since the previous home visit.  As he leaves, he has given not only some medicines and ordered some more physical therapy but he has also given the family and the patient dignity, respect, and acknowledgment through his manner, his interactions, and his presence.

And, of course, as we make it back to the van, it’s time for Dr. Raj to write page after page of notes so the follow-up treatments can be done and so the next home visitor can pick up right where he left off.

 

CFHI Partners Develop Competency-Based Medical Education

What is Competency Based Education?

CFHI India StudentCompetency-based education (known as CBE) has been all the rage in medical education for nearly a decade.  Competency in this realm has been described as the “habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served” Continue reading

New US Census Data Shows Diversity of US Population Increasing

We are approaching a new highpoint in the prevalence of US residents who were born outside the country.”  This is part of a message on the Director’s Blog of the US Census Bureau website that is aimed at the marketing industry, at advertisers of goods and services, but we at CFHI believe it is also important information for current and future health professionals.

While the Census Bureau is providing this new data, none of the basic trends of an increasingly diverse population for the United States should be a surprise to us.  Forward thinking health professionals and medical educators have seen the indications of these trends for many years.  Health science students (including medical students, nursing students, and public health students) have not waited for courses to be developed by the data that is now beginning to be analyzed, but have taken the initiative to seek out medical electives and rotations that would give them first-hand experience of different cultures and the different ways people view health around the world.

Source: US Census Bureau -Director's Blog

With some 6,000 alumni of CFHI Global Health Immersion Programs to date, we hear over and over again from them how their CFHI experience gave them insight into the role that culture plays in health and healthcare.  Tenny Lee, a 2010 CFHI Mexico alum, reports: “My experience in Mexico has given my medical career a foundation to help underserved communities and break though language and cultural barriers.”  You can read more about her CFHI experience  in her review posted on the website Great Nonprofits.  The ability to competently serve a more widely diverse patient population will clearly become the expectation for health professionals, as we can see from the wealth of information that the US Census Bureau is releasing.

One of the most important data points released so far is that the Hispanic population of the US now exceeds 50 Million, a 43% increase since the last census as reported by CNN.  And it is not just in border states in the south.  The CNN article quotes demographer Jeffrey Passel at the Pew Hispanic Center as saying, “Previously, the Hispanic population was concentrated in eight or nine states; it is now spread throughout the country.”

Medical schools, organizations, and institutions of higher learning have also recognized these trends, and CFHI has been happy to work with many of them to design specific programs.  The Patient Advocacy Program at the Stanford Medical School began a program abroad with CFHI in 2007.  The University of California at Davis has partnered with CHFI for over five years now to offer a Bi-National Health Quarter Abroad program for undergraduates in special arrangement with the Chicana/o Studies Department at UCD.  Both of these programs also make use of CFHI’s built-in Spanish Language and Medical Spanish Instruction.  Students are also living with host families so they are immersed into the culture during the program.  Guided journaling and weekly meetings help students reflect and integrate what they are learning from their daily interactions.  CFHI is also working with others, including Northwestern University, The Student National Medical Association (SNMA), -which you can read more about in an earlier posting–  and the Public Health Institute in association with the Global Health Fellows Program.  CFHI has been able to partner with each group and use our 20 years of experience working at the grassroots level in underserved communities abroad to design programs that meet specific learning objectives that are achieved in real life settings with the help of local health professionals who have the unique expertise of the local healthcare system and the best understanding of the local culture.

Jessica Brown, a 2010 CFHI Ecuador alum, pulls it all together in her reflection about her CFHI experience:

“… [I] learned a wealth of information about health that extended beyond the Reproductive realm.”  Jessica goes on to say, “I learned a lot about Ecuador’s healthcare system by discussing health care access, education, socioeconomic class and ethnic background with my mentors and preceptors. I learned about how religion, education and customary social/cultural schools of thought (i.e. machismo) weigh heavily on Ecuador’s society, and individual minds; I saw how the cultural “way” dictated the population’s attitude towards healthcare, especially in Women’s Reproductive Health.

The moments that caused me to question belief systems in place within myself really stretched me beyond limits I never knew possible.  And it is these reflections upon the state of health care in Quito that can broaden my understanding of client needs, beliefs and culture here in the states.”

World AIDS Day – What We Can Celebrate

World AIDS Day2010_WHO-EMRO

World AIDS Day2010_WHO-EMRO

World AIDS Day gives us a chance as a world community to stop and get some perspective on this epidemic that has been with us now for three decades.  In the past this day served as a day for us to remember with dignity those we lost to this horrible disease and as a day for carrying out advocacy to improve and better coordinate our efforts at combating this killer.  Today is still a day for us to collectively morn the incomprehensible human toll.  Today is still a day to increase awareness and mobilize efforts that transcend the hurdles of politics, prejudice, and lack of knowledge.  Indeed “Health, HIV, and human rights are inextricably linked,” as the Director General of the World Health Organization reminds us in her statement today.

On this World AIDS Day in 2010, I am struck by the great amount of information we now have.  So today is also a day for us to look back and see from whence we have come in this effort.   There is great loss, and yes, there needs to be more committed to this effort but the work has gone on for more than 25 years now and there are milestones and accomplishments we must not forget.  The numbers are still staggering, over 33 million cases worldwide, and with over  two and one half million newly infected, etc, etc.  And on the face of it, this can be enough to keep someone feeling discouraged.  But there is hope.  There are things to celebrate.

UN_AIDS_Global_Report_2010

UN_AIDS_Global_Report_2010

If we look deeper into the Global Report from UNAIDS, we find that although the greatest burden of disease is still in Sub-Saharan Africa, this is also one of the greatest success stories as the rate if infection has dropped considerably.  The report concludes, “In 22 countries in sub-Saharan Africa, the HIV incidence rate declined by more than 25% between 2001 and 2009.”

The Global Report contains a great deal of information that is well presented, and with little effort, one can gain a great deal of perspective not only on the huge effort that we are still deeply engaged in, but also some real sense of what has been accomplished -like the “Significant progress in the virtual elimination of HIV to babies.”  Make one of your “things to do” this World AIDS Day a visit to the UNAIDS Report on the Global AIDS Epidemic 2010.  It contains an AIDS info Database, Epidemiology Slides, a Global Scorecard, and more.  One thing we have clearly done as a global community is arm ourselves with a wealth of information as we combat this continuing threat.  Spend 20 or 30 minutes today educating yourself about one of the world’s greatest crises.

Finally there is one more thing that must be celebrated today and that is the the tremendous and heroic efforts of healthcare workers on the front lines of this epidemic.  One of the great privileges for me as part of CFHI, is the opportunity I get to visit doctors, nursers, and other healthcare workers in the field.  Finding local health professionals who are dedicated to their own underserved communities and trying to support them in their work is at the heart of what we do.  We see them in hospital wards that are overflowing, we see them on strenuous trips to rural areas to test, educate, and treat -thus making healthcare accessible to  more of the population.  We see them in hospitals where the staff room has become a small ward or infection control area thus leaving them spending long hours with no place to go for a break.  We see them in clinics working tirelessly as as line of patients stretches out the door and down the street, more than a city block.  We see them morn the loss not only of patients but of so many of their colleagues, and yet they continue.  We see them in these situations every day, and we see them more dedicated and more earnest in their efforts each day.  These are the real heroes in this global fight and we salute you on this World AIDS Day and we pledge our continued efforts to help support and champion your work.

Global Health TV Looks at CFHI Program In India

Global Health TV, based in London, recently visited one of CFHI’s Community Health Projects in India. The Catch Them Young Program is a health education program directed at youth ages 12-19 in a rural area outside the city of Pune. This is one example of a typical CFHI Community Health Project that originates at the local level and therefore has local ownership. CFHI has been happy to provide some of the funding to advance this project and to support the great dedication that local health professionals and community workers have to their own underserved communities.

The 5 minute short film can be seen on the Global Health TV website.  We have posted it to the CFHI YouTube Channel as well.   It also shows one of CFHI’s Global Health Immersion Programs in India. CFHI seeks to identify local community health professionals who are dedicated to local underserved  communities.

GHTV Feature of CFHI Community Health Project Computer View

GHTV Feature of CFHI Community Health Project in India

These unsung heroes are local experts and CFHI works with them to develop the 4-12 week Global Health Immersion Programs that international students of the health professions attend. The programs are empowering to the local community as the community sees their own health professionals instructing and mentoring international students. The film had its debut at the Canadian Conference on Global Health in Ottawa, November 1-3, 2010.

CFHI Convenes UN Forum on MDG 3 Empowerment of Women

Earlier this month on September 15, 2010, CFHI convened a Forum on the Empowerment of Women, at the United Nations in New York.  The purpose of the event was to increase awareness of the United Nations Millennium Development Goal #3, to Promote  Gender Equality and Empower Women.

Ambassador Anwarul K. Chowdhury, former Under-Secretary General and High Representative for the Least Developed Countries, moderated a panel of women representing Panel of Speakers at CFHI Forum on the Empowerment of Women 2010 UN New Yorka cross section of leadership roles.  As world leaders met this past week to discuss the MDGs, this Forum, held a week in advance,  provided an opportunity for the voices of women from everyday life t be heard.  Co-sponsoring NGOs included the NGO Committee on Spirituality, Values and Global Concerns, The International Center for Good Business, The Institute of International Social Development, and The Spiritual United Nations.  Panelists included M. Christine MacMillan, Commissioner, Director of the International Social Justice Commission of the Salvation Army, Monika Mitchell, Executive Director, Good Business International, Hema Pandey, India Coordinator, Child Family Health International, and Jessica Evert, MD, Medical Director, Child Family Health International.

The Title of the Forum was Successes and Challenges of Women in Leadership Roles in Traditionally Male-Dominated Environments.  As women are increasingly taking on leadership roles, it becomes important for them to share their experience.  The panelists spoke with examples from their own lives and the audience was invited to share their comments and life experience as well.

We were especially happy to welcome our India Coordinator, Ms. Hema Pandey who was visiting from New Delhi.  Hema is responsible for coordinating six CFHI Global Hema Pandey Speaking and Jessica Evert at CFHI Forum on the Empowerment of Women 2010 UN New YorkHealth Immersion Programs taking place in Mumbai, Pune, Delhi, Dehradun, and Rishikesh, as well as multiple ongoing community health projects.  In the course of this work, she manages a group of five local CFHI Medical Directors, all of whom are men.  Ms. Pandey spoke of using a cooperative style of working that invites the participation of those she works with thus creating a joint feeling of ownership.  This being her first trip outside of India, Ms Pandey said she was surprised to find that women in the United States also felt that they were still struggling to achieve gender equality.

As the Forum drew to a close, there was a common expression of the panelists and the audience that this Forum should become and annual event until 2015, the target year for the Millennium Development Goals.

CFHI Medical Director Blogs on Day 2 of CUGH Conference

This is the second of two guest blogs by Jessica Evert, MD, CFHI Medical Director, blogging from the CUGH Annual Meeting in Seattle.   Be sure to leave a comment.

Ann Dower of University of Washington’s I-TECH Center said today “we must practice the art of partnership” in order to be successful in global health. Additionally, I was struck when Kevin De Cock MD, Director of the Center for Global Health at CDC, candidly reflected on his early career immersion experience in Nairobi, Kenya, saying, “I wish I was more humble.”  I think this humility and the ability to form meaningful partnerships go hand-in-hand.

This idea of ‘partnership’ has come up countless times at the CUGH meeting over the last 2 days.  Many seasoned global health experts have lamented over the lack of partnerships and failures of global health attempts due to this shortcoming.  How can we learn from this history?  How can we build training and educational programs that prioritize partnership?  It seems that many times our process (the process of US based individuals, universities, and organizations) of global engagement is not necessarily the best approach to foster partnership or humility.  We often have our own ideas of how to solve problems based on our views and our skills, rather than based on the voice of communities abroad.  In academia, there is the nagging issue of faculty, and sometimes students, having to demonstrate personal accomplishments and quick outcomes which often trump the empowerment of communities to own the accomplishments and guide the outcomes.  To find the answer to these important questions we need to look at how we frame introductory global health experiences for health science trainees (pre-health, medical, nursing, public health, allied health, dental, and other students) and how our academic institutions approach global engagement. The first experience abroad (a stepping stone experience) or first visit to a region or country is pivotal to frame how future global engagement occurs.  If individuals go abroad and set-up a tent clinic outside the local healthcare infrastructure, an appreciation for local capacity, systems, and workforce is not realized.  If students go to a hospital with faculty from their US institution who displace local physicians and assumes US clinical expertise translates immediately into similar expertise in an international setting, the student sees the glorification of US faculty, rather than the appreciation of unique practices, language, and expertise of local, native practitioners.  It is time we recognize that the skills necessary for partnership need to be fostered from early levels of engagement and need to be modeled by our US teaching institutions and mentors.

How do we teach health science students and trainees about partnerships?  What skills does partnership require?    To delve into these questions, we must define partnership.  The Partnering Initiative, an NGO that specializes in partnership training, defines partnership as follows: “a cross-sector collaboration in which organisations work together in a transparent, equitable and mutually beneficial way towards a sustainable development goal and where those defined as partners agree to commit resources and share the risks as well as the benefits associated with the partnership.”  This is no simple task.  They also define the partnering principles as follows- equity, transparency, mutual benefit.  If partnership is fundamental to the success of global health activities, then we must judge global health activities in part based on these fundamental principles.  The need for trust, mutual respect, and communication are presupposed in the process of building partnerships.

We can teach the principles and precursors to partnership through thoughtful global health immersion programs.  I am proud to be a part of CFHI.   I think CFHI is setting a standard for both academic and NGO based immersion programs.  I liken CFHI immersion programs to participant-observation techniques I utilized during my thesis work.  In anthropology the mechanism of understanding a culture, community, and executing research is participant-observation.   Participant observation involves gaining an understanding of another social group or community, by inserting yourself into that community in a way that is agreeable to the community, while observing the practices and learning about the culture, social structure, systems, and other behaviors.  CFHI immersion experiences provide an opportunity for participant-observation.  I would argue that such participant-observation, done in the context of long-term CFHI partnerships, lay the groundwork and start fostering skills necessary to form meaningful partnerships with individuals and organizations abroad.  The local health care providers are the experts who teach CFHI participants what their communities are facing.  We have received feedback from partners that patients consider their local providers more capable because they are teaching western health science students (rather than Western physicians or students providing the expertise in patient care at the international setting).  This dynamic is very important and very powerful.  The first step in the cycle of partnership, as defined by The Partnering Institute, is “scoping.”  In essence we are teaching our students and trainees how to scope, which includes listening, observing, and appreciating a local reality before trying to change it.

If partnerships are key to the success of global health programs and interventions, it is time we look at what it takes to impart the skills necessary to foster partnerships.  These skills include observation, humility, and restraint so we can give voice to the local community and engage in truly mutually beneficial ways.  By providing stepping stone global health immersion programs that prioritize the “scoping” necessary to form partnerships, we can engender a new generation of globally-active professionals who understand from early in their exposure and interaction with global communities the fundamentals of partnership and humility that Dr. De Cook and others wish they knew from the start.  It reminds me of a quote by Nietzche, “When one has finished building one’s house, one suddenly realizes that in the process one has learned something that one really needed to know in the worst way – before one began.”  We can provide these lessons before students build their proverbial global health houses through conscientious global health immersion.

CFHI Board Member Appointed by White House to Bi-National Board

POTUS SealThe Chair of the Board of Directors of Child Family Health International (CFHI), Mr. Gunjan Sinha, was appointed this summer to the US Endowment Board on Science and Technology during the US-India joint commission meeting of the White House Office of Science and Technology.

The Volunteer Board of Directors of CFHI functions far from the limelight but plays an essential role in the success of CFHI.  We congratulate Gunjan on this accomplishment!  Gunjan’s expertise as an entrepreneur has been indispensable to CFHI over the years, and we are sure he will be viewed the same way in his new role.

The Governments of the United States and India held the meeting of the Joint Commission on Science and Technology cooperation in Washington, D.C. on June 24-25 at the Smithsonian Institution’s National Museum of Natural History. CFHI’s Board Chair, Gunjan Sinha joined the meeting as part of the U.S. delegation lead by Dr. John Holdren, Assistant to the President Barak Obama for Science and Technology and Director of the White House Office of Science and Technology Policy. The Indian delegation was lead by Sri Prithviraj Chavan, Minister of State for Science and Technology and Earth Sciences. As part of the overall focus on science and technology policy, Mr. Sinha was appointed on the US Endowment Board, set forth between US and India to foster Science and Technology cooperation between the two largest democracies in the world.

The meeting follows the June 3rd discussion between US Secretary of State Hilary Clinton and India’s External Affairs Minister Shri Krishna that focused on the importance of facilitating cooperation in strategic and high technology sectors as a key instrument to achieve the full potential of the strategic partnership between the two largest democracies in the world.

Mr. Sinha is also Chairman of MetricStream, a market leader in Enterprise-wide Governance, Risk, Compliance (GRC) and Quality Solutions for global corporations, based in Palo Alto, California.

The delegates at the commission include senior officials from various US federal agencies and departments including the Office of the Chief Technical Officer, Office of International and Tribal Affairs, US Environmental Protection Agency (EPA), US National Institutes of Health (NIH), US Department of Energy (DoE), National Science Foundation and Bureau of Oceans, Environment and Science.

The joint commission between the two countries and the US-India Endowment Board will look to inspire public good and economic prosperity in US and India, through science and technology cooperation, greater public-private partnerships, promoting innovations and entrepreneurship and creating appropriate policy environment for greater bilateral co-operation. Areas of focus of the Endowment Board will include such significant areas like Food Security, Climate Change, Energy Policy and Healthcare among others.

In line with the mission of the White House Office of Science and Technology Policy, the commission’s aims to ensure that Federal investments make the greatest possible contribution to economic prosperity, public health, environmental quality and national security, and to foster professional and scientific relationships with government officials, academics and industry representatives for providing policy-relevant advice, analysis and judgment for the President on major policies, plans and programs of the Federal government

CFHI Convenes Forum on the Empowerment of Women

CFHI is proud to convene a Forum on the Empowerment of Women to be held at the United Nations Church Center on September 15, 2010, in conjunction with the opening of the 65th Session of the United Nations General Assembly.

Symbol fpr MFG Number 3 The Forum, entitled Successes and Challenges of Women in Leadership Roles in Traditionally Male-Dominated Environments, is an effort to shed light on the global effort to achieve Millennium Development Goal Number Three.

In government and NGO organizations worldwide, women are increasingly taking on leadership roles.  What are women finding as they assume these roles?  From the grassroots level to the executive level, women are succeeding in roles heretofore held only by men.  Are there common experiences across these different levels?  Are there common challenges?  What cultural issues need to be considered?  What strategies are most successful?

Join the audience along with a distinguished panel including CFHI Medical Director, Jessica Evert, MD, and direct from New Delhi, CFHI India Coordinator, Hema Pandey, as these topics and others are discussed in this lively forum.  Gain insights and share your own story.  Join us September 15th at 1:00 PM at 777 UN Plaza (44th Street between 1st  and 2nd Avenues) 8th floor, Boss Room.  The forum is free and open to the general public but we do ask that you RSVP.   Please click here to see more information here and the email address to RSVP.

CFHI Students make Local Press in Ecuador

CFHI students made the local press in Ecuador this summer.  La Prensa, a local publication in the town of Puyo in the Pastaza Province of Southern Ecuador, carried a full page story of CFHI Students on the Amazon Indigenous Health Program, one of CFHI’s Global Health Immersion Programs.

CFHI Students Make New in Ecuador Summer 2010

CFHI Students Make New in Ecuador Summer 2010

Puyo, a city of about 25,000 people, with its close proximity to the Amazon Jungle, functions as the base for this program that allows students to see the interplay between the government Ministry of Health and the traditional medicine of indigenous populations living in the jungle much as they have for many hundreds of years.  Dr. Wilfrido Torres, a local physician and the Medical Director of several CFHI programs, reports that international students coming to Puyo and to the Jungle Region, “help the local population see that local doctors and community health workers have important knowledge to share with the world.”  CFHI is honored to have local experts like Dr. Torres who are eager to interact with international students.

This summer, the CFHI students were able to participate in a medical conference that CFHI helped support.  The conference, a multidisciplinary conference on the latest treatments and testing for diabetes and hypertension, was part of a series of conferences to educate health professionals and paraprofessionals on these chronic diseases that are relatively new to the local population.

Expectations –When Helping is Complicated

Kim McLennan, an accomplished physical therapist, and long-time CFHI volunteer, is now in Haiti and has been communicating to us some of the complexities of just trying to help.  A veteran of many humanitarian missions, Kim knows that to lend a helping hand is not always as easy as it looks on the surface.  The crisis in Haiti, and the

Some of the many peopel who have volunteered their time going to Haiti in the aftermath of the 7.1 earthquake

This is a U.S. Navy photo of some of the many vounteers who have gone to Haiti to help after the great earthquake

outpouring of volunteers to give assistance has amplified the Grey Areas of coordinating and managing international aid.  The questions of culture,  ethics, passion, compassion, and the realities of unexpected complexities are raised in her moving, first-hand account.  Dr. Evaleen Jones, CFHI’s Founder and President, asked Kim if we could share her writings through this Blog.  Kim gives us her experience alongside her on-the-spot reflections which are informed by her years of cross-cultural work in some very challenging situations.

We are grateful to Kim for her permission to present her observations and thoughts here.  Unfinished and raw, they give us an unvarnished view of reality with no easy answers –much as the real situations in Haiti, and elsewhere in the world.  You are welcome to click on the “Read More” button to leave a comment.

Expectations

Here in Haiti, 5 months after the devastation of a 7.1 earthquake, volunteers are coming in droves.  I am one of them.  By the end of my stay, I will have been here 7 weeks.  Most of my fellow volunteers come for one week or two if they’re lucky.  Professionally, the greatest number are doctors, nurses, emergency room specialists, pediatric and wound care specialists, prosthetists and physical therapists. The majority have never been to a developing country or to Haiti before they arrive.

They come with the expectation of being welcomed for their concern and service, everyone paying their own expenses and hoping their week of selflessness will do some lasting good.  Most leave, probably feeling that their mission was accomplished, even if in some small isolated way.  This morning, at the hospital I’m working in, there are 20 American doctors, nurses and other hopeful people wanting to do something useful.  They’re surprised when they realize how different the system is here, how charts and notes and procedures that are standard in the US are hardly used here. They are surprised that the Haitian nurses don’t speak English or seem happy to share their small desk or coveted stash of medical supplies.  Many come with their own supplies of state of the art medical technology and toys and blankets and shoes.  Most of it is very useful and appreciated by the patients.  The Haitian staff seems to disappear when the volunteers arrive to see the rare and unusual patient injuries that have occurred here.

There have been many surgeries and interventions that would have never occurred without the volunteers being here.  External fixators and wound vacs are found throughout the hospital, and the meticulous care given to the patient’s wounds is without parallel.  But this is precisely the problem. The nurses here do not have the training to change the dressings or change the wound vacs and no one is training them. There will be no physical therapy or discharge planning when the NGOs pull out for good.  For all their good intentions, the volunteers seem to ‘take over’ when they arrive and then complain that the Haitian staff doesn’t seem interested.  Cultural differences aside, who likes it when someone new arrives on the scene, walks in,  starts to do your job and then leaves, making you feel less than adequate after witnessing such expertise.

As you know, this is a touchy subject.  Everyone who comes here has the best intentions, simply wanting to help.  The problem is when they come, they come in groups with their own comfortable systems in place, just in a new setting.  Most of the Haitian hospitals are not equipped to house or feed these additional visitors and the plumbing in Haiti already is barely serviceable.  They often don’t seem to try to learn a few words of Creole, or go outside the compound to meet the Haitians and share a local meal.  It probably feels like a vacation except that the food is scarce and the air-conditioning doesn’t work.

The first time I went overseas to volunteer 12 years ago in South Africa, I stayed for one month and it took me almost three weeks to feel I was accepted a little by the local staff and they still did not seem keen to have me in their midst.  I have been looking ever since for better ways to interact and contribute to poor people in need of basic healthcare.  I believe the answer is recognizing the potential of the local people….

It truly does no good to ‘do your thing” as a volunteer, no matter how much it is needed if you don’t teach someone else how to do it also.  Volunteering in Haiti can contribute to the Haitian infrastructure only if we volunteers think about the consequences of us being here.  Are we willing to be patient and work alongside someone whose future may improve from our training?  Are we willing to trust that they may know a better way than the way we’ve been taught?   We are influencing an entire system by our presence and we should be including them every step of the way…..”

Interview with CFHI’s Medical Director –Audio Post

I had the chance to sit down with CFHI’s Medical Director, Dr. Jessica Evert, at our offices in San Francisco,  just before she was honored with an award from the Global Heath Education Consortium (GHEC) at their annual conference in Cuernavaca, Mexico.  Dr. Evert began her role as CFHI Medical Director in January.  Her education career includes studies at Emory University, The Ohio State University College of Medicine, and the University of California at San Francisco, where she continues to serve as a clinical faculty member of the Department of Family and Community Medicine.

Jessica Evert MD

We spoke about her introduction to Global Health, how she integrates her work as a physician in the San Francisco Bay Area with her Global Health Activities, and what attracted her to CFHI.  She talks about how CFHI’s model is one that changes the dynamic by empowering local communities through actively building on their strengths in ways that lead to sustainable solutions.

Please click on the links to listen to our conversation and you are invited to join the conversation through adding your comments below.

Dr. Jessica Evert 1

Dr. Jessica Evert 2

Dr. Jessica Evert 3

Dr. Jessica Evert 4

South-South Collaboration -Second Report From Cuernavaca

This is my second report from the Global Health Conference happening in Cuernavaca, Mexico.  The conference is the joint effort of the Global Health Education Consortium (GHEC), based in San Francisco, California,  and the Instituto Nacional de Salud Publica (INSP), here in Curenavaca.  I spoke with Lisa DeMaria, Investigadora en Ciencias Medicas of INSP and she told me about a perhaps lesser known part of the Global Health field. “There is a sophisticated network in Latin America of middle income countries with similar health issues that are working closely together to address common challenges.” “The face of Global Health is changing,” she told me as we discussed that there is much more happening today in Global Health than just the very wealthy countries attempting to help the very poor countries.

The conference this weekend is a good manifestation of this with at least 22 countries represented.  It is also the First Latin American Caribbean Conference on Global Health and so the extensive regional network of health professionals is strongly represented.  INSP and GHEC have championed the effort to establish this first of a kind conference without knowing for sure if there would be a second conference but the momentum that has been created here seems to be sufficient to ensure continuation with countries like Brazil, Chile, and others stepping up to carry on the tradition.

South-South Collaboration

The 19th Annual GHEC Conference and the 1st Latin American and Caribbean Conference on Global Helath

GHEC - INSP Conference 2010 Cuerenavaca, Mexico

GHEC - INSP Conference 2010 Cuerenavaca, Mexico

Of course, the planning for a conference like this  happens more than a year in advance so as we are gathered comfortably here in Curenavaca, Mexico, having important discussions and sharing of ideas, it is important to look back and see all that has happened along the way on the journey to Cuernavaca.  Not long after the decision to have the conference, came the outbreak of H1N1 in 2009 and many questioned the wisdom of continuing with the conference plan especially with the fear that a repeat flu outbreak could happen in early 2010.

More fundamentally, the intention of this conference –different, I think, from other South-South conferences– is to have the South participants truly take the lead.  “The idea from the beginning was that the North participants are the guests and are primarily coming to learn” said Karen Lam, the Global Health Education Consortium (GHEC) Program Manager.  With its almost 20 year history and strong following,  GHEC has been able to bring the numbers that frankly support the undertaking of a major conference like this and make it financially feasible.  The back story is all the effort to truly make it a success.  GHEC has partnered with the Instutio Nacional de Salud Publica (INSP) here in Cuernavaca.  INSP is the conference venue and has been a great host for this event.  Both INSP and GHEC are to be highly commended for all the hard work to bring this event to a reality and in such a successful way!

“The vast majority of the presentations  are by and from the perspective of the South participants,” Lam pointed out.   Sessions are covering everything from Ethics and Equity Issues, to Global Health Diplomacy, to Public Policy, and Social Determinants of Health.

It is encouraging to see so many Mexican, Caribbean, and South American students able to be a part of this conference and to see the work of the collaborations of  their fellow students and teachers so prominently featured.  So far the sharing and exchange of ideas is stimulating and leaves one hopeful for all the collaborations that will now have their beginnings here in Cuernavaca.

A Dental Program for International Students

One of CFHI’s newest programs is a Dental Program set in Quito, Ecuador.

CFHI Global Health Dental Program

CFHI Global Health Dental Program

CFHI is happy to partner with the Sonrie Ecuador Clinics to provide an outstanding program for pre-dental and dental students who want to understand how oral health is approached in a different culture and a different healthcare system.

The “Sonrie Ecuador Clinics” provide dental care and promote oral health in Quito and its surrounding neighborhoods.  The clinics have been operating for over twelve years and continually strive to better the services offered to their patients give attention to the dental health.  In general, the main dental problem seen by Ecuadorian dentists is cavities.  Ecuadorians are considered to be concerned about their dental health, although adequate oral hygiene is not, in reality, reported amongst the majority of the population.

This program will provide a rich and diverse experience for pre-dentistry and dentistry students, allowing them  to  view  local oral  health   practitioners  providing  close to  world class care in a developing country while at the same time improving their cultural competency and broadening their public health knowledge.  Ecuadorian dental professionals who work  in a country are interesting and thought provoking as they give context to the real challenges of  providing the best possible dental care to the different socioeconomic classes of Ecuador.

Global Health South/South Collaboration Conference in Mexico

2010 GHEC Conference png

The 2010 Global Health Education Consortium’s  (GHEC) Conference will be held in conjunction with the Instituto Nacional de Salud Publica (INSP) in Cuernavaca, Mexico.  This promises to be an engaging conference.  The theme of the conference is Alliances for Global Health Education: Learning from South/South Collaboration.  More information on the conference can be found on the GHEC website here.

Those who have worked in Global Health for any period of time, will find the idea of a major conference with the focus on South/South Collaboration to be refreshing.  Many conferences have had sessions featuring purely South/South partners but we believe this is the first major conference to have this as its main focus.  In addition, it is being identified as the First Latin American and Caribbean Conference on Global Health.

We of course all remember that it was almost one year ago that many of the first reported cases of the A(H1N1) Virus were identified as occurring in Mexico.  Clearly Mexican health workers and scientists performed heroic work in the face of a mysterious epidemic. Their work helped the world avert a public health problem that could have been significantly worse that we have experienced so far.  The location of the conference, at the premiere Mexican public health institute in Cuernavaca, will provide a great opportunity to hear first-hand the story of the crisis and to share the lessons learned.

The Great Asian Tsunami Five Years Later

The anniversary of the great Asian Tsunami is December 26th.  Do you remember where you were on that day in 2004?

The effects of the huge earthquake, estimated at 9.1 or greater, and resulting tsunami were devastating.  Some reports say that about a quarter million people in some eleven countries,  lost their lives, almost in an instant.  For those who were left, they not only had to deal with the grief and loss but also with the fact that their lives and livelihood would be forever changed.  Many made their living off the sea and now the trauma of this event made it hard for them to comfortably return to their work.Tsunami Map India 26-12-2004

CFHI’s loyal donors and alumni were quick to respond.  Within 48 hours, we had connected with other international organizations and had a disaster relief container with supplies for 10,000 people, on the ground in one of the worst hit areas in Indonesia.  Our donors continued to give.  We let people know that CFHI did not have any programs in the areas that were directly impacted and suggested several other organizations to which to donate.  Many of our donors still wanted to give to CFHI, they said that they trusted CFHI to find the best way to use the donations.  So after helping with the immediate disaster response, we started doing our homework.

With many programs in India, CFHI was asked to help in the areas of Southern India that were greatly impacted.  CFHI met with local and WHO health officials by conference calls.  There was great concern that widespread disease would be one of the effects of the tsunami so we were asked to wait while health officials conducted surveillance to see where disease would most likely occur, along that portion of the Indian coastline.  As it turned out, preventative efforts held disease in check so we began looking for other lasting effects of the tsunami.  For young children, the trauma was the most significant lasting effect.  In a number of small coastal fishing villages, much was lost including the schools.  One of the most important things to help children dealing with trauma, is to reestablish a routine that is safe and comforting to them.  With the loss of the schools, there was a big hole in the day of every child.  CFHI teamed-up with the service organization Round Table India –that was charged by the Indian Government with rebuilding the lost schools.  CFHI’s donors were able to support the rebuilding of two schools that were lost in the tsunami, thus reestablishing this most significant daily routine for many children.

Sewing Class at Kovalam

Sewing Class at Kovalam

Some of CFHI’s donors have continued to donate to make sure that efforts to help those so devastated by the tsunami would not fade away.  As this fifth anniversary approaches, CFHI is happy to be continuing in this effort.  Loyola College in Chennai started an outreach program to provide ongoing assistance to people affected by the tsunami.  A successful community college effort has been established and is training people in skills to help them find jobs in many fields including culinary work and food service for the tourist industry, website design, mechanical work on air conditioning and refrigeration systems, etc.  In addition, the Kovalam Community College is providing general courses in English, general life skills, health education, and working with the large population of widows created by the tsunami doing women’s empowerment workshops and helping the widows develop their skills. Kovalam_Community College

During my visit to India earlier this month, I met Fr. Xavier Vedam, S.J. the Vice Principal of Loyoal College in Chennal and the Director of the Loyola Outreach program.  I was very impressed with these efforts by local students volunteering to help in the villages that continue in their recovery from the devastating events of December 26 2004. I was struck by the passion of Fr. Vedam and the fact that they are not giving up but continuing to provide services, engaging the community, and helping people in real ways.   To see that many people are now in gainful employment and that the self confidence and attitude of people in whole villages have been so positively impacted, is a wonderful accomplishment and we applaud these ongoing efforts that bring development based on the strengths of the local people.

Fr. Vedam and Students at Kovalam

Fr. Vedam and Students at Kovalam

From Untouchable to Breadwinner, From a Human Waste Disposal Problem to Useable Fertilizer: A Sanitation and Public Health Success Story

Human waste is always a strange topic to talk about but it is clear that sanitation is one of the biggest public health challenges.  The idea of a Toilet Museum may bring a laugh but I was introduced to an organization that, while understanding the lighter side of the issue, has taken this subject very seriously.  “This is nothing short of amazing work,” reports CFHI India Coordinator, Hema Pandey, as she has made it an important part of CFHI’s Public Health and Community Medicine Program in New Delhi.  Students also report that this experience is very enlightening to them.   It is all the great work of an organization called Sulabh International, an NGO based here in New Delhi, that has for all practical purposes, solved a problem as old as the human race: how to effectively manage human waste.  Moreover, they have done it in one of the poorest and most populated countries in the world.  At the heart of it, was the desire to free the Scavengers, a caste of Indian society who, for as long as anyone can remember, were relegated to cleaning the excrement of others and carrying it in buckets on their heads, therefore being considered untouchable.

CFHI Students Visiting Sulabh International in New Delhi

CFHI Students Visiting Sulabh International in New Delhi

Sulabh is nothing short of a movement, started by Dr. Bindeshwar Pathak.  Dr. Pathak’s outstanding accomplishments can be summed up in two areas, a new technology for waste management and a social revolution for more than a million people to whom society gave no hope for self-determination.

The technology is alarmingly simple.  Sulabh’s design of a two-pit, pour flush toilet is an appropriate, affordable, environmentally sound, and culturally acceptable technology.  Many United Nations groups including WHO and UNDP have recommended this technology for more than 2.6 billion people in the world.  Essentially the pits are constructed in such a way that one side can be used and filled over about a three-year period.  Once it is filled, you switch to the second pit.  Over the next three years, the pit design allows for the natural breakdown of the waste in the first pit so that after the three year period, the pit can be opened revealing a dried substance with no harmful bacteria, that is 100% recyclable as a high qulaity fertilizer.  This design is perfect for rural areas but Dr. Pathak has taken it to the next step by designing a process of dealing with large-scale public toilets.  In this process, bio gas is generated in significant portions to power lighting, heating, cooking, and electricity.

CFHI Students visiting Sulabh International

Receiving Instruction on 2-Pit Toilet System at Sulabh

Dr. Pathak is credited with changing the mindset of the Indian people about sanitation and the persons who were required to do the sanitation work.  He has done this by example. He went to live among Scavengers learning the affects of the life they were considered destined to and thereby designing a social movement to raise them out of poverty and their unacceptable destiny.  Sulabh has schools, training centers and successful assistance programs that are training former Scavengers for everything from light industry, to culinary and food service jobs, and all aspects of computer technology.

This is a terrific success story, making great progress for health as well as a wonderful human story, and one that definitely gets the attention of our students.