Tag Archives: Global Health

The LGBTQ+ Population in Uganda

Homosexuality is illegal in Uganda, but homosexuality is also illegal in 69 other countries worldwide, and the practice of labeling individuals as homosexual, gay, or lesbian was traditionally not a part of Ugandan culture. This topic was not politicized, and Ugandans accepted different practices. Recently, however, LGBTQ+ Rights in Uganda have become a prominent issue in politics and in the international media. In 2009, MP David Bahati proposed the Anti-Homosexuality Bill and in February 2014, it was signed into law by President Museveni. The Ugandan constitutional court struck down the law in August 2014, but civil rights activists say the situation for LGBTQ+ Ugandans is still worse than it was before the law. LGBTQ+ individuals, numbering around 500,000 in Uganda, often face consequences if they reveal their identity, so discussions about sexuality are rare.

While in country, focus on your safety and trust your gut. It is usually best to avoid questions about your sexuality and be ambiguous if asked. Please respect the local culture and assess who you are speaking to. Also, remember that travelers to Uganda often don’t face the same discrimination that locals do. As someone with “tourist privilege,” you may have slightly greater freedom of expression, but your actions may have repercussions for the locals you engage with, so please take that into consideration.

Traveling is always challenging, and LGBTQ+ individuals often face additional levels of complexity. The followingresources will help you to educate yourself on the local culture and social context. There are a wide range of resources available that will allow you to better understand the political climate and cultural nuances of a country. Some resources to explore include: ilga.org, the US State Department, the Geert Hofstede Center for Cultural Insights, the CIA World Factbook, alturi.org, ilgta.org, and HSBC Expat Explorer. It is also a good idea to register yourself with the State Department so they’re in a position to advocate for you. Staying in touch with friends and family back home who know your identity often helps travelers as well. Skype, Whatsapp, and Viber are good options for this.  

We also want to make explicitly clear that CFHI does not agree with or condone any discrimination based on sexuality. Our partners in Uganda are welcoming and do not practice discrimination, and students have not experienced any issues in the past. However, understanding the local context regarding LGBTQ+ rights will help ensure that there are no incidents in the future.

For more information, please refer to the following sources:

The OSAC LGBTQ Guide to Travel Safety

The State Department’s Website for LGBTI Travelers

The Human Rights Watch

The International Policy Digest’s Article on the Origins of Uganda’s Anti-Gay Law

Why Global Health Ethics Matter: A Personal Story

Image result for antigua guatemala

In the summer between my sophomore and junior year of college (undergraduate), I participated in a medical volunteering program for 2 weeks in Antigua, Guatemala. As a pre-med student, I knew I wanted to do something during my summer that involved medicine and figured volunteering in a hospital or clinic would be my best bet. Unfortunately because I had a mostly full time job, I was unable to secure any type of volunteering program locally since they all required a certain amount of hours that I would not be able to complete before returning to my university in the fall.

I then decided to look online at volunteering abroad, and found a myriad of programs that fit my time constraints perfectly. I honestly did not do too much research and just clicked on the first organization I found that had a solid amount of positive reviews and wasn’t too expensive. Looking at the cheapest options, I saw that in Latin America they offered an affordable medical program in Guatemala. While scrolling through the program description, the phrases “gain hands on experience” and “provide check-ups and basic medical care” piqued my interest as the idea of actually getting to perform medical procedures sounded incredibly appealing to myself as a student interested in a career in medicine. I imaged working in a hospital with doctors and nurses and getting the opportunity to experience medicine directly. The program description made it seem that these “poor” communities needed any help they could get, so I figured that I could kill two birds with one stone-help this underserved country while also gaining medical experience. Even though there were red flags consistently throughout the program description-the program oozed “voluntourism” and provided very brief and limited information on what actually would take place during participation- I wasn’t suspicious at all because I didn’t expect anything that involved volunteering to be problematic.

After signing up, there was a very brief pre-departure guide I had to complete before embarking on my trip. The guide was just a general guide and mostly focused on the logistics of getting there (ie. visas, packing list, etc.). There was a short list on my responsibilities, but it didn’t really mention anything about ethics. There were also 2 optional pre-departure training modules that were more informative on ethics, but were brief and took less than 30 minutes to complete. I didn’t really feel that prepared for my program, but figured I would get more instruction and guidance once I arrived.

Once I finally made it to Guatemala, I started to see problems and holes within the program. Before starting my rotation, I met with the medical coordinator for the program to have orientation. The orientation was pretty short and consisted of a powerpoint on the kind of care we could provide. After telling him I had had no prior experience in medicine, he told me that I would act somewhat like a nurse, taking weight, height, blood pressure, heart rate and temperature, making beds, cleaning, talking with patients, preparing materials and sterilizing equipment. Even though I told him I didn’t know how to take blood pressure or heart rate, he assured me the other visiting volunteers at the clinic would teach me. This orientation started to leave me a little hesitant about the program since he asked us to provide medical care, but expected other volunteers to teach us instead of himself as a doctor showing us.

After arriving to the clinic where I would be volunteering at, I was sent to work at the nurse’s station. At my rotation, there were 2 other volunteers placed there as well who had been there for about 4 weeks. One was applying to medical schools in the United States and the other was a 3rd year medical student at a university in Ireland. Luckily, one of them spoke spanish fairly well and was able to translate for us when we interacted with both the nurses and patients.

After the other volunteers briefly taught me how to perform the basic nurses duties (blood pressure, height, weight, and temperature), I was mostly on my own. It was definitely very nerve wracking having these duties when I’d never done them before and was even more difficult considering I spoke very little of the language. I was especially confused on taking blood pressure and while I immediately should have said that I wasn’t sure what I was doing, I was embarrassed to tell the other volunteers since they insisted it was an easy task and that I’d get the hang of it eventually. This is definitely something I wish I could’ve gone back to and done differently because there is a large possibility that patients’ information was recorded incorrectly due to my lack of experience. This was when I started to realize that gaining hands on experience wasn’t what I imagined at all. In my head I thought that everything would go smoothly and I would be ready to help the professionals in anyway possible. In reality though, my lack of experience became even more apparent to myself and I started to become suspicious that the “help” I was providing wasn’t all too helpful.

Image result for antigua guatemala crossWhile my lack of training may have led to incorrect patient information being taken down, there were other pre-med volunteers who were given duties that were even further beyond their scope of understanding and led to medical complications for patients. Since there were other volunteers working at my clinic, they cautioned me right away that I shouldn’t help with procedures such as giving stitches or injections since we didn’t have the training for that (I think they figured taking down patient information was harmless enough that my inexperience wouldn’t be an issue). I was very thankful for that advice since I was already feeling uncomfortable with the duties I had, I couldn’t even imagine how stressed I would have been if I had to perform anything more advanced. However, other volunteers weren’t as reserved. I remember this one other volunteer bragging to me about how the doctor had allowed him to give injections to a patient. He said that he didn’t really know what he was doing and he ended up piercing her 5 times because he kept doing it wrong. Another volunteer told me she helped stitch a patient up and said she was concerned that her stitches weren’t done right since she had never done it before. It was at this point that I really started to question the program we were on. Why weren’t there more regulations enforced by the program? Why were the duties of the volunteers so ambiguous? Why was I starting to feel so uncomfortable with what I was doing and why weren’t the other volunteers having the same questions I was?  

Besides just the volunteer aspect of the program, there were a lot of problems with the program as a whole, in particular when it came to safety. We were warned to never travel by ourselves at night. In keeping with those rules, two volunteers on my program walked home together one night after hanging out downtown. On their way home, someone pulled a knife on them and took all their belongings. The volunteers were traumatized and felt very unsafe about what had happened and contacted the program to let them know of the situation. The program responded incredibly insensitively and told them it was their fault for walking home late at night and didn’t provide any support for the two. Their response to an emergency situation such as this really made me concerned about the legitimacy of this program. They had told us it was okay to be out at night as long as we weren’t alone, yet blamed the volunteers for what happened instead of offering emotional support and/or more information on how we could stay safer while out at night.

I left my program feeling differently than I had expected. While I loved the country I was staying in, I felt disconnected from what I was actually doing. I felt uneasy about what myself and other volunteers had done without any medical experience and questioned my helpfulness. My experience showcases how easy it is for medical volunteering programs to be problematic and harmful for the communities they’re situated in when there is not an emphasis on global health ethics.

 

Note from CFHI: Many thanks to Zoe for sharing her story. If you have questions about ethical engagement in global health experiences please visit the publications page on the CFHI website (https://www.cfhi.org/publications) or listen to a recent webinar (https://www.cfhi.org/cfhi-webinars). We are also always available to answer questions about ethical global health engagement- contact us at students@cfhi.org.

Getting One Step Closer to a Unified Global Health Curriculum


The term “Global Health” can be an all encompassing, and sometimes, vague term.  Individuals from the fields of public health, medicine, and more have all defined this term in different ways.  That is why when the Consortium of Universities for Global health convened in 2008, one of the items that members called for was to define the field of global health and standardize required curricula and competencies for the emerging discipline.

We are excited to announce that, as of this week, we are one step closer in providing that definition as the Global Health Competencies Sub-committee of CUGH released a new toolkit that brings together resources from a wide array of subjects and authors in the field of global health.  All this under the leadership of CFHI and our Executive Director, Dr. Jessica Evert.  Thank you for this great effort across dozens of institutions and fields!

Referred to as the CUGH Global Health Competencies toolkit, the resource is designed to help Global Health faculty build curricula and competencies that may stretch beyond their immediate area of expertise.  As the field of Global Health grows in its maturity as an academic field, we here at CFHI are proud to be at the vanguard.

 

Ethical Dilemmas in Global Internships: Lessons from the GIC 2016

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by Robin Young
Assistant Director, Africa and Asia

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

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

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

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

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

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

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


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

 

The Joys of Motherhood: Sharing CFHI’s Impacts with my Children

Mother’s Day post by Jessica Evert, MD, CFHI Executive Director

It’s been said that “having kids- the responsibility of rearing good, kind, ethical, responsible human beings- is the biggest job anyone can embark on” (Maria Shriver). The challenge of mothering is monumental, yet there are precious pieces of this world that aid us in the journey. For me, one of those pieces is Child Family Health International (CFHI). IMG_7937 Jess & the kids

Through my involvement with and support of CFHI, my daughter has come to learn about a world beyond her imagination and comfort zone. I have been able to support mothers in 10 countries; community leaders who are passionate about making those struggling in their midst better off; and young people who are embarking on a transformative experience abroad that will raise their consciousness of global citizenship and make them feel a “a little softer about places that are not as economically well off,” as one CFHI Medical Director put it.

The day in and day out of mothering is a frequently overwhelming cacophony of whining, laughter, hugs, and shrugs. There are moments that intersperse our daily routine and allow us to expand our children’s worldview. These moments make us feel like super mamas. Through CFHI I am able to be the mother I want to be for my children and the children of the world.

Although my financial support of CFHI is modest, it is steady. Through this steady giving to CFHI, I am confident I am contributing to a better world. Through modeling generosity for my children, I am confident I am shaping the kind, ethical, responsible humans that I hope they will become.

CFHI Convenes Pre-health Advisors for Workshop on Global Health Best Practices

Advising Students on Health Experiences Abroad

On June 26th, I collaborated on a workshop entitled “Beyond the Basics: Advising Students on Health Experiences Abroad,” led by Child Family Health International (CFHI) Executive Director Dr. Jessica Evert and Tricia Todd, MPH, Assistant Director of the University of Minnesota Health Careers Center. The workshop coincided with the National Association of Advisors for the Health Professions (NAAHP) Annual Conference, held this year in San Francisco. Advisors arrived at CFHI’s San Francisco headquarters in to a full house with over 20 attendees representing 15 different colleges and universities. Small Liberal Arts colleges from Maine were particularly well represented, with advisors from Bates, Bowdoin, and Colby College in attendance.CFHI Advising Health Students Workshop

As a grad student of International Education Management, I was interested to observe the backgrounds represented amongst the attendees. Some were faculty in science departments, some staff from career development offices, and others from programs specifically geared towards global health. What everyone had in common was knowledge of issues relating to advising pre-health students, and all expressed worries regarding the growth of an “industry” to meet the rapidly growing demand from students seeking health-training programs abroad.

Health Students Doing Too Much, Too Soon – How to Choose Reputable Programs

The issue of the commodification of education abroad, which I was familiar with from graduate courses, took on greater significance when discussing health-related programs where issues of medical ethics and patient safety come into play. In such cases, not only are students being sold an education abroad “experience”, but unethical program providers tell students that they will be able to perform clinical work that exceeds their training and “change the world” through their work, effectively putting patients’ lives at risk.

Advisors were eager to discuss strategies for guiding students towards reputable programs and avoiding companies and experiences where students are encouraged to “do too much, too soon.” Case studies were presented, based on actual incidents from the field. Some were particularly alarming: undergraduates delivering babies, students conducting hospital rounds unsupervised, even instances of students scrubbing in for surgery! Unfortunately many students are under the erroneous impression that participating in this type of hands-on clinical experience will give them a leg-up in the competitive world of medical, nursing or other health professions school admissions. Part of the messaging to pre-health professions students therefore needs to focus on how performing clinical duties beyond what they are authorized to do here in the U.S. is highly unethical, and could jeopardize their own careers.

CFHI Advising Health Students

Before the evening was over, Dr. Evert, playing the roll of the advisor, and I, playing the part of a well meaning (but naïve) pre-med student, acted out an all too common scenario for the group. Fortunately, in our fictional advising session the student wasreceptive to ideas. The advisor convinces the student to re-examine motivations for wanting to go abroad, and suggests the right questions to ask when choosing a global health education program. The role-play emphasized the many tools available for students to examine their motivations for taking part in a health experience abroad. I think advisors in attendance left the CFHIUMN Health Careers Workshop with new resources, a feeling of community, and a better sense of how to guide students to help them make better decisions for their global health education.

 

Special thanks to our guest blogger, CFHI Intern Alex Nichol, for authoring this post.

Internationalizing Medical Education: Shaping Healthcare Providers for Global Health

Internationalized Medical Education: How do we develop competency-based education and realize its full potential?  UN-recognized NGO Child Family Health International (CFHI) has been running global health education programs for over 20 years.  We have seen a lot along the way since our beginnings in a small garage in the San Francisco Bay Area.

Global Health and Study Abroad See Upward Trends

CFHI Uganda Program Photo Woman

Fast forward to 2014.  Global health has become a buzzword, conjuring up images of Bill and Melinda Gates projects and Partners in Health initiatives.  Once a field that rallied for press, global health is receiving increasing limelight.  Take a look on the Kaiser Family Foundation webinar on U.S. spending towards global health initiatives or the entire Center for Global Development event devoted to discussing Best Buys in Global Health. Global health teaching in undergrad and medical curricula is also increasing and the 2013 Open Doors Report on International Educational Exchange, states study abroad by U.S. based students is steadily increasing and is at an all time high.   The Association of American Medical Colleges data demonstrates that 35% of US medical students participate in international experiences.  Spurred by increased participation, global health education is evolving from a phenomenon of one-off volunteer experiences to a field of educational theory and practice, shaping the world’s next generation of healthcare providers with skills demanded by an increasingly inter-connected world.

Looking at Competencies in Medical Education & How Students Engage

A study in the journal Academic Medicine shows the structure of global health programs, the degree to which they are imbedded in local health care systems, and having a capacity-building agenda, affects what students learn.  In an era where competency-based education is dominating pedagogy in medical education, we must leverage the richness of global health experiences to meet accreditation standards and competency-based outcomes.  Like studies have shown and CFHI’s 7,000 alumni can attest, global health exposure and international experiences make for better practitioners and global citizens.  CFHI’s approach leverages asset-based engagement and encourages students to “Let the World Change YOU.” stethescopeglobe

As we strive to meet demand and look at the nuances of programming, we must continue to examine students’ international experiences. This month thousands of international educators will gather at the NAFSA conference and discuss these topics at the Colloquium on Internationalizing Education for the Health Professions.  Here and on our own we must consider key questions—what competencies does a globalized health practitioner need?  What competencies are nurtured during global health programs? How do we wed international global health and what is taking place in our own back yards?  Just as important, not all global health experiences are created equal.  As educators and leaders in the field, we must advocate for socially responsible and ethically sound approaches to placing students in health settings abroad.

Global Health Uncensored: Notes from Western Regional International Health Conference

I descended upon the city through drizzle in true Seattle fashion, the Olympic Mountains revealing themselves in the distance. A local next to me argued against Seattle’s reputation for unyielding damp weather and boasted that the previous four days were dry and full of sunshine.

Rain or shine Seattle was brimming with energy and dialogue, as The University of Washington hosted the 11th Annual Western Regional International Health Conference (WRIHC) April 4-6, themed “Uncensored: Gender, Sexuality, & Social Movements in Global Health.”  The largest student lead conference in the nation, nearly 600 attendees from around the country and the globe joined the dialogue around gender and sexuality, topics too often stigmatized and neglected. I was there as an alumna of three different Child Family Health International (CFHI) global health education programs, representing CFHI amongst an army of global health enthusiasts.

Jessica Stern, Executive Director of International Gay and Lesbian Human Rights Commission (IGLHRC), boldly declared, “It is not an option to silence sexuality. It’s everyone’s business to talk about these issues and more importantly, we need to talk about the sex we actually have, not the sex we pretend to have.”

The conference kicked off with a fiery presentation by keynote speaker Stella Nyanzi, PhD. A native to Uganda and a seasoned medical anthropologist, Dr. Nyanzi has worked extensively on youth sexuality and sexual and reproductive health issues in East Africa and contributed notable social science research and academic literature surrounding these topics. She encouraged the audience to not waste any time and to ‘uncensor’ gender, sexuality and social movements –the hardcore issues. She wasn’t kidding and even stunned the audience with the use of curse words, repeatedly followed by, “Pardon me, but I thought this conference was uncensored?” The diverse crowd immediately took to her, listening intently as she urged all in attendance to mobilize against issues that, whether we realize it or not, are relevant to us all.

Simply being in that room meant we were all comrades in the struggle for global health no matter what our focus, being that gender and sexuality permeate all aspects of health. Don’t forget, she sternly reminded us, that health transcends the mere absence of disease. “Become radical in a radical way and stop doing business as usual. Global health is about the global North and South. Arrive in foreign lands with a teachable spirit and empower everyone involved.”

Those with a teachable spirit can learn more about sexual and reproductive health issues touched upon during the WRIHC event. CFHI’s Sexual Health as a Human Right: Ecuador’s Unique Model in Quito, Ecuador affords understanding of sexual and reproductive health issues in Ecuador, the first Latin American country to guarantee sexual rights in the constitution despite a conservative societal context. Participants learn and help devise and execute educational and outreach strategies to take out into the community.

Going forward it’s imperative to continue ‘uncensoring’ topics, such as sexuality and gender. Jessica Stern from IGLHRC reminded us, “Sexuality is not just homosexuality. We all have sexual identities and sexual health is a human right.” Carlton Rounds, Founder of Volunteer Positive, urged the crowd to “lead with your stigma.”

 

Thanks to three time CFHI alumna Lyndsey Brahm for authoring this blog post.

Beyond International Women’s Day

Women’s Empowerment Beyond International Women’s Day

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

Just a few weeks ago, in partnership with CFHI, Winnie and James Chang of Palo Alto, California hosted an event celebrating the recent opening of The Center for Empowerment of Young Mothers (EMJ) in Bolivia. The Changs are spearheading fundraising and donations for this project based in Bolivia working to empower young mothers.

Bolivia is one of the poorest countries in Latin America and the education system is often underdeveloped. In addition, the rate of sexual violence is extremely high; 7 out of 10 female teenagers are assaulted.  Many of these young women become pregnant, some as young as 14 or 15.  To combat these issues and provide support to young mothers, the EMJ Center was created. It operates a facility in El Alto, Bolivia, staffed by doctors, nurses, administrators and volunteers and provides help to young women from all socio-economic backgrounds.  In South America, young mothers are often impoverished, socially isolated, and have little education. Understanding the importance of education and improving their self-esteem is key to mobilizing change. Because South American women are usually in charge of the family, they play a very important role in society. The EMJ Center in partnership with CFHI works through education and empowerment so these women will positively affect Bolivian society at large.

EMJ provides daycare services for more than 20 mothers, recreational activities for children and moms, and are launching a fair where mothers are able to sell crafts and handiwork they have created. Mothers at the center were interested in learning about family planning, so EMJ provides education on these issues as well as women’s rights and gender issues.

CFHI and the EMJ Center are physically far away from one other, yet they strive for the same goal – to empower women.

You can help this great cause and do your part to further United Nations MDG 3 and women’s empowerment by donating to support the EMJ Center.

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

 

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

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

A Doctor Walks Into a Community..

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

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

Two Approaches to Global Health aamcacademicmed

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

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

Humility and Knowledge Key

CFHI Student with Local Doctor, India

CFHI Student with Local Doctor, India

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

Social Justice: Embracing Global Health Complexities

Internationalizing Medical & Health Education

At the recent NAFSA Conference for international educators, the Colloquium on Internationalizing Medical Schools proved to be a forum marked by many thoughtful remarks, especially those of the opening speaker Edwin Trevethan, MD MPH.  Yet nothing struck me as much as the name of the school he heads–  Dr. Trevethan is dean of the St. Louis University College for Public Health & Social Justice.  The social justice part piqued my interest.  Social Justice is a term that did not receive enough exposure during my undergraduate and medical education, despite dedicated studies about global health, underserved care, and health equity. jessicanlauren nafsa 2013

Importance of Social Justice in Health Evolving

Why hasn’t this term gotten the play it deserves?  What does it mean anyways?  One of my favorite definitions of Social Justice is a “historically deep and geographically broad” understanding of gross inequities, power imbalances, and underlying causes of ill health.  Dr. Josh Freeman, the creator of the blog ‘Medicine & Social Justice’ offers further insight into definitions of justice, social justice, and how they relate to health and health care.  Social Justice has also been studied as one of the key ethical principles for students wanting to be involved in Global Health.  Increasingly there has been discussion on whether social justice should be a factor when selecting students for admission into medical school.

I think the reason Social Justice has not always made it into our medical and educational syntax is that it encompasses the utmost complexity.  Particularly in medicine we like things that we can boil down to cause and effect, test while controlling for variables, and fix with evidence-based antidotes.  Social justice doesn’t allow us to be logical and create such neat solutions.  Social justice demands we consider a host of influences on health, wellness, and disease.  It requires that we humble ourselves.  It requires we admit that problems causing health inequities worldwide defy the scope of one solitary discipline, or the involvement of just one prestigious university.

I want to commend St. Louis University and Dr. Trevethan’s leadership for their insight in going so far as to include social justice in name of their school of public health.  They, alongside other leaders such as CFHI partner association American Medical Student Association, demonstrate the fundamental ability to embrace the complexity of global health, and not unlike CFHI persevere with programming and partnerships that give social justice its due attention–both as a goal and as a lens through which to understand health.

At the annual NAFSA: Association of International Educators Conference CFHI was represented along with over 8,000 professionals who come together in late May each year to network and learn about today’s issues related to the fields of study and interning abroad.

Student Essays Reflect Realities and Impact of Global Health

Student Essay Contest Winners with CFHI Executive Director Jessica Evert, MD (far left)

Student Essay Contest Winners with CFHI Executive Director Jessica Evert, MD (far left)

At CUGH’s Annual Meeting last week in Washington, DC educators and students from over 60 countries met to discuss the global health landscape.  Perhaps one of the most powerful and emotional sessions was one that captured power of reflection in global Continue reading

The Power of IFMSA & The Global Health Placebo Effect

International Federation of Medical Students’ Associations (IFMSA) is not just another acronym in a field laden with catchy abbreviations- it is a groundbreaking organization that despite its 60+ years of existence is doing something that remains innovative- bringing together medical student colleagues from around the world to work together as peers.

IFMSA Meets in U.S. for the First Time in Decades

Dr. Jessica Evert, CFHI Executive Director & IFMSA Alumna, with other IFMSA Alumni

Dr. Jessica Evert, CFHI Executive Director & IFMSA Alumna, with other IFMSA Alumni

This year the setting for the IFMSA General Assembly is Baltimore.  Medical students from Sudan work alongside colleagues from the US, those from Panama collaborate with Poland, the interactions are endless.  As an alumna of IFMSA I got the privilege to join the meeting and reconnect with old friends from my days as IFMSA-USA Vice President.  IFMSA’s US affiliate is the American Medical Student Association (AMSA), who is also partnered with CFHI.  IFMSA is a great resource for AMSA members, especially those interested in global health.  Often the global health dialogue is dominated by Western voices.  IFMSA allows 1,000+ medical students from around the world to work face-to-face twice a year.  It democratizes global health and allows for crucial relationship development that is necessary for a unified global advocacy voice for health equity and justice.  It has the secondary effect of humanizing perceptions of the developing world- rather that breading pity; it engenders mutual respect between colleagues from both resource-rich and resource-limited countries.

CFHI Global Health Approach Shared & Praised at IFMSA

Child Family Health International (CFHI) was in great company during the IFMSA alumni meeting.   Attendees praised CFHI for its gold-standard model for global health education.  Colleagues from Ghana, Serbia, Philippines, Nigeria, and beyond approached me with gratitude for CFHIs important advocacy voice in the global health education field.

I was equally as impressed by the candid discussion about advocacy provided by Predrag Stojicic from LeadingChange.  Predrag distilled buzz words and espoused a platform for grassroots champion recruitment and leadership.  A thoughtful organization, The 53rd Week, took the stage to describe their pragmatic approach to evaluate and maximize short-term medical trips.  These trips are characterized by volunteers going to resource-limited communities, usually for 1-2 weeks to deliver medical care and related services.  While well intended, the global health community is increasingly leery of short-term volunteer experiences, as their impact has been questioned and downfalls revealed.

 The ‘Global Health Placebo Effect’

Lawrence Loh, co-founder of The 53rd Week, calls the appearance of impact enabled by short-term medical missions the “Global Health Placebo Effect.”  Under the strong leadership of Loh and co-founder Henry Lin, The 53rd Week is creating a platform for the multiple, disjointed teams who visit a community at different times during the year to coordinate their efforts to created continuity, sustainability, and an overarching orchestrated approach targeted towards upstream interventions. Concurrently, they are raising awareness of the risks of short-term medical missions and suggesting alternatives that may lead to more tangible and sustainable ‘help.’

The efforts of these great colleagues and the synergy with CFHI philosophical approach and model of running Global Health Education Programs has been inspirational!

CFHI: Asset-Based Community Engagement

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

What Makes CFHI Different?

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

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

Not Just Talking the Talk, But Walking the Walk

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

Turning Dark Profits into Enlightened Transformation

From Skepticism to Hope: Turning Dark Profits into Enlightened Transformation

I’ve been a doctor now for 13 (lucky) years but I recently had the opportunity to reflect on my path towards becoming a physician and my involvement in Continue reading

CFHI Welcomes new Director of Research and Evaluation

In the rapidly growing field of global health education, looking at the effects and effectiveness of global health immersion on participants, host communities, and the larger health equity movement is essential.

Dr. Gieseker with CFHI Medical Director Dr. Jessica Evert

Karen Gieseker PhD, MS joins Child Family Health International (CFHI) with a passion for Continue reading

How Can We Think Globally & Act Locally?

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

CFHI Featured at AAFP Global Health Workshop

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

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

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

New MCAT Means Greater Need for Global Health Exposure

The New MCAT – Shaping Future Physicians for the Better

For pre-medical students their life choices are often defined by the MCAT—the often-dreaded U. S. medical school entrance exam that determines whether their professional dreams are dashed or realized.  Rarely do we consider that what we test and emphasize on such exams determines what is prioritized in undergraduate education and consequently Continue reading

Global Health Training Guidebook: 2nd Edition Out

Global Health Training in Graduate Medical Education: A Guidebook

Extra, Extra! Read all about it!  Just published, the second edition of the guidebook is edited by Jack Chase, MD and CFHI’s own Medical Director, Jessica Evert, MD.  The book builds upon the  first edition to provide an expanded, evidence-based perspective on curriculum and capacity-building in the global health workforce.

The guidebook contains relevant material for readers at many career levels, from college and professional students to medical educators and residency and fellowship training program directors.

The 2nd edition is now available in paperback and e-book from Amazon.com, and can be read from the GHEC website.

Congrats, Dr. Evert!

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Read more about CFHI’s Global Health Education Programs that provide global health training to 700 students per year.