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Emerging Best Practices for Training Residents in Global Health

By Dr. Jessica Evert
Executive Director, CFHI


As trainees are more and more senior (think resident physicians compared to pre-health undergraduate students), the questions around the content of their global health training, particularly in clinical settings, are more complex. As residents or young faculty we have more clinical skills and expertise, but does that mean we should use international opportunities to focus on clinical care? Is clinical care as a primary focus of global health activities a sustainable endeavor? What happens when we leave and our clinical skills leave with us? As Michelle Morse pointed out in 2014, residents undertaking global health training and service activities requires a new mind-set (read her great commentary: Its no longer acceptable or desirable for resident physicians from High-Income Countries to use large volume patient opportunities in Low and Middle Income Countries to bolster their clinical encounters or surgical case requirements. We have to do better. Even though residents are still in ‘training’ they have skills that can contribute to the capacity of resource-limited health settings, and often these capacities have little to do with directly providing clinical care to patients.

A new article in the Journal of General Internal Medicine walks residency programs through a thought process on how to create opportunities for residents to engage in global health. The approach is based on four fundamental questions.


Who are you teaching?

How are you teaching?

What are the goals of your Global Health program?

What are your resources?

The last question is an important one. While many programs aspire to build a wide breadth of opportunities in global health for trainees and faculty, the administrative support can be lacking. For programs with limited resources, it is suggested that partnering with an organization, such as Child Family Health International, as an ‘extender’ of the personnel, relationships, quality improvement, and curriculum necessary to provide thoughtful and impactful global health education and engagement. Residency programs grappling with the opportunities and challenges presented by Global Health are well served by this new publication and the thought process it outlines. Here’s to developing the fundamentals and collaboration necessary for safe and impactful global health training and service!

Looking forward from the 21st AIDS Conference

By Lyndsey Brahm
Program Coordinator

AIDS 2016 began in earnest as public health officials, policy makers, civil society leaders, dr-geoffreypersons living with HIV/AIDS and others committed to ending the pandemic, converged to collectively assess the global AIDS response and to roil the assembly into accessing equity rights now, the conference theme that resonated throughout the Durban International Convention Centre for five eventful days. Those in attendance, including UN Secretary-General Ban-Ki-Moon, UN AIDS Director Michel Sidibé, KwaZulu-Natal Premier Willies Mchunu, and His Royal Highness Prince Harry, were called to redirect attention to vulnerable populations and scale up prevention and treatment for women, girls and youth.

Child Family Health International (CFHI) is a fierce advocate for local capacity building within our partner communities across the globe. One mechanism used to support this effort is through funding of professional development opportunities for our international partners. CFHI Local Medical Director in Kabale, Uganda, Dr. Geoffrey Anguyo, and Founder of Kigezi Healthcare Foundation (KIHEFO), CFHI’s partner organization in Kabale, attended the conference along with his colleague, Martin Ngabirano, Volunteer Projects Coordinator at KIHEFO.

Dr. Anguyo specializes in HIV/AIDS. In more than twenty years of practicing medicine in Uganda as a primary care physician, in private and government hospitals and through non-profit healthcare delivery, he has devoted himself to the cause and inspired his team at KIHEFO, as well as members of his local community, to join the march. Dr. Anguyo is pursuing a Doctorate of Public Health at Bath University in the United Kingdom with a specialization in HIV/AIDS.

“It was a very great opportunity for me to attend the 21st international conference on AIDS supported by CFHI. I was able to interact with many international scientists and organizations on the KIHEFO version of community engagement in managing HIV/AIDS using integrated and sustainable approaches,” remarked Dr. Anguyo.

UNAIDS ( reports that 7.1% (% of population ages 15-49) of Uganda’s population in 2015 suffered from HIV, nearly 1.5 million people, 96,000 of whom are children aged 0-14 living with HIV. 28,000 people in Uganda have died of AIDS and 660,000 children (age 0-17) were orphaned due to AIDS.

dr-geoffrey-martin“I was honored to be able to connect the leading industry decision makers and get their commitment to join our efforts to step-up public health through volunteering among others. Dr. Anguyo and I were able to learn trending research findings and targets and share KIHEFO’s renewed commitment to contribute to ending this deadly disease by 2030,” commented Martin Ngabirano, reflecting on his experience during the conference.

The conference has provided Dr. Anguyo and Martin with a unique set of tools and an expanded network within the global HIV/AIDS community to continue their efforts with renewed strength and a fresh perspective back home in southern Uganda. They plan to engage CFHI participants in these efforts, which will prove to be a valuable learning opportunity for those who take part in either of the two program tracks offered in Kabale (link to programs).

“I was involved in discussions to promote comprehensive sexuality education as a tool in decreasing HIV risk factors in adolescents and young, including creating demand for sexual reproductive health. I am now applying this knowledge to create youth groups and use peer approach to get more young people involved in decreasing HIV risk factors. We plan to engage more CFHI students in this activity to promote cross-cultural approaches in decreasing HIV risk factors in young people in the coming months,” said Dr. Anguyo.

Martin commented excitedly, “The conference has renewed my confidence in working with available resources both local (our nature and wildlife) and beyond borders, like CFHI participants, to inspire us to change our lives.”

Quality End-of-Life Care in the Face of “A Global Moral Failing”

“Modern medicine’s focus on mastering each part of the human body and the diseases that make them malfunction has generated remarkable power to sustain life. But this focus… has neglected the dying and their suffering, as if repressing a shameful secret.” (1)

Dr. Raj conducting a home visit, Trivandrum Southern India

Dr. Raj conducting a home visit, Trivandrum Southern India

This “shameful secret,” revealed in the 2015 Quality of Death Index (2), is

no secret to Dr. M. R. Rajagopal, co-author of a new piece in the Lancet that reviews the 2015 Index. As the founder and Chairman of Pallium, India, he has brought palliative care to the fore in India through education, advocacy, and service provision. Through various initiatives, he has dramatically expanded access to palliative care in India’s state of Kerala and beyond.

Dr. Rajagopal and Pallium, India, are CFHI partners and offer CFHI students the opportunity to learn firsthand about palliative care in Kerala.

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

Ms. Hema and Dr. Raj on home visits

The 2015 Index findings indicate that poor countries can, under the right circumstances, offer effective palliative care. The authors point out that while most of the top scorers in terms of palliative care provision are high income countries, several low and middle income countries (for example, Mongolia and Uganda) did score much better than certain high income countries such as Russia and Saudi Arabia. Findings in the report also indicate that investment in palliative care can actually save money for healthcare systems in the long run.

Despite notable limitations in the 2015 Index (lack of a comparable instrument for validation; the fact that it excludes countries from the study which offer no palliative care services whatsoever, to name two), the authors offer this conclusion: “The 2015 Quality of Death Index is an insightful and credible effort that laudably calls attention to the woefully inadequate care for some of the neediest and most vulnerable patients across the world, those near the end of life.”

Many thanks to Eric L. Krakauer and M. R. Rajagopal for drawing attention to this critically important issue that affects millions, and will become increasingly pressing as more of the world’s population lives longer and with a higher  number of non-communicable diseases.

  1. Eric L Krakauer, M R Rajagopal,, Vol 388, July 30, 2016, page 444
  2. Economist Intelligence Unit. 2015 Quality of Death Index: ranking palliative care across the world.

CFHI Student Spotlight: Madison

Screen Shot 2016-07-21 at 6.10.09 PM
(CFHI Student, Madison, Pictured on the left)

A little about Madison:
I graduated from Washington University in St. Louis and will be starting medical school this August at Upstate Medical University. I heard about CFHI as an undergraduate when a representative from CFHI came and spoke at my school. After deciding to take a gap year between my undergraduate years and medical school, I thought a CFHI program could be a perfect way to bridge the gap between my undergraduate experience and the beginning of medical school.

Why she chose CFHI:
I chose the Primary Care and Social Medicine program in Córdoba, Argentina becauseargentina of both the location and the focus of the program. My time working in the Emergency Room during my gap year had made me acutely aware of the necessity of learning Spanish and the importance of primary care. Everyday, I saw patients who used the Emergency Room in lieu of a primary care provider, patients who were born into a system where structural violence had stripped them of access to quality preventative care. The Primary Care and Social Medicine program in Córdoba allowed me to explore primary care in another country while simultaneously improving my Spanish. The one-on-one Spanish lessons combined with complete Spanish immersion greatly improved my ability to communicate in Spanish. I left Argentina with a deeper commitment to medicine, to global health, and to communication.

Reflection on what’s next:
Screen Shot 2016-07-21 at 6.13.00 PMAs an Anthropology: Global Health and Environment major at Washington University in St. Louis, I enjoyed applying an anthropological lens to global health issues and studying the complexities of global health issues and policies played out on a local level. CFHI gave me a valuable opportunity to immerse myself in another culture and see those complexities firsthand. Ultimately, my hope is to be involved in initiatives that will reduce the number of premature babies, combat the many adversities associated with prematurity, and improve medical care for people with disabilities. I know I will take what I learned from CFHI with me as I continue along the path to become a physician and work toward those goals.

When Public Health and Clinical Health are One: Remote Island Medicine in the Philippines

by Robin Young
Assistant Director, Africa & Asia

Medical students often tell me that they are focusing so intensively on the science of health that they forget to see the person behind the pathology.

IMG_5046That won’t be a problem when you complete CFHI’s Remote Island Medicine program in the Philippines.

I recently returned from a visit to this program, and it was clear that while you are in the Philippines, every day and every moment spent interacting with patients and healthcare providers will remind you that clinical and public health are inextricably linked; that social factors so often determine health outcomes.

As a program that focuses on remote and rural healthcare, these links are intrinsic to the work, but it’s the local team that really provides the insight and reflection for CFHI’s participants in this program. The CFHI Philippines team is a group of passionately committed doctors, all of whom are currently or have in the recent past served as medical officers on remote islands. In many cases, they have served as the only doctor for miles; though they will be the first to tell you that their teams of nurses and midwives are highly skilled and serve as a critical first line of care and response for the local community. They believe firmly in the right to free, high quality healthcare for all, and they have devoted their lives to bringing that reality closer, both in the clinical setting and also by participating in advocacy work with the International People’s Health University, and the People’s Health Movement..

Before traveling to the remote islands, you’ll spend a week in Manila visiting the WHO IMG_5290offices, local NGOS, and other sites that provide context for the healthcare system in the Philippines. You’ll visit the public hospital in Manila where healthcare is meant to be freely available to all, but in reality, most people have to pay for elements of their care. In the hospital, you’ll learn how changing diet and a more sedentary lifestyle are leading to a dramatic increase in non-communicable diseases (NCDs) including diabetes and heart disease, reflecting a global trend. You’ll see the effects of public health initiatives that require breastfeeding and institutional birth. Through your local team, you’ll learn that many people at the hospital in Manila have come from far away to seek care and treatment: Sometimes, whole families make the trip to Manila, in order to support a sick relative. Often, they come all the way from one of the 7,000 islands in the Philippines.

Next, you’ll head out to your assigned island, either Quezon, Quezon, or Tablas, Romblon. In these remote settings, accessible only by boat or air, you’ll work alongside the Municipal Health Officer to learn about key public health initiatives including immunization and deworming campaigns, breastfeeding, and education to help families recognize danger signs during pregnancy. You’ll also shadow nurses as they treat patients at the health center or health station, managing everything from labor and delivery, to diabetes and heart disease, to severe trauma. You’ll experience every stop along the referral chain, learning about the possibilities and limitations of the system as you go.

By the time your wrap up your weeks on the island, you will have heard many stories that remind you of the links between clinical and public health work. You’ll see families who have to spend their small savings to travel to the mainland for treatment. You’ll observe the highly effective tuberculosis treatment centers, which are structured to help people complete their treatments (even after they feel better, and might be inclined to stop taking their medicine), and has drastically reduced TB on many islands in the Philippines. You’ll see cases that are intimately linked to the realities and the livelihoods of island life, such as farming and fishing. You’ll learn about traditional healers and beliefs, and how the healthcare system has made strides toward including traditional healers and birth attendants in its work, rather than alienating them.

I think Jennifer Harter, a recent participant in the program, summed it up best when she said: “There is a visible connection between all aspects of the healthcare system from public health at the international level (WHO) to the rural barangay health stations at the community level. I saw how each sector interacts and the roles each play. It is hard to explain, but trust me when I say it is truly fascinating.”

Celebrating the 7th Annual Traditional Midwife Training

by Lyndsey Brahm, Program Coordinator

You could feel the afternoon heat of Puerto Escondido’s tropical sun blazing through the open-air patio that overlooks a precious slice of Oaxaca’s coastline. The fans provided little relief from the thick air, nor did the ocean breeze coming off of Puerto’s infamous Playa Zicatela. But the heat and subsequent lethargy were no match for 37 practicing midwives (parteras tradicionales), 6 medical students from Northwestern University Feinberg School of Medicine, CFHI participants and staff, and clinical and public health officials from the Oaxaca Ministry of Health who joined forces for the 7th Annual Traditional Midwife Training in Puerto Escondido, Oaxaca, Mexico.

IMG_2956This CFHI community health project is a shining example of the value of reinvesting in host communities and the importance of collaboration, welcoming diversity in our interactions, and connection amongst people of different cultures; all of which represent values CFHI has long held in high regard. The curriculum for the training is prepared by the coastal region branch of the Oaxaca Ministry of Health and addresses safe birth techniques, detection of warning signs, knowing when to refer to a physician, appropriate care for a newborn, etc. The training is then delivered by Northwestern University medical students entirely in Spanish. Even though the midwives are receiving the training they are also very enthusiastic about sharing their expertise and the traditions that have maintained their virtue across generations.

It is an extraordinary opportunity for each midwife to take part in the 4-day training in Puerto Escondido, especially those traveling from remote villages of Oaxaca’s coastal region. This year 37 midwives attended, several of whom returned from previous years and quickly showed leadership within the group. The midwives are selected according to location, the goal being to invite those spanning a large geographic area, and the number of births they attend to, a statistic reported to the Ministry of Health by a practicing physician within each community. The midwives are often leaders within their communities and held in high esteem. They return to their villages and share knowledge and resources gained during the training.

DSC00107Two of the midwives braved the Oaxacan sun and traveled on foot for 4 hours to reach Puerto Escondido after catching a bus from their villages. You could see the determination on their faces to make the most of this professional development opportunity.

It is programs such as this that CFHI takes pride in supporting year after year. One that impacts the community by giving them the tools to take ownership of their own future.

CFHI Bolsters Staff With Advocacy Expertise

Child Family Health International is pleased to welcome Keaton Andreas as Director of Outreach.  Keaton brings to CFHI a passion for advocacy and community organizing having honed his skills as Campus Campaigns Organizer for Universities Allied for Essential Medicines. CFHI Board Chairman, Gunjan Sinha, reflects “it’s exciting to hire someone with a community-building approach to our outreach position.  Keaton’s unique point of view will allow CFHI to expand the thought leadership community that CFHI has been nurturing for nearly 25 years.”  

keaton_bio_picKeaton will expand CFHI’s advocacy training for CFHI scholars and alumni in order to meet CFHI’s mission of creating changemakers through programs that emphasize the strengths in communities abroad often noted for what they are lacking. Keaton received his Master’s in Intercultural Studies from Fuller Seminary in 2011.  Fuller Theological Seminary is one of the United States most influential institutions of its kind with over 4,000 students representing 90 different countries.

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

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

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

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

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

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

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

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


Hasta pronto, Córdoba

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

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

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

Read more from Sophia’s blog at


Traditional Healer

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

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

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

Read more from Courtney’s blog at

Young Leaders of Global Health Ask for a Seat at the Table if They are to be the Ones to Usher in the Sustainable Development Goals (SDGS)

This blog was written by Caity Jackson, Co-Founder & Communications, Women in Global Health and Director of European Engagement, CFHI. It summarizes Panel 4 from the GHLS 2015 Symposium titled Young Global Leaders Reflect – How Will I Shape the SDGs? It was originally published on Global Health Council’s Young Global Leaders Blog on November 23, 2015.

The 2015 Global Health Landscape Symposium’s final panel, ‘Young Global Leaders Reflect: How will I shape the SDGs,’ challenged today’s leaders to institutionalize young peoples’ involvement in the Sustainable Development Goals (SDGs).  Three themes guided the discussion, including recognizing the important role the enormous population of youth have in ushering in these goals, ensuring young voices are heard in these discussions and invited to the decision-making tables, and encouraging true collaboration at all levels, with a focus on capacity-building and training in this skill for young leaders.

Moderated by Kyle Peterson of FSG, the stage was alive with ideas and energy as all the panelists considered on their own experiences as young leaders and what they see as the role they can play in the SDGs. Sahil Angelo from the Center for Strategic and International Studies (CSIS) started out the discussion focusing on the immense number of young people in the world – almost 2 billion between the ages of 10 and 24. This is in-part due to the successes of past global health efforts, but as a community, we have not really considered or planned for the implications of these strides. What does 2 million young people (and rising) mean in the context of the SDGs? Nowhere in the “Means of Implementation” section of the SDGs’ text does it mention that youth would be the ones to usher them in.

Many panelists commented on the comprehensiveness of the goals and saw them as tangible objectives that address the root causes of inequity in health outcomes, even as a chance to do it ‘right this time’, referring to the previous Millennium Development Goals (MDGs). Yet in terms of young leader involvement, Oliver Anene of the New York City Department of Health commented that young leaders need to be invited to the decision-making table and their voices need to be heard – especially since they are currently on the receiving side of the policies created by today’s leaders. Anne Heerdegen of the Global Health Fellows program echoed this thought, commenting on how young leaders should be invited to speak at conferences and events alongside their experienced colleagues.

Read the complete blog post here.

Celebrating a Decade of Growth and Positivity

Hema Pandey 2CFHI would like to thank Hema Pandey for her 10 years of outstanding service with CFHI! Since joining as India Coordinator in July 2005, Hema has grown into the role of India Director while leading CFHI’s growing presence in India. Today, there are 8 thriving programs in India, located throughout the country and offering a variety of health topics to meet participant interests. Hema has played an integral role in program development by establishing and maintaining strong partnerships with a wide and diverse network of health professionals and NGOs in India. Her professional interests include rural and urban healthcare, water and sanitation, gender, and social development. She holds a Bachelors in Business and Commerce from Kurukshera University and a PG Diploma in Fashion Design from the International Institute of Fashion Technology.

Hema explains that her work with CFHI is always exciting, and that she learns something new from every student she encounters. Working with CFHI has been a learning process, and every student adds to her understanding of different cultures and worldviews, including perspectives on health and health care systems. Since working with CFHI, she shares that “instead of looking straight, I’ve started to look in all directions for answers. I am still learning with every student, so it’s as enjoyable as it was on day one.”

Hema represented CFHI at the Forum on the Empowerment of Women at the United Nations in New York in September 2010, and experience that she says was “The highlight of (my) 10 years at CFHI.” At the conference, she spoke alongside CFHI’s Executive Director, Dr. Jessica Evert, on a panel that highlighted their experiences working and leading in male dominated professions. Hema spoke about her successes using a collaborative approach to get the work done. Hema also represented CFHI at the 5th International Symposium on Service-Learning at Stellenbosch University in Cape Town, South Africa in 2013.

Landour Community Hospital, MussoorieHema is very appreciative of the years she has spent with CFHI, giving her the opportunity to improve herself while improving the communities around her. She reflects that her role as India Director allows her a path to help so many people. Hema is very supportive of her local staff and as an individual, she receives immense satisfaction when connecting grassroot organizations with aspiring students. She explains that this is her way of giving something back to society at large.

Robin Young, Assistant Director Africa & India, shares, “Hema is a force of energy and vision for CFHI’s programs in India. She has built our engagement in India into what it is today- 8 strong programs with 2 more coming very soon- each offering a unique perspective on health and public health, from maternal and child health, to traditional medicine, to chronic disease and palliative care. Here’s to ten more years!”

CFHI’s programs in India: What does the future hold?

robin & hemaBy Robin Young, CFHI Assistant Director, Africa and Asia

I just returned from a month-long site visit to India, where I delved deep into CFHI’s 8 programs in that most captivating of countries. It was a whirlwind journey that took me from a small village clinic in the foothills of the Himalayas, to a bustling OB/GYN unit in a hospital in Pune, to the home of an 80 year-old woman receiving palliative care from a team of nurses and doctors in the Southern state of Kerala.

India is a dazzling, intense place. With a population of 1.25 billion people, the scale of its cities; the ease with which so many people co-exist, struggle, and thrive; and the fascinating public health challenges, triumphs, and pitfalls, are enough to make any visitor want to stay much longer than a month.

But one month in India is enough to take in plenty of new information about health and medicine in a country that has so much to teach us. CFHI’s India programs offer an array of topic areas, clinical rotations, and geographical settings to choose from—there is truly something for everyone. Each of our programs is grounded in deep and longstanding local partnerships and a commitment to ethical practice—two key components that guarantee a rich and unique experience for CFHI scholars.

Under the leadership of CFHI’s India Director, Hema Pandey, we are finalizing exciting new partnerships and integrating program enhancements that will make our programs in India even stronger and more impactful. Here’s a sneak peek at a few of the exciting developments you can expect from CFHI’s programs in India:

  • In Delhi, we are finalizing a new research program that will welcome students with an interest in completing research in India on a variety of topics in global health, biomedicine, and beyond.
  • In Mumbai, we are opening a new program that offers students an up-close look into hospital medicine and infectious disease in this glittering, world-class city. Observe hospital medicine in urban and rural settings and learn about infectious diseases in a variety of locations, from outpatient clinics to small, family-run practices, to non-governmental organizations.
  • IMG_0312Also in Delhi, our “Public Health Delivery Innovations and Community Medicine” program will have an increased focus on three themes, around which all rotations and non-governmental organizations will center: water and sanitation, social services safety net, and programs for marginalized populations. As always, this program will provide an inspiring and eye-opening look into public and community health efforts in Delhi, working with populations ranging from young children who are addicted to drugs to women formerly considered “untouchable” who now prepare crafts and food for their communities.
  • All India participants can expect expanded pre-departure training and orientation in the form of webinars, question and answer sessions, and more. A recent addition to CFHI’s pre-departure training is Aperian Global’s online cultural intelligence tool, GlobeSmart, which provides detailed information on how to engage effectively with people from India and around the world. Competencies based on the new roadmap for global health training will frame each program and articulate the learning outcomes that you can expect to come away with after participation in our programs.

For a complete list of India’s programs in India, review our website. Learn about the wide offering of programs—from traditional and alternative medicine and Rural/Urban Himalayan Rotation in and around Dehradun, to Maternal and Child Health in Pune; and from End-of-Life and Palliative Care in Thiruvananthapuram (Trivandrum) to Ophthalmology in Delhi.

CFHI’s programs in India are the best way to come and experience the magic of India while immersing yourself in the intricacies of the health system and the social determinants of health in this fascinating country. Having just visited these programs myself, I am already excited for my next visit!


image20Julia Tanguay is a 4th year medical student at Rocky Vista University College of Osteopathic Medicine and a two-time CFHI alumna piloting CFHI’s new Global Health Education Programs in Ghana, Child Health and Social Determinants and Hospital Medicine in Coastal Ghana. The following is an excerpt from her blog “My Trip to Ghana.” This post was originally published on November 2, 2015.

Hello everyone! I have thoroughly enjoyed my first week in Cape Coast and my third week in Ghana. Since I last wrote, I spent all of last week in the Pediatric department, except on Friday, when I worked in the Emergency Department. I have seen children with various conditions, like type I diabetes, bronchopneumonia, cerebral palsy, among others. The pace in Cape Coast is quite different than that of Accra, but I am enjoying more teaching and time spent with house officers and medical students. I also met some others from other NGO organizations that are volunteering in the hospital, and we ended up all going to Kakum this weekend, which I will discuss later.

On Tuesday, there was a morning talk about the management of preterm and low birth-weight infants. It was very interesting to get this lecture and then later in the week a lecture on the morbidity and mortality in the NICU. It is crucial to review those cases and reflect upon management to see if there is anything to improve upon in the future. Of note, there is a rate of 14.5% preterm births in Ghana in 2012, versus a 10% rate in the United States for comparison. Of the 111,500 preterm births in Ghana, the mortality rate was 7800. Often, in low-income countries, those born at 32 weeks or earlier often die, whereas they survive in more developed countries. The two themes that stuck out in prevention of mortality and management of very ill neonates is the need for infection control, including cord care, as well as close preterm follow up.

On Wednesday, I spent time going over the High Dependency Unit charts and then got a tour of the NICU with Dr. Bukarie. It was very interesting and eye-opening to see how they treat tiny babies without ventilator support or CPAP. They have the machines, but lack compressed air and continuous oxygen built into the walls, therefore, they treat the children with oxygen by nasal cannula. Also, there are 3 working incubators and otherwise used a heat lamp. We discussed how there might be potential with this sleeping bag looking device that is like an incubator. I am going to look into it further and see if I can get some donated or funded for Cape Coast’s teaching hospital. It is the simple things that make a huge difference in the outcome of neonates, especially preventing hypothermia in premature infants. I also have spare glucometers from diabetes camp this summer, so I will make sure at least two meters and strips go to Cape Coast and two to the Malnutrition ward at Princess Marie Louise in Accra.

Read more from Julia’s blog at

Reflecting on the 2015 Family Medicine Global Health Workshop

By Dr. Andy Baldwin, CFHI Alumni Advisory Board (AAB) Member

Greetings from Denver! My mind is racing with excitement and ideas after spending the past three days with fellow family physicians passionate about global health at the American Academy of Family Physicians (AAFP) Global Health Workshop at the Grand Hyatt in Denver, Colorado. The organizers did a fantastic job establishing several tracks and special sessions that ran throughout the conference—General Plenary Sessions, Global Expansion of Family Medicine, Reflections in Global Health, Global Health Lecture Series, Focus on Research, Case Studies in Program CQb34BLU8AAWMjCDesign, Ideas Worth Sharing and Facilitated Discussions. I had the opportunity to present at the Ideas Worth Sharing session, condensing two years of work in El Salvador into a 7-minute presentation. It was rapid fire. There were also two poster presentation sessions, of which I was fortunate enough to have my shipboard influenza outbreak case featured. The best part about the workshop was the intimate size of the group, allowing for collaborative discussions, mentor-mentee interactions, and sharing of stories. This is what the future of Global Health depends on—relationships. The opening plenary speaker, William Ventres, MD spoke about the work of global family medicine being one of creating, developing, and sustaining relationships. The other plenary speaker whose words resonated for me was Lynn Eckhert, MD who encouraged all of us to “tell the story” of global family medicine. Our lives are full of stories around the globe, and by sharing it defines us, and allows others to learn and gain appreciation. As faculty in charge of developing a global health track at Fort Belvoir Community Hospital Family Medicine residency, I found it incredibly helpful to go to CQaQw6xU8AA-6rUsessions focusing on global health curriculum development. The number of medical schools and family medicine residency programs with “global health” tracks is growing substantially. We also learned how to do journal clubs more effectively, as well as ethical approaches to Global Health engagements. One of the challenges in global health education is that competencies have not been standardized yet, making it difficult to determine a learners level of proficiency with global health. It was exciting to see the work that Jessica Evert, MD, Executive Director of CFHI, is doing to achieve this. She referenced her recent publication in the Annals of Global Health with the Consortium of Universities for Global Health (CUGH) that proposes four levels of Global Health competency. Global Family Medicine is a relatively young field, and it was an honor to be in the midst of those forging its path. As stewards of global health we are making progress toward a more connected and healthier world. I’m already looking forward to next year!

The International Classroom

by Caity Jackson, CFHI Director of European Engagement

The European Association for International Education (EAIE) conference held in Glasgow last week was a great start to CFHI’s Autumn European activities. It was also my first time attending an international education conference of that size and scope and it was exciting to be amongst the hustle and bustle of hundreds of institutions, partners and participants that had flocked together from all corners of the world.

IMG_7329The EAIE is a non-profit, member-led organization serving individuals actively involved in the internationalization of their institutions through a combination of training, conferences and knowledge acquisition and sharing. Their annual conferences welcome over 5,000 international higher education professionals and this year saw these participants coming from over 90 different countries.

There was an excellent opening speech by the dynamic
Baroness Helena Kennedy, QC, which struck a chord with me about the movement education sees these days. Not only are there students who are completing their full degrees abroad, but there is constant movement between regions for short courses, specialized training and immersion education. It is becoming the norm and I think it speaks to how the world has become a community and how our aims and objectives align no matter where in the world we live.

That being said, disparities still exist in stark contrasts and for us to truly be educated in a subject in our globalized world, we have to experience these contrasts first hand. There is nothing like having your hands deep (literally or metaphorically) in the complexities of what you have studied in textbooks to drive home a message and increase knowledge retention. I left the auditorium after Baroness Helena Kennedy’s speech mulling over her message about being enablers for education and allowing students to have mobility to obtain the knowledge they desire. The classroom truly is global now more than ever and students should be encouraged to broaden their horizons and reach out to the knowledge they know will enhance their education. I think that if we are to be true global citizens, we must all strive to include a little ‘international’ to our classroom.

Child Family Health International (CFHI) provides community-based Global Health Education Programs for students and institutions. Our unique model fosters reciprocal partnerships and empowerment in local communities, transforming perspectives about self, healing and global citizenship.

Alumni Spotlight: Q&A with Olivia Low

Q.  Tell us about the CFHI program you participated in.

I participated in Sexual Health as a Human Right: Ecuador’s Unique Model. I spent one month in Quito and was placed with Fundación Equidad, a LGBTQ health and human rights organization. This program stood out to me because it was not clinical, but rather community-based. Though I’m Processed with VSCOcam with hb2 presetin medical school already, I chose this program because I believe that practicing socially just medicine requires an understanding of the social, political, and economic forces that underpin communities. Volunteering with Equidad was a great way to gain insight into the activism and health-related challenges that LGBTQ people face in Quito. As a volunteer, I helped them organize their database of people who had received their services, such as HIV counseling and testing, human rights training, and safe sex education. I also participated in their staff meetings, helped them prepare for Orgullo (Pride), and was the photographer for one of their events.

Q.  What were your goals going in to the program? How did CFHI help you in achieving those?

Because I will serve Spanish-speaking populations as a physician, one of my main goals was to learn Spanish. Being able to speak Spanish is not only a practical skill, but in my opinion reflects a greater gesture of respect and solidarity with patients. CFHI helped me do this in part by setting me up with a wonderful host family. My abuela had hosted students for 18 years, and every night she would cook us a delicious meal. We would chat about everything from Caso Cerrado, a hilarious TV show, to current events and politics. I was grateful for her desire to teach and to take good care of us. In the process, I realized that a lot of communication is about confidence. You can’t be afraid to speak, to fail, and to be present in the room.

Q.  Who was the most inspiring person you met on the program?

Efrain Soria is the Director of Equidad, and it was great to be able to work with him so closely. He was not only approachable, kind, and welcoming, but also clearly an effective leader. I was able to gain a glimpse into his leadership style during meetings in both informal and formal settings. By doing some research for Equidad, I learned that his voice matters in Ecuador–popular newspapers often quote him, for example. In doing so, he advocates for his work and amplifies the voice of the LGBTQ community. It was beautiful to see Efrain lead with such fearless calm and grace.

Q.  Did the CFHI program influence your career path? If so, how?

Because I’m already in medical school, I have stopped debating my career path and have instead begun to think about how to be the best doctor I can be. For me, part of that involves sustaining my passion for human rights, and fighting for marginalized and underrepresented people. One requirement of being a physician ally is learning how to honor the way my patients wish to identify themselves in terms of their gender and sexuality. When Equidad counsels people on HIV, for example, they complete a very thorough interview that honors the language that the LGBTQ community in Quito prefers to use to describe themselves. Seeing how this works was valuable for me. As a medical student, I am learning how to communicate in a way that allows my patients to feel safe, discuss their medical problems freely with me, and define their own identities.

DSC_0267-4Q.  What are you doing now?

I’m about to begin my second year of medical school at Albert Einstein College of Medicine in the Bronx. For the rest of the summer, I’m working on a very interesting research project with Dr. Johanna Daily in her lab at Einstein. It’s a longitudinal study that examines the immunological and clinical dynamics of mild malaria in a rural population in Malawi. Other than that, I’m reading lots of books, working on my photography, and loving summer in New York.

Q. Do you have any advice for students who are thinking about applying or about to go on a program?

Before you go, look at your motivations for going on this program with honesty and ask yourself lots of questions. What do you hope to learn? What can you realistically learn? What might you be able to contribute? What is the space that you’re taking up by entering this country and what are the implications of your presence? Doing global work is ethically complex and can be problematic. But it can also further collaborative movements for social justice when done with critical mindfulness.

In a practical sense, define specific goals and have clear conversations with your supervisors from the very beginning. This will help you achieve tangible, shared goals. Lastly, be open-minded, respectful, and spontaneous. Do your best to connect with local people in addition to your host family, whether it be your barista or your taxi driver. They are secret reservoirs of some of the best stories.

Special thanks to CFHI alumna Olivia Low to authoring this guest post.

Bridging the Healthcare Divide: 6th Annual Midwife Training

By Lyndsey Brahm, CFHI Program Coordinator

Sounds of interaction, excitement, cultural exchange, and a mix of English and Spanish could be heard from Hotel 55’s top floor balcony in Puerto Escondido, a lively coastal town in southern
Mexico that lures surf enthusiasts from every corner of the world. However, Hotel 55 was bustling the final week of July not for those seeking the thrill of Playa Zicatela’s ferocious waves, but for an annual midwifery training that provides essential continuing education for parteras tradicionales or traditional midwives serving their communities throughout the state of Oaxaca.

The project, now in its 6th year, is critical to the health and well being of pregnant women and their families throughout Oaxaca. Over the course of 4 activity-packed and eventful days, a training DSC00169mandated by the Oaxacan Ministry of Health is carried out in collaboration with Child Family Health International (CFHI), a group of ambitious medical students from Northwestern University Feinberg School of Medicine who are members of the institution’s Alliance for International Development (NUAID), and local health professionals, including Dra. Isabel Saucedo, an employee of the Reproductive Health Office of Jurisdicción 4 and CFHI’s Medical Director in Puerto Escondido. Dra. Saucedo is a local champion for bridging the gap between the local healthcare system and traditional midwives, and has shown great perseverance and commitment to ensuring this project takes place year after year.

Themes covered were safe birth techniques, recognition of obstetric emergencies, and addressing newborn distress. The Oaxacan Ministry of Health builds upon each year’s training and seeks quality improvement to establish consistency and correctness with prenatal guidance, fertility advice, family planning, and birth attendance.

This year’s training incorporated an interesting component that complimented the materials provided throughout the project. Hesperian Foundation’s award-winning Safe Birth App was introduced to a select group of midwives using low-cost computer tablets. This app was created for low literacy audiences and has been piloted in several midwife cohorts in Latin America with great success. Working in tandem, CFHI and Hesperian will continue to track the response and impact of the application and the use of the tablets on the health of local communities.

Due to limited public funding, CFHI and NUAID have joined forces to provide generous donations to breathe life into the project for the past several years. The joining of hands is what makes this project unique and generates an impact that is far reaching. Traditional midwives are highly respected members of their communities and women often seek out their services at least twice DSC00172during their pregnancy. Therefore, the reproductive health of Oaxacan communities, especially those in dangerously remote locations, is vastly improved. The opportunity for the midwives to sharpen their skills, foster relationships with members of the formal healthcare system, and engage with foreign medical students is invaluable to their careers and their livelihoods. Lastly, the medical students from Northwestern University thrive off of the cultural exchange and the opportunity to contribute to a meaningful grassroots project and greatly improve their Spanish language skills. First year medical student Kyle Yoo explains, “Overall, I felt like I was really doing something. I was fully engaged. Without CFHI, I don’t believe I would have this opportunity otherwise to interact with the community and learn in the way I did.”

Puerto Escondido’s intense heat presented no match for the enthusiasm of the 30 midwives who traveled from various parts of Oaxaca, many of whom were eager to join the training for another consecutive year and to proudly represent their communities.

Learn more about the Traditional Midwives Training at:

CFHI as my stepping stone: New MCAT embraces age-old tenets of humanism and society

maniaBy Mania Kupershtok, CFHI Alumni Advisory Board (AAB) Chair

Each year, thousands of pre-med students around the country will begin to stress and pore over their medical school applications, writing and re-writing personal statements, reaching out to mentors for letters of recommendation, logging endless hour of community service and shadowing experience, and burying their noses in textbook after textbook studying for the dreaded Medical College Admission Test (MCAT). If you haven’t heard already, things have changed for the MCAT, which now is 3 hours longer and includes sections on sociology and psychology. “Being a good doctor is about more than scientific knowledge. It also requires an understanding of people,” observes Darrel G. Kirch, M.D., President and CEO of the Association of American Medical Colleges (AAMC). “By balancing the MCAT exam’s focus on the natural sciences with a new section on the psychological, social, and biological foundations of behavior, the new exam will better prepare students to build strong knowledge of the socio-cultural and behavioral determinants of health.” It’s about time that the MCAT caught up with what is truly vital in medicine today. Our doctors today need to understand these aspects just as much as they need the basic sciences, and finally, it’s beginning to hit them at the pre-med level.

As a pre-med student, I remember loving the sciences, but that’s not why I became a doctor. I wanted to understand suffering, to really get to the bottom of why patients of different backgrounds and social status were having such drastic difference in health outcomes. Not only that, I wanted to know why this was happening all around the world. When I got the opportunity to work with Child Family Health International, a non-profit organization that partners with international healthcare providers, it changed the direction my future took. I participated in CFHI’s program, Tropical Medicine and Community-Based Care on the Coast of Mexico, based in the southern state of Oaxaca. Oaxaca is one of the poorest states in Mexico with the largest concentration of indigenous populations. Working with 10 other medical students, we worked parteras thursday 039closely with the local midwives, physicians, and women in the community to understand their experiences and needs with regard to family planning, sexual health, and maternal health. Using this information, we assisted the local health team in developing and delivering a four-day training for roughly forty traditional midwives from across the state of Oaxaca. I will never forget what it was like to sit down and listen to the midwives’ experiences of providing maternal and child health care in this setting, and the opportunity we had to work with them in their efforts to improve the health of their community. What struck me most about CFHI’s approach was that they work to empower local communities and really take “service-learning” and “partnership” to heart. The focus was not providing a service, but partnering with local organizations and offering the skills and training in an ethical way. After this experience, I continued to have multiple global experiences throughout Central America. By the time I finished medical school, I would not have taken back any of these experiences for anything. I had a better knowledge about communication barriers between physicians and patients, cost burden of disease, importance of relying on physical exam over technological tests, and treating patients as a whole, not just their illness.

Now, as a shiny new family medicine intern, currently working at a hospital where nearly 100% of the population is underserved, I’ve made a pledge to myself to never lose that empathetic side of medicine. I challenge the pre-meds and medical students of today to do the same: Get out there! Yes, learn the basics, but don’t overdo it. Be a real person, spend time outside medicine, get out into the community and the rest of the world and really, truly try to understand where disease comes from and how your patients live their everyday lives outside your clinic. Even the new MCAT wants you to.

Learn more about the recent changes to the MCAT here: