Tag Archives: South Africa

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

Oxford Handbook on Neuroethics

Oxford Handbook on Neuroethics

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

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

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

Read the full CFHI Press Relase and Chapter.

The Roots Have Taken Hold –A Follow-up on a Success Story in the Making in South Africa

Ukwanda Logo

Ukwanda Logo

In October of 2009, fresh from a visit to South Africa, I wrote an entry to this Blog called The Roots in Grassroots –Ukwanda Rural Health Program.  I was so impressed with the intentional efforts of the University of Stellenbosch to successfully bring primary health care to Avian Park, an underserved community in the rural areas well north of Cape Town.  CFHI’s work has always intentionally been at the community level so this was the first time that we were helping to fund a project of a university.  On paper, it looked like a serious effort to truly do the relationship building and ground work necessary to successfully establish the first primary healthcare facility for this poor but growing community.  Our contacts on the ground were also very enthusiastic about this initiative and so CFHI chose to help support it.

What I saw in 2009 was an idea beginning to take form.  What had looked so possible on paper, was proving to be a significant challenge to implement.

Avain Park Old Clinic

Avain Park Old Clinic

I saw a very run down set of metal freight containers being used as a makeshift TB clinic.  I saw some initial linkages with the community but everything was still new and tenuous.  CFHI’s commitment was funding that would be used to renovate the freight containers to make them fully functional.  The project was already well beyond its targeted schedule and I could see during my visit that the freight containers were not in good enough condition to be renovated but would need to be replaced.  Stellenbosch was able to get some additional funding as well as some in-kind help to make the new containers possible.  Concerns about acquiring the land where the new clinic would be, the full support of the local political and community leaders, and other logistical details were still not resolved.  Success felt illusive.  Yet, in the face of the many challenges, the Ukwanda team from Stellenbosch chose to dig in deeper, engaging the community, dealing with their concerns and creatively finding the resources to deal with many unforeseen issues that arose.

Freight container being prepared at Cape Town Water Front

Freight container being prepared at Cape Town Water Front

At a stage like this, I am, quite frankly, used to seeing a big university either pull back its funding and  sunset the project, or do an end run around the community and find a maneuver that would give them the legal security they need to move forward even if it does not lead to community support.  Instead of using the university’s paid legal teams to get it out of a jam, the University of Stellenbosch chose to involve its School of Law and get faculty and students from this arm of the university to research creative solutions.

This week, I paid another visit to Avian Park and I met with Prof. Hoffie Conradie, also a medical doctor whose blood, sweat, and tears have flowed into this clinic for years now.  What I saw this time was the brand new set of freight containers fully set up, painted, and functioning at about 80% of the planned use.

Avian Park New Clinic 2011

Avian Park New Clinic 2011

In addition to the original TB clinic, there is now an ARV clinic and a team of home-based care workers based out of the clinic.  Weekly physician clinic hours by Dr. Conradie are well attended and welcomed by the community.  Still to come will be family planning and other health education initiatives.  While a water line has made it to the clinic, electricity is still lacking but this is in the works and seen only as a minor inconvenience.  The clinic was bustling with activity and clearly has become a focal point of the community.

Even more impressive was that I just happened to arrive as a team from the University Of Stellenbosch School Of Sociology was just concluding an intensive study of Avian Park.  A social anthropology professor and his students had made many visits and conducted house to house interviews.  The students made use of volunteers from the community, mostly young people who assisted the students in navigating the unpaved maze of roads and any unfamiliar customs or local norms.  The result is a significant body of primary research data that will now be analyzed and synthesized to produce a profile of the community that will not only help the Medical School in its work in the community but also all the other arms of the university; agriculture, theology, social work, as they also look to begin projects in Avian Park.

Meeting later with Project Coordinator, Lindsay Meyer, in Cape Town, she attributed the tremendous cross pollination of efforts from Stellenbosch at Avian Park to the leadership of the university.   The Rector of the University of Stellenbosch has motivated and guided his faculty across all schools to develop strategic plans that have goals that are connected to the Millennium Development Goals of the United Nations.  All schools and departments are also required to have initiatives that are benefiting the community in some way.  With this kind of guidance, a university that often has so many disparate activities can instead become like an orchestra, each producing their own sound but from the same sheet of music.

Prof Hoffie Conradie addresses sociology & medical studnets and community members at Avain Park clinic

Prof Hoffie Conradie addresses sociology & medical studnets and community members at Avain Park clinic

And so it was in Avian Park. The sociology students and the medical students were each doing their own endeavors but in a way that appeared to the community and to this outsider as a coordinated effort that will build on each other.  Universities can easily become a place of many silos of information growing ever higher and rarely moving horizontally in a way that combines data for richer analysis and in a way that can most effectively benefit communities.  How refreshing it is to see what can happen when the full resources of a university are coordinated and focused to help a community.

Our hats are off to the University of Stellenbosch and its Ukwanda Rural Health Project and the Avian Park Rural Clinic for their dedication and commitment to community-based work done well!

CFHI Alum Reflects on Her Experience in South Africa

Stella Chiu who spent part of her summer on one of CFHI’s Global Health Immersion Programs in South Africa contributed to a blog on the IE3 Global Internships website.  Her blog postStella Chiu CFHI CapeTown 2010 Coming Home with New Perspectives is an honest sharing of her thoughts as she is still in the re-entry process.  Stella says, “I haven’t had any major problems re-integrating. However, the only difficulties I’ve encountered are through the new perspectives that I’ve gained.”

Stella reports that after being completely immersed in the South African culture and healthcare system, and especially with the  warm welcome of her South African host family, she now finds herself, at times, ‘homesick’ for South Africa.   Stella recommends to others who go abroad to build in time to reflect after coming home, to “sit down and think”  so that you can become aware of how your perspective has changed “both personally and professionally” by what you have experienced.   She says of her friends, “Sometimes it is hard for others to understand my outlook on certain things because they have not experienced what I have experienced.”

As part of her own reflection, Stella shares, “I am grateful for the opportunity CHFI-South Africa has given me in developing my clinical skills and finding my niche. I did rotations in surgery, pediatrics, ophthalmology, and in internal medicine and found an unexpected love for surgery. I grew to understand South Africa’s health care system, as well as its deficiencies, setting the groundwork for when I can return someday to work. I have built lifelong relationships with students in the program, and the families that I stayed with. I know that I will always have a home in South Africa.”

We wish Stella well as she continues her re-entry and we know that her host family and those who worked with her in South Africa were grateful for her presence and will never forget her.

University of Oregon Students Receive Awards for CFHI Programs in Bolivia and South Africa

Ann Oluloro and Stella Chiu, both students at the University of Oregon have received scholarships awarded by the IE3 Global Internships Program.   Many other students from participating IE3 Schools will attend CFHI programs this year and will receive credit from their home institutions.  Oluloro and Chiu, “…stood out among their peers…” according to the IE3 Field Blog Website.

Ann Oluloro Bound for Bolivia

Ann Oluloro will be participating in CFHI programs in Bolivia starting in July 2010.   In her CFHI application she identified several reasons for seeking entrance to a CFHI program in Bolivia.  Becoming a fluent Spanish speaker is important for her professional goals.  “Being fluent in Spanish is an important part of my future career because I plan on working in public clinics.   Currently, as a volunteer at White Bird Community Clinic, I often see the doctor communicate with patients in Spanish. By being able to speak another language, the doctor is able to break down a communication barrier that would have otherwise existed and is therefore able to provide the patient with the best care she possible can.”  She dreams one day of working with Doctors Without Borders and she believes that her CFHI experience, “…will give me a deeper insight into international medicine…” and help her “…learn about a culture and a way of life that books and textbooks cannot provide.”  She hopes that her time in Bolivia, “…will give me a glimpse and understanding of a culture that I may otherwise not have a chance to learn about first hand. In addition, the internship will teach me about the structure of public health systems and how such systems are implemented in under developed nations both in rural and urban settings.  Ann has done her homework, reading about the challenges faced by many countries to provide healthcare to their populations.  “I am highly interested in how some under developed nations are still able to find ways and means in which to implement effective public health systems.”

Stella Chiu will be participating in CFHI programs in South Africa.  Stella’s goal is to become a doctor and also to have an impact on underserved populations.   She sees being part of a CFHI program as, “…a perfect match for what I want to do with my future. I want to become a physician and gain clinical experience, but I also want to help underdeveloped countries with public health efforts.”   For Stella, it is important to be immersed in another culture, “I hope to gain clinical experience in a setting that is different from that of the United States. I believe this would make me a better physician in the future because it will help me see beyond the privileged population and be more competent in serving the less privileged. I hope CFHI will provide me with opportunities to learn and experience things first-hand.”

Both Ann and Stella will be reporting on their experiences so we look forward to more in their own words.  We wish these students well as they embark on a summer that they will surely remember forever, and good luck with the tremendous potential of career opportunities that await them in the future.

CFHI South Africa Alum in the News

David Liskey (in a photo by Jan Sonnenmair), was a 2008 CFHI South Africa participant that came to us through our Oregon partner IE3.

David Liskey photo by Jan Sonnenmair

David Liskey photo by Jan Sonnenmair

David was featured recently in the Oregon State University President’s report.  Read about his experience and “how race, culture and poverty affect health care in a country with one of the highest HIV infection rate in the world.”

David participated in an 11 week program with CFHI and received credit from his home institution.  From his first-hand experience, he wrote a University Honors College senior thesis.  David was perceptive and able to see how culture impacts health.

In the president’s report, he reflects, “The different experiences and topics I studied had an effect on how I see the world.”

The Roots in Grassroots -Ukwanda Rural Health Program

Ukwanda is a Xhosa word meaning to grow and develop.  It is also the name of a rural health project run from the Tygerberg Medical Campus of Stellenbosch University in Cape Town. CFHI, with a generous grant from the Dickler Family Foundation, has helped to fund part of this  project to bring more healthcare to Avian Park, an underserved community near Woster in the rural area well north of Cape Town.

Long story short, they are building on the success of a TB clinic, which was the only healthcare in this community.  Once people saw their neighbors responding to TB treatment, the numbers of patients willing to come for treatment began to climb.  Now they are increasing visits to homes in the community and beginning distribution of antiretroviral medication (ARVs) for the treatment of HIV/AIDS.  The hope is to add more regular visits by a doctor and bring primary care to this community.

While it is still a work in progress and well on its way to success, the story behind the story is fascinating.  Stellenbosch University was a bastion of Apartheid.  Among its graduates are a number of the country’s prime ministers during the Apartheid regime. It still has a majority white student population but the diversity of its student body is increasing.  Even for years after the change to majority rule, to think that Stellenbosch University would be successful leading an initiative to build strong relationships with multiracial rural communities would simply not have made any sense.  It is wonderful to see the progress that has been made here.  The university has hired a diverse team and has supported their efforts to build the relationships necessary for successful collaboration at the grassroots level.  Working to earn the support of the local Rotary Club, local politicians, community leaders, and even seeking out the strongest voices block to block, the university has committed its time, talent, and funding to truly engage the community.

I met with Lindsay Meyer, who is coordinating the community engagement on this project for the university, and it is easy to see that her heart and soul are completely committed to its success. By building the support that she has, she managed to find the creative solutions when road block after road block surfaced along the way.  She has taken her guidance from the leadership of the university as all the resources of the university have been made available to this project.  From agriculture, to education to law and even theater, the various parts of the university have had a hand in this project.  The process of acquiring land for the project has been assisted by the legal faculty; the soil was tested and found suitable for a community garden by the agriculture faculty and students; education programs have been set up and educational storytelling through drama has engaged the community even more.

Lindsay sees her work as cutting edge and it truly is.  We congratulate Lindsay, her team and Stellenbosch University for doing what it takes to make this project a real part of the community and not just a satellite office of the university.

Report from Kwazulu-Natal: Filling a Need for Forty Years –The Islamic Medical Association of South Africa

Dr. Ebrahim Khan is a family practitioner with a private practice in the Kwazulu-Natal  Province of South Africa and serves as Medical Director of the CFHI program based out of Durban. As with most doctors in South Africa, the demands on his time are great.  Dr. Khan’s daily schedule is easily enough for two or three men.  His long and distinguished career has earned him the respect and confidence of the local community, and even at this point in his career, his desire to be of service and give back is as vibrant as I have seen in twenty-year-old students, so he is a good match for the many CFHI students from around the world who choose the Durban program. I especially sensed a love for teaching medicine in a way that guides the students to make their own discoveries.

Among the many hats Dr. Khan wears is that of being the Vice President of the Islamic Medical Association of South Africa.  In the early 1970’s, a few Muslim Doctors, noting with concern the disparate health services under the Apartheid government of South Africa, embarked upon the establishment of a modest Sunday clinic on the south coast of Natal in Eastern South Africa, where there were virtually no services for the black rural community.  This was the birth of what would be called the Islamic Medical Association. With such a deeply personal mission, it did not fade away after the end of Apartheid.  Now almost 40 years later, IMA has set up various healthcare and crisis relief centers operating full time in various places in the country where there is dire need for such facilities; social work and counseling are happening for families and children as well.   The IMA mission challenges them as healthcare professionals to “establish and project a value system that is a living entity in our own lives, and in the practice of health care solely for the service and the pleasure of the Almighty. ” The health professionals who give their service are truly dedicated to improving primary care for the underserved.

Avril Whate, Vusi Ngcobo, Steve Schmidbauer

Avril Whate, Vusi Ngcobo, Steve Schmidbauer

One of the many programs that IMA provides here is a small community clinic in Marianhill outside of Durban, a favorite site for CFHI students.  One of the services that has been happening for some time now is voluntary counseling and testing (VCT) for HIV.  Vusi Ngcobo is the counselor who is responsible for the success of the VCT program here. In an area with such a high prevalence of HIV, it is important that voluntary testing happens so that the virus can be detected as early as possible.  For those found to be HIV-negative, they will still receive valuable information about HIV prevention.

The clinic here and the many other projects of IMA are the continuation of a very long tradition of providing healthcare and teaching medical students. I learned that in ancient times, medical education was flourishing in Islamic society as evidenced by written case studies for teaching that date to the seventh century!

South Africa –Local Hospital Takes Courageous Stand Against New Menace

During a program visit to South Africa, I continue to be amazed by the dedication, commitment, and resourcefulness of the healthcare workers.  I find examples everywhere I go –this one, I wasn’t ready for:

With HIV rates among the highest in the world, you’d think there may be no higher priority in South African health services than addressing this disease and working to prevent it.  Meet the new menace, “Tik.”

Dr. Adam has been head of G. F. Jooste Hospital for a little more than a year and in his short tenure, he has witnessed an explosion of drug use in the surrounding community that at times has crippled the functioning of this district hospital.  These are the Cape Flats, just ten minutes from the beautiful city center of Cape Town, and there is a real fight here to stop this menace from spreading.  The drug is crystal meth, and the impact is devastating.  Dr. Adam has had a long and distinguished career as a practicing physician and in more recent years, adding a degree in public health, he has been the doctor/administrator at various facilities in South Africa but he has never seen anything quite like this.  They thought they had a challenge seeing 40 or 50 patients per month in the ER who were out of control, high, and totally unpredictable, but now these patients number more than 180 per month, and this is in addition to all other patients seen in the facility.  The psychiatric effects of tik (which gets its name from the noise made when the crystalline structure is heated) are severe, and Dr. Adam explains that the ER is not a psychiatric ward.  Instead of adding medical equipment, they have been forced to add bullet-proof glass and a metal detector to the entrance area.  Patients can arrive in a wild state, combative, and completely noncompliant.  “The only choice we have is to sedate them until they calm down and we can begin to help them,” Dr. Adam says, noting that recently one female doctor had to be rescued from underneath a male patient who simply jumped on top of her. This 184-bed hospital is already stretched beyond capacity most every day, and sees 4,500 patients in its emergency room every month.  But the evidence suggests things may get even worse.  In today’s  edition of the Cape Times newspaper, a story by Anso Thom reports that “Tik is the most commonly abused recreational drug in Cape Town…,” and that a new study shows one in ten pregnant women are using tik.

“Tik is holding us hostage in this hospital,” proclaims Dr. Adam.  But he is not sitting still.  He has formed strong alliances with neighborhood and community groups to help coordinate a positive response from within the community to reclaim its streets and build a network of neighborhood watch and support.  He opens the hospital auditorium on Saturdays for community meetings and to provide a safe place for children to come for organized activities.  He is most proud of getting approval and funding for an outpatient substance abuse program that will begin very soon.  The relentless cycle of treating patients, releasing them, only to have them return in a worse state in only a few days can finally be stopped.  Armed with a psychiatrist, an addiction recovery expert, and a local public health masters student to document the progress,  Dr. Adam is putting together a team that will take a stand against the menace.  Dr. Adam knows that the only way to really fight this new epidemic is to break the cycle of addiction.  A holistic approach will aim to help strengthen the family unit as well as the patient.  Strengthening the community by strengthening individual families is a plan for wellness in the face of an almost hopeless situation.

“We’ve got to start somewhere,” says Dr. Adam.  Reflecting on the toll it has taken on his hospital, Dr. Adam says it would be tempting to say that the hospital is simply not equipped to treat these patients and send them elsewhere. But there is really nowhere else, and Dr. Adam is not the kind of person who could turn a blind eye to a problem like this.  You can sense the conviction and commitment in his voice as he says, “Our core business is the health of the community.”

CFHI Granted Consultative Status at the United Nations

Just prior to the opening of the United National General Assembly this year, I was fortunate enough to be at the UN to represent the small but powerful global family of Child Family Health International (CFHI).  Recently CFHI was granted Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC).  This is a great honor that speaks to our unique collection of dedicated professionals and students who truly work at the grassroots level to improve the health of the world community.

As the Executive Director of CFHI, it was indeed a high honor for me to represent our organization and I came prepared to explain our work and our efforts in Bolivia, Ecuador, India, Mexico, and South Africa. To my great surprise, I did not have to do any of that.  I found the staff at the NGO Section of ECOSOC  wonderfully welcoming and accommodating, and also found they had done their homework and already were quite aware of CFHI and our work.  They had read the documents we had sent more than a year earlier in the process of being granted consultative status and they also brushed-up by reading our website prior to my arrival.

What with the UN being such a huge organization, I expected everything to be very bureaucratic and fairly impersonal.  Sure it is a big place and with the leaders of the world, about to arrive, there was quite a bit of bustle all about, so it was a surprise to find such personalized service and attention.  My meetings with the Deputy Chief of the NGO Section and the Program Officer were cordial and productive.

I learned that there are about 3,200 NGOs around the world that have been granted consultative status.  Many are more associated with a cause while they see CFHI as a more “practical” organization.  The grassroots nature of our work is appealing to them as well as the diversity of our global family along with the close, long term relationships with CFHI partners who are at the front lines of the delivery of healthcare in so many places.  To a large extent, we have our finger on the pulse of global health at the grassroots level and so we have much to share, especially the CFHI model of empowering local communities.  Of those more than 3,000 organizations, only about 800 are really active.  Work is going on to improve the website of the NGO section and the hope is that there will be much more online functionality to allow for sharing and collaboration.

Flags of the CFHI Global Family now including the United Nations

Flags of the CFHI Global Family now including the United Nations

One official told me, “The international community has looked at your organization from top to bottom and the feeling is that it is a good organization and has a model that is important. We actually hope that it can be replicated in areas of health yes, but also in other areas.” So as we add the UN flag to the flags of nations comprising the CFHI Global Family, we do so with great honor and great pride, and with responsibility for the role that we have assumed through this honor.