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

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

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

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

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

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

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

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

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

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.

CFHI at the Forefront of Ethical Standards in Global Health Education

As global health programs increase in popularity among students based in the Global North, an important conversation around “voluntourism” and intentionality in international health-related programs has emerged. Voluntourism often consists of students engaging in short-term volunteer work that they are not professionally, socially, or culturally equipped to take on, and – though well intentioned – often perpetuates hurtful stereotypes that low and middle-income countries need help from high-income countries. At their worst, global health voluntourism programs may offer students opportunities that end up harming patients and other community members. The pitfalls of voluntourism have been widely critiqued, including through popular satires such as the “Barbie Savior– The Doll That Saved Africa.”

How then, as an organization that promotes global health education, does CFHI make sure that our programs – as well as health-related global education programs more broadly – are ethical in theory, approach and practice? Part of the answer to that question is by getting global health organizations on the same page, ethically, and giving them the guidelines needed to run quality health education programs abroad.

CFHI Executive Director Jessica Evert, M.D. has recently co-authored two sets of internationally recognized guidelines for health-related experiences abroad which outline standards in programming that can improve global health programs for students and global partners. These guidelines shift the focus of global health programs away from hands-on clinical work (which can be dangerous and have long-lasting negative impacts for patients and visiting students) and toward cultural and contextual education of healthcare in different settings globally, as defined by local experts and community host partners. They also provide key frameworks for establishing long-term partnerships with host communities rooted principles like reciprocity, local leadership, and fair trade.

Guidelines for Undergraduate Health-Related Experiences Abroad was released by The Forum on Education Abroad, a conglomerate of US colleges and universities, organizations and foundations aimed at establishing standards of best practices in international education programs. Their newly updated set of guidelines is the first of its kind set forth by the Forum and is meant to be used along with the Standards of Good Practice for Education Abroad in order to promote ethical practices specific to health-related international education experiences.

In addition to the Forum Guidelines, Dr. Evert also recently co-authored the article “Guidelines for Responsible Short-Term Global Health Activities: Developing Common Principles” in Globalization and Health, which helps to summarize existing standards and guidelines in the field.  With the release of both sets of guidelines, Dr. Evert and colleagues focus on creating a common ground between institutions and organizations involved in global health education. With clear and concise standards of best practices in global health, organizations are given the opportunity to improve the ethical standards of their programs, and to keep the best interests of host partners and student trainees in mind.

By contributing to standards of best practice in global health education, CFHI is challenging the narrative around health-centered international experiences and pushing other global health organizations to do the same.

A BRIEF REFLECTION: CUGH 2018 ANNUAL CONFERENCE

The definition of Global Health as a field can be traced to the 2009 Lancet article that reflects a consensus reached within a sub-set of CUGH leadership at the time.  There was an alternative definition put forth at the same CUGH meeting by a colleague from Kenya. He proposed that the definition of Global Health is a “concept fabricated by developed countries to explain what is regular practice in developing nations.”  Though an oversimplification, this perspective emphasizes a real risk in Global Health education and practice — the fabrication of a context outside our own frame of reference.
The Consortium of Universities for Global Health (CUGH) is the premiere gathering for academic institutions from the United States who are embracing the field of Global Health. As an academic field, Global Health is striving to better include institutions and colleagues from low and middle income settings, and to foster a burgeoning ‘walk the talk’ movement focused on representing “local” Global Health for health equity in our own backyards.  As I return from this year’s annual conference, I am struck by an evolution in the recognition of CFHI’s work and our growing Academic Partnerships.

Though we have long been at the forefront of conversations around ethical global health engagement, often helping to define standards in the field, Child Family Health International, (CFHI) as a non-profit “NGO,” has sometimes been perceived by faculty and academic institutions as inferior to colleges and universities.  This type of thinking has pervaded universities and has led to derogatory labels such as “ivory towers.” After more than 25 years, alas, I am happy to report an increasing recognition that CFHI’s rigor, evidence-based educational programs, and operationalization of best practices in Global Health education and partnerships deserve the admiration and respect of academia.  The conversations I am having are no longer in a spirit of convincing faculty and institutions of CFHI’s legitimacy, but rather constructive discussions about the how and the why of subtle, yet essential, nuances of quality, ethical, and transformative Global Health Education and Experiential Learning.

CFHI will continue to lead with research, constructive dialogue, and standard-setting programs. We will do so because this risk of fabrication of complex realities and global health contexts worldwide is a driving force behind our work. Gratefully, CFHI, a collaboration of community and academic-based educators from 10 countries partnering with universities to provide Global Health Education, is receiving well-deserved esteem from academia.  CFHI looks forward to continuing to strengthen our partnerships with universities to teach Global Health through mutually respectful collaborations and partnerships.

How to Engage Men to Advance Change

“Finally, we can all be ourselves”

Peter Piot, the Director of the London School of Hygiene and Tropical Medicine, echoes these words to a Stanford University conference room consisting of 390 women and 20 men, all eager to absorb this simple, yet powerful, statement.

At the Women’s Leadership in Global Health Conference, the How to Engage Men to Advance Change panel addresses what many of us, as women, have grown to understand so well: an imbalance in power dynamics does not solely alienate women and minorities, but a lack of equity truly ostracizes and limits society as a whole. Creating equal opportunities for all genders sets the stage for a world of freedom, empowerment, gender fluidity, and empathy. It provides a world where men can express emotions as humans, rather than adhering to stringent and limiting stereotypes.

Equity presents a world where a woman can confidently write her name on a grant proposal for research funding. Currently, a woman’s name on a research grant decreases her chances of obtaining the grant by a striking 50 percent.

Contrastingly, Dr. Piot’s university ranks best in the UK for women obtaining research grants. At the London School of Hygiene and Tropical Medicine, women are actually succeeding their male colleagues in receiving grants.

What makes this university different?

Dr. Piot posits that the UK recently appointed its first female Chief Medical Officer, Dame Sally, also the founder of the National Institute of Health Research. Sally advised that all universities that wish to benefit from research funding need to show that they fully embody gender equity by 2020.

While this created panic in the country, it also enacted prompt change, which serves as an effective example of top down approaches benefiting gender equity within a short time frame.

Gary Darmstadt, Associate Dean for Maternal and Child Health at Stanford University School of Medicine, echoes Piot’s words, reflecting that men are already “giving up a lot” in a world without gender equity. By leveling opportunities for women, it provides avenues for healthy relationships, wholesome family dynamics, and more women leaders. Dr. Darmstadt reiterates that, rather than a “zero sum game,” imbalance in power itself is a loss. We have a lot to gain through women’s leadership.

How do we get there?

Steve Davis, President and CEO of PATH, believes that we need to stop taking the “easy way out” by letting comments, actions, or marginalizing words slide without correction.

Among what we read, the media, what we are exposed to, music, and the realities of day to day life, the fundamental issue is that men and women alike, don’t “call it soon enough when people cross the line.”

Taking action on a day to day basis, without underestimating transgenerational impact, will lead to a society that is mindful, intentional, and empathetic. It will create a world where all genders are valued based on the same principles.

Most importantly, it will give all people, men and women alike, the freedom to finally be their true, authentic selves.

The Power of Community, Connection and Communication

We love hearing from CFHI Almuni about how their global health immersion experience impacted them as health providers.  This month we’re sharing the reflections of Magdalene Kuznia. Maggie   participated in the Tropical Medicine & Community-Based Care on the Coast of Mexico program in Puerto Escondido.  She’s currently a clinical nurse at Stanford University, and a graduate of the University of Michigan School of Nursing.

As a nursing student I had the opportunity to travel to Puerto Escondido with CFHI. I was looking to broaden my nursing education experience. Faculty at my school recommended that I spend a summer working with CFHI so that I can better understand community health in nursing and improve my Spanish. The other CFHI scholars on my program were two physician-assistant students, and one student applying to medical school. It was fun for me to work with other pre-health students, especially ones that were going into different fields in medicine. We each had varying levels of Spanish and knowledge of medicine, so we were all able to learn from each other.

The first few weeks we rotated at different primary care clinics or “Centros de Salud.” I was in a nearby clinic that usually had two doctors and two nurses. The nurses would triage the patients, and then the doctor would see about 10 to 20 patients for about 20 to 30 minutes. The nurses there had autonomy to decide which patients saw the doctor that day, which streamlined the process for the doctor. I loved watching how the healthcare providers interacted with their patients. Appointment time was crucial, since most patients only came in to see the doctor when something was wrong. The doctor had minimal time to provide teaching on the ailment and healthier lifestyle practices. The nurses were able to compliment the doctors sick-care with wellness counseling.

My last few weeks my colleagues and I were together in the hospital. I think some of my favorite experiences were in the labor and delivery unit. The people of Puerto Escondido do not celebrate birth in the hospital like Americans do – the unit had about 10 beds all in one line with each other. The nurses’ station faced the beds, and the doctor would come by and assess down the line which patient was ready to give birth next. There were no men allowed, and the only private room was where the patient was transported to for the actual labor part. The mother hoisted herself on the delivery table, and hoisted herself off when the baby arrived. None of the healthcare workers celebrated outwardly when a baby was born; the mother later received her baby and went on with her day. However, one man was so excited to have his first child, he snuck on to the unit to visit his wife and baby. The new parents were so excited and burst into tears of joy. The nurses allowed them to have their time together and then promptly shooed the man away to give the other patients their privacy. Their touch of excitement broke up the hustle and bustle of the day.

In nursing school, we discussed often the importance communicating on the same level as our patients. While we are educated in medical terminology, many people are not. As nurses, it is our focus to translate the medical language and apply it to our patients’ world. Puerto made this layer an important challenge for me. My Spanish skills were put to the test as I did my best to understand the common language of the people and the medical language of the health care practitioners. My Spanish going into the trip was purely conversational at best. My first weeks in Puerto I was able to physically see the affects of the disease or trauma on the patient, but later I became much better at listening to how the ailment affected the patient personally. CFHI offered us medical Spanish classes in the afternoons, which helped us piece together some of the issues we saw in the clinic or hospital earlier that day. I definitely saw an improvement in my Spanish-speaking skills by the end of the trip.

To this day, I still dream of the food that I ate and the beaches I ventured. Additionally, my time in Puerto ensured how I much loved taking care of different populations. It was a challenge taking care of people with a different language than myself. As a nurse today, I am constantly humbled by what I have to learn from others, and I am so happy my time in Puerto helped open me up to what the world can teach us.

Thoughts on Experiences in Global Health: Synthesizing perspectives from students, the literature, and global communities

CFHI is honored to receive interns from around the world at our offices in San Francisco. This summer we have the pleasure of welcoming Alessandra Khodaverdi from the University of San Francisco. Alessandra is a Master of Public Health student who is deeply passionate about traveling and ensuring global health equity. During and after her internship, she hopes to integrate CHFI’s guiding principles of sustainability, humility, and reciprocity into her own work on community and global health disparities to build a better future for all.

Greetings! I am Alessandra Khodaverdi, an MPH student from the University of San Francisco. I am currently in my final program semester, and am finishing my current capstone project on health equity and access from the lens of undocumented migrant workers in host countries. Recently, I participated in an internship through the United Nations-mandated University of Peace in Costa Rica. This short-term experience in global health (STEGH) made such a profound impact on my life not only as a student, but also sharpened my public health lens as a professional. The first-hand knowledge and education about the integrative aspects of culture, human rights, environment, and sustainable health practices are immeasurable, and I will carry them with me forever.

Benefits and Drawbacks of Short-Term Experiences in Global Health

While high-income countries (HIC) student trainees are embarking on global health experiences in low-and middle-income countries (LMIC) in growing numbers, the perceived benefits and disadvantages for host communities are not well captured. An obvious interest and increased demand for global health education has directly expanded educational programs and STEGHs. However, despite positive intent to gain knowledge and make an impact in developing communities, such STEGHs may actually exacerbate global health inequities. In the absence of clear definitions, standards, impact data, and appropriate conducts, STEGHs may represent a suboptimal use of time and resources, harm the host community, and even perpetuate global health inequities” [4]. Frequently, an array of ethical issues arise when trainees volunteer or are asked to perform tasks beyond their scope of training. Other factors such as  false advertisement by unreliable volunteerism programs, vague admissions criteria, and lack of program and student oversight contribute to an unethical nightmare. This is a particular problem when HIC trainees travel to under-resourced communities where patients are completely unaware that these pre-health students are not actual health professionals, despite the trappings of white coats and scrubs.

A plethora of studies have well-exemplified and highlighted the various benefits of STEGHs for student trainees. Such benefits include increases in skills and confidence, better understanding of the social determinants of health, and dedication to underserved communities back home. As supplemental studies into the underrepresented LMIC voices are desperately needed, a recent CFHI study conducted in La Paz, Bolivia and New Delhi, India revealed important insights into the perspective of LMIC host community members with regards to STEGHs. Benefits for hosts included improvements in job satisfaction, rise in local prestige of physicians and their practices, resource enhancement, and opportunities for global connectedness, leadership skills, and improved local networks and leadership development. Adversely, reported drawbacks for hosting HIC trainees were the perceived hesitancy and apathy of student trainees, unfulfilled promises, lack of cultural sensitivity and equal opportunity. Additionally, the costs of host undertakings continue to go unrecognized despite best practices outlined the Working Group on Ethics Guidelines for Global Health Training (WEIGHT). These WEIGHT guidelines outline and advise the importance of recognizing the true costs in terms of labor, time, and resources for host communities in educational student immersions. [2]

CFHI: Ensuring Reciprocity and Sustainability through Asset-Based Community Engagement and Development

CFHI was designed to prioritize strength-based partnerships, sustainable reciprocal benefits, and clear recognition of costs incurred by host communities. Being that reciprocity and sustainability are central to CFHI’s organizational approach, programs and reciprocal investments in host communities center on the asset-based community engagement/development approach.

With this model, the outsider supports community empowerment by enabling local asset mapping, organizing assets around a mutual agenda, and building consensus toward a shared development goal. The emphasis for support is placed on a community’s existing strengths and potential as the building blocks for success, rather than rewriting the entire script.

As CFHI’s motto is “Let the World Change You,” the organization highlights students as learners, rather than agents of change—as it is imperative that trainees must first understand culture, reality, and context before initiating change. As a future public health professional, these concepts of health equity and sustainability are immensely important, especially in my past work with undocumented women and migrant workers, and future endeavors with vulnerable populations. The most important point I have taken away from both internships so far is the importance of respect —especially for host marginalized communities that invite us to learn. When a mutual respect and cultural understanding is established, it paves the way for open communication, positive leadership, and a true appreciation for the complex challenges and solutions in global health.

Sources:

[1]  Cherniak, W., Latham, E., Astle, B., Anguyo, G., Beaunoir, T., Buenaventura, J.H., DeCamp, M., Diaz, K., Eichbaum, Q., Hedimbi, M., Myser, C., Nwobu, C., Standish, K., & Evert, J. (2017) Host perspectives on short-term experiences in global health: a survey. The Lancet Global Health, 5(9). DOI: http://dx.doi.org/10.1016/S2214-109X(17)30116-X

[2] Evert, J. (2015) Teaching corner: child family health international: the ethics of asset-based global health education programs. Journal of Bioethical Inquiry, 12(1), p. 63-67. DOI:10.1007/s11673-014-9600-x

[3] Kung, T.H., Richardson, E.T., Mabud, T.S., Heaney, C.A., Jones, E., & Evert, J. (2016). Host community perspectives on trainees participating in short-term experiences in global health. (2016). Medical Education, 50, p. 1122-1130. DOI: 10.1111/medu.13106

[4] Melby, M. K., Loh, L.C., Evert, J., Praterm C., Lin, H., & Khan, O.A. (2016). Beyond medical “missions” to impact-driven short-term experiences in global health: ethical principles to optimize community benefit and learner experience. Academic Medicine, 91(5). DOI:10.1097/ACM.0000000000001009

Global Health Reflections with CFHI Alum Meghan Brombach

One of the best ways to get to know CFHI is through the experiences of the students who attend our programs. Here you can find a story from Meghan Brombach, a 3rd/4th year med student from the AT Still University of Health Sciences – Chicago School of Osteopathic Medicine.

Meghan joined CFHI in Bolivia for a 4-week program in order to grow her experience of global medicine and to understand how to prevent and treat infectious disease pathology not common in North America. She was one of the CFHI AMSA Global Health Scholarship recipients.  This award is presented three times annually to outstanding students from the American Medical Student Association who are attending a CFHI program.  I recently had a conversation with Meghan about her time with CFHI and some of her reflections on her journey:

In her blog, available at https://medicinainlapazbolivia.wordpress.com/, she sums up her experience:

“I have seen extreme pain and poverty in this place. I have had days where I didn’t know what to do with what I saw but I have also had days where the beauty has overcome it and I 
have found peace in just being where I am. Within the present moment, devoid of judgement for yourself and others is truly where I believe the most fulfilling life exists and where we learn and grow most. That is also where inspiration exists to see the light and keep pushing through the overwhelming need that exists in the underserved (which is the majority) of our world. I really can’t put into words what this time in Bolivia has taught me, nor how much I have been affected by the kindness and vibrant culture I have experienced here. I leave Bolivia with a deep gratitude for all of the teachers and generous souls who have opened their hearts so widely and shared with me their Andean world.”

A CFHI Reflection for World Refugee Day

CFHI is honored to receive interns from around the world at our offices in San Francisco. This summer we have the pleasure of welcoming Amani Ruiz from Rice University. Amani is passionate about understanding health disparities and exploring how CFHI’s programs can help bring awareness to the social and environmental determinants of health globally. In recognition of World Refugee Day, Amani has written a piece highlighting the important work taking place on her campus focused on the staggering 65.6 million displaced people in the world today.

Hi everyone! I’m Amani Ramiz, a CFHI intern from Rice University.

Since Congress passed the Refugee Act of 1980, America has accepted over 3 million refugees.

For World Refugee Day, I wanted to focus on a project showcased at Rice’s Moody Center of Arts earlier this year: Olafur Eliasson’s “Green Light— An artistic workshop” and a brief history of Houston’s refugee involvement.

Olafur Eliasson’s “Green Light— An artistic workshop”

In this exhibit, local refugees and migrants from various countries, including Afghanistan, Iraq, Iran, Syria, and Cuba, united to build “Green Light” lamps from recyclable and sustainable materials. Rice University was chosen as the first location for this workshop in America, which has now expanded internationally to other countries. The workshops are site-specific, helping refugees transition to their new community.


Pictures 1&2: The green lights are sold as individual units, but can be stacked to form larger shapes.

Green light serves as a metaphorical representation of hope and purpose for refugees, who are celebrated as survivors rather than victims. According to creator Olafur Eliasson, “there is a very strong tendency to see refugees as resourceless. One of the strategies of the ‘Green light’ project is to promote the idea that refugees are also resourceful; they’re full of potential.” (1) This potential serves as encouragement for refugees as they search for work in their local communities.  Refugees are often seen as victims needing aid rather than self-sustainable. They arrive in a new country where they don’t always speak the language, often resulting in miscommunication. The persistence amidst loss and hardship is rewarded with hopes of a better future for their families and themselves. “Green light” serves a green light for refugees that they are protected now, in a country that will try to help them acclimate and follow their dreams. With multiple refugee services in Houston, refugees are provided with resources to transition smoothly into American life.

This artistic workshop is an immersive experience that goes beyond lamp creation. It includes language courses, seminars on cultural displacement, a film screening of a recent release, and initiatives accustomed for the local community. For example, Rice baseball players taught refugees about the American sport of baseball. Sharing tips and practicing pitches with the players, refugees are integrated into the local community and American life. The “Green light” also gives back to the refugee community, with proceeds benefitting local NGOs dedicated to refugee and migrant assistance. The exhibit is currently in Venice until November (2)

Houston- Refugee Center and Most Diverse City in America

The United States received 71 percent of U.N.-referred refugees between 2010 and 2014. Houston welcomes more refugees than any other city in the country. Houston alone welcomes about 25 of every 1,000 refugees, which is more than most nations. If Greater Houston were a country, it would rank fourth in the world for refugee resettlement (3).

Houston began a refugee resettlement program in the 1970s, resettling 200,000 Vietnamese migrants after the Vietnam War (4).  Since then, Houston has welcomed refugees from more than 40 countries.

With Houston’s sustained efforts for refugee resettlement, Rice University was the perfect location for “Green light” in America. The refugee community comes from diverse backgrounds from different countries, time periods, and struggles. Hence, the refugee resettlement is what makes America great. It produces a blend of culture and traditions, the melting pot that America has always been famous for.

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Sources:

  1. http://news.rice.edu/2017/03/27/olafur-eliassons-green-light-welcomes-refugees-to-houston-and-rices-moody-center-for-the-arts/
  2. http://theartnewspaper.com/news/eliasson-s-green-light-to-welcome-refugees-in-venice-and-houston/
  3. http://www.houstonchronicle.com/local/gray-matters/article/The-refugee-who-welcomes-the-refugees-6468958.php?t=5f776781bd438d9cbb&cmpid=email-premium
  4. http://www.sbnation.com/2017/2/1/14473536/super-bowl-2017-houston-refugees-trump-travel-ban

Mabuhay: The Philippines During National Women’s Month

by Ally English
Program Manager, Africa and Asia

Mubuhay!  

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

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

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

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

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

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

National Women’s Month

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

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

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

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

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

How does a month celebrating women translate to health?

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

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

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

How do locals celebrate women’s month?

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

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

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

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

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

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

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

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

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

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

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

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

CFHI’s place in the 2030 Agenda

By Lyndsey Brahm
Program Operations Manager

There is a certain energy that is felt walking through the doors of the United Nations (UN) in New York City. It’s inspiring being surrounded by so much diversity, in a place where cultures collide for the common good.

As a long time partner of the United Nations Economic and Social Council (UN ECOSOC), Child Family Health International (CFHI) had the honor of being invited to the 2017 Partnership Forum  to engage in the promotion of opportunities to increase prosperity and sustainable development for all. The forum’s theme was “taking action to improve lives”. CFHI has long been a part of this movement and is recognized for its unique approach to community engagement, prioritizing local empowerment through ownership and recognition of expertise, and utilizing an asset-based approach, which draws attention to strengths within the community rather than weaknesses.

Mrs. Mary Robinson, former President of Ireland and High Commissioner for Human Rights, stressed in her keynote speech that, “we cannot achieve anything without partnership. It simply won’t happen.” In conversation amongst foreign diplomats and UN members, the importance of inclusive, bold and innovative partnerships was discussed in order to strive for resilient infrastructure and to honor the Sustainable Development Goals (SDGs), with special regard to vulnerable countries and a changing climate.

CFHI seeks to bridge the gap between the global north and south through sustainable partnerships that allow for communities to take ownership over their own development and to provide a means for those with great promise to remain within and dedicated to their communities. CFHI’s global health education programs highlight local expertise and encourage program participants to understand and value what it means to be a guest in a community other than their own. This approach has the power to shape future collaboration for the better and instills hope in achieving important global initiatives, such as the SDGs.

Toward Planetary Health

By Anne-Gaëlle Jacquin

What could a phycologist (an algae researcher) possibly do at CFHI? If you type this query into an Internet browser, it will probably ask “Do you mean psychologist?“ The link between global health and algae doesn’t seem obvious at first but there are definitely some common threads, specifically around sustainability.

I am a marine biologist. When I was in grad school, there was a daily barrage of news about the unprecedented scale of environmental and ecological damage  to our planet. While working on my PhD in algal biotechnology, what struck me was how algae had so much potential to help mitigate some of our sustainability challenges. Inspired by this, I founded The Algonauts Project in 2010 to chronicle algae innovations for sustainability. I met with more than 150 specialists, whom I call Algonauts, living in over 17 countries. These Algonauts are scientists, entrepreneurs, NGOs, fishermen, farmers and inventors. They develop applications with algae which help with food production, wastewater treatment, environmentally friendly aquaculture, CO2 offset, biomaterials, new medicines and many more innovations. To help spread their knowledge and enthusiasm about algae, I document these innovations and the stories of the Algonauts at www.algonauts.org.

When Dr. Evert, CFHI’s Executive Director, told me about the concepts of Planetary Health and One Health, I wasn’t familiar with them. In the subsequent weeks, the more I learned about these concepts, the more I found myself jumping with the excitement of a breakthrough!

Over the last few years, a common theme has emerged in sustainability science: to reach universal objectives of sustainability and address the complexities of global problems, there is a clear need for transdisciplinarity approaches and an integration of knowledge from experience and from science. The archetypal convention of separating natural and social science in academia had conducted in an incomplete understanding of nature-society interactions and the integrated dynamics of the ‘Earth system’ as a whole.

And often times, in such transdisciplinary work, weaving a compelling narrative across complex disciplines isn’t always possible.

This is where the concepts of Planetary Health and One Health make so much sense – they offer a powerful bridge between very different disciplines – health of the human population and the health of our environment, including animal health. This emphasis on the human health consequences of the degradation of natural systems throws into sharp relief the urgency and fragility of our current situation, and emphasizes that the health of one can not be examined without examining the other.

The concept of Planetary Health, recently formalized through the launch of a new journal, The Lancet Planetary Health, is defined as the achievement of the highest standard of health, wellbeing and equity worldwide. It encompasses a wide spectrum of disciplines for investigating not only the effects of environmental change on human health but also the human systems (political, economic, social) that govern these effects.

One Health recognizes human, animal and environmental health as interconnected and particularly emphasizes the interdisciplinary collaboration between human and veterinary medicine.

CFHI has long been committed to the promotion of Planetary Health and One Health and the diversity of its nearly 40 programs offer students and faculty the possibility to explore these transdisciplinary and integrated approaches and to acquire an intercultural literacy which is also fundamental for sustainability.

Offerings include the “Community Medicine from Rainforest to Coast” program in Ecuador, where students gain exposure to rural and community medicine in both rural and urban settings, exploring chronic, acute, and infectious and tropical diseases. The program provides anthropological insight into indigenous communities by learning the unique worldview of the Shuar tribe and their uses for traditional medicinal plants combined with spiritual practices. In this program, students will learn from local experts about a wide range of environmental disciplines (botany, animal husbandry, forestry, entomology) and the sociocultural and political aspects of jungle preservation.

In Kabale, Uganda, with CFHI’s “Nutrition, Food Security, & Sustainable Agriculture” program, students learn about veterinary approaches developed in the Rabbit Breeding and Training Center in Kabale, exploring how proper care and hygiene for raising rabbits are the grassroots for integrated economic, social and health improvements. Students also learn about ground-breaking integrated approaches for improving food security and nutrition. From primary care clinic to rural communities, students observe and contribute to the implementation of practical solutions in health, farming and education and the positive impact of these programs on maternal and child health.

You can explore CFHI’s offerings in Planetary and One Health here: CFHI Planetary Heath & One Health Initiative

Looking at sustainability through the lens of global health has been a very enriching experience, opening lots of new prospects. I can foresee algae in some of them and can’t wait to explore them further!
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Anne-Gaëlle is a marine biologist from Plogoff, a village in Brittany at the Western tip of Europe where the ocean is all around! In this end/beginning of the land, there is wilderness, quiet, wonderful lights and powerful storms. Anne is fascinated by nature, the universe and life as a whole, from the complexity of cellular mechanisms to human societies. She obtained her PhD from the University of Western Brittany in France and afterwards she felt the need to look at the bigger picture.  She saw that microalgae and seaweeds are fundamental in ecosystems and could play an even bigger role in the future for sustainability. After her PhD, when the reputation of algae was very negative due to green tides, she started a journey around the world to share the wonders of algae.  Learn more about her project at www.algonauts.org

How the World Changed Me in Argentina

One of the best ways to get to know CFHI is through the experiences of the students who attend our programs.  Below is a story from Southern California student, Daniel Sarkissian.
About Daniel
I am a third year neuroscience major at UCLA. I currently do clinical research at the Neuromodulation Division of the Semel Institute of Neuroscience and Human Behavior and volunteer at the UCLA hospital as a Care Extender. After graduation, I plan to take a gap year, during which I will apply to medical schools across the United States. Going into medicine has always been my life goal, and when my biology professor told me about this program and how I would gain valuable clinical exposure, I knew this was meant for me.
Why he chose CFHI
I chose the Hospital Medicine program in Córdoba, Argentina because I wanted to gain clinical exposure shadowing surgical procedures and to explore the beautiful sight s in Argentina. My experience of volunteering at the emergency room is what made me strive to attend this CFHI program, as I wanted to expand my knowledge of global health, how hospitals are run in other parts of the world, and to enhance my Spanish skills. Southern California has a large population of Spanish speaking people, which is also why I chose to go to Argentina, as I would be forced to get out of my comfort zone and speak Spanish on a daily basis. When I first began volunteering at the emergency room at the local hospital in Glendale, CA, one of my notable experiences was translating Armenian, as that is my native language. Seeing this language barrier is also why I decided to go to Argentina, as I would improve my Spanish skills and have a larger outreach to people who do not speak English. The Spanish lessons, both the one on one and the group session, greatly improved my Spanish communication skills. My experience with the Hospital Medicine program in Córdoba was at the Hospital Pediatrico del Niño Jesus, where I gained experience in general pediatric care, surgical procedure, and radiology. I observed over 30 surgical procedures which taught me more about different disabilities and conditions while learning about human anatomy underlying each procedure. I departed Argentina with improved Spanish skills, a greater understanding of their healthcare system and a greater drive to pursue my medical career in surgery.
Reflection on what’s next
The four weeks I spent in Córdoba were undoubtedly the most enlightening four weeks of my life. The general pediatrics unit taught me where to check with a stethoscope for various conditions. When I was shadowing surgeries, some doctors responded to questions and explained the procedure. After seeing all these surgeries and how big an impact each surgery has on the patients’ lives, it reinforced my ambition to become a surgeon. This experience also drove my lifelong ambition to work with Doctors Without Borders, to further broaden my understanding of other cultures and deliver healthcare to all of those who need it. CFHI gave me the opportunity to fully immerse myself in the surgical field and this experience of learning medicine in a totally different culture is invaluable to my future.

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.

 

Emerging Best Practices for Training Residents in Global Health

By Dr. Jessica Evert
Executive Director, CFHI

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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: http://www.pih.org/blog/dr.-michelle-morse-a-new-mindset-for-global-health-training). 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.

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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!

CFHI Impacts: How Local Communities are Transformed

By Lyndsey Brahm
Program Coordinator

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

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

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

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

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

Midwife Training in Oaxaca, Mexico

Midwife Training in Oaxaca, Mexico

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

Student Spotlight: Ariel

For our newest Student Spotlight we introduce CFHI Alumni Ariel from California. In June this year Ariel chose our program Healthcare Challenges with focus on Hospital & Inpatient Medicine, HIV/AIDS and Global Health Nursing. She went to Cape Town in South Africa for 5 Weeks. A few months after her return, we asked for a short reflection on her adventure:

 

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CFHI Alumni Ariel in South Africa

A little about Ariel:

I am a third year biological sciences major at UC Davis. After graduating from Davis I want to pursue a career in health by becoming a nurse practitioner or PA. Studying abroad was one of the experiences I was most excited for when I came to college. When I heard about an internship abroad opportunity through CFHI it seemed like the perfect fit.

 

Why she chose CFHI:

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I chose CFHI for a number of important reasons to me. First, I wanted to experience living in a new country to really understand the culture and daily lives of another part of the world. I chose Cape Town because the city seemed like such a lively place with so much to do and so much history to learn about regarding Apartheid. The best way to truly get a feeling for another way of life is to immerse yourself in the country’s culture. I had never been to Africa so I was super excited to learn about a new continent and compare the healthcare challenges with the ones we face in the States. Also, volunteering at Community Day Centers and observing procedures at a pediatric hospital in Cape Town were unlike any other opportunities I had had in the past. Through CFHI, I was able to witness healthcare first hand and be a part of a typical day for physicians right in the middle of the action.

What is next for Ariel:

Taking part in a CFHI program opened my eyes to the different fields of medicine and global healthcare. Before I went to Cape Town, I thought I was set on going into nursing. After going through rounds with med students, watching surgeries, and attending lectures and tutorials, the experience influenced me to consider a PA program. Also, it confirmed my inclination that I want to work in pediatrics. I plan on becoming involved with one of the student run clinics at UC Davis to get more experience with patients. If I was given the opportunity after I become licensed, I would definitely work in a hospital in another country for a longer period of time.

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Service Learning and the Strive for Social Justice

by Robin Young
Associate Program Director, Africa and Asia

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As a nonprofit organization offering international health programs to students, is it our job to incorporate social justice into our work?

How can we bring feminist perspectives into our programming?

Does research coming out of “the Academy” in the United States apply to our partners and colleagues in the Global South?

These are the types of questions that were explored at the annual International Association for Research on Service Learning and Community Engagement (IARSLCE) conference, held in New Orleans.

IARSCLE is an international non-profit organization devoted to promoting research and discussion about service-learning and community engagement, aimed to advance understanding of scholarship from international perspectives.

At CFHI we offer service learning components in many of our programs for health students whether it is engaging with an ongoing, locally-led nutrition project in southwestern Uganda, or offering educational trainings to youth in an addiction rehabilitation center in Delhi, India. A lot of what we know about best practices in service-learning come from members of the IARSLCE community.

Mid-wife training in Port Escondido, Oaxaca, Mexico

Mid-wife training in Port Escondido, Oaxaca, Mexico

CFHI has recently played an instrumental role in bringing patient safety (and specifically, service-learning projects in which under-qualified students practice medicine beyond their level of education) into focus within the IARSLCE community, highlighting important tools such as the Global Ambassadors for Patient Safety (GAPS) modules, among others.

This year, CFHI presented a session called “From Research to Practice: Service-Learning in Healthcare Settings,” which allowed us to explore the case for general and program-specific learning competencies; explore the ethics of global health service-learning through the lens of case studies; and climb into best practices that prioritize both patient and student safety in healthcare settings abroad. As is always the case when surrounded by brilliant colleagues, it was an opportunity to share knowledge and resources and continue to think about how CFHI and other program providers can ensure that we are helping students to be prepared for their global health experiences.

Refugees and the Desire for Education

by Caity Jackson
Director of European Engagement

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Unusually hot weather welcomed me to the town where The Beatles famously made their debut. Coincidentally, the theme of the conference was ‘Imagine’, with a strong emphasis of thinking outside of the box and engaging everyone’s imaginative side in relation to European and international education.

But ‘imagining international education’ had a more serious tone this year, with the presence of sessions focusing on refugee education and how to increase inclusivity in all aspects of the recruitment, delivery, and evaluation of the educational process. How are we making international education possible for all?

This year, the EAIE conference held a track focusing on refugee education, in an attempt to address and respond to the refugee crisis in Europe. These 13 events focused on fair admission, recognition of international educational attainments, and how Germany is responding to the influx of refugees through intercultural certifications and integration programs.

Not only being represented through sessions and posters, refugee education wove itself into the opening and closing plenary of the entire conference. Kilian Kleinschmidt began his keynote address with harrowing figures: 1.2 million people have been displaced from their homes over the last year, with the total budget available for all aid, including refugees, natural disaster assistance, etc, worldwide, adding up to approximately US$20 billion. “Compare that to the money spent on real estate development and you understand why aid is the wrong concept. Aid is an arrogant concept of charity”, Killian asserted.

Photo by: Russell Watkins/Department for International Development

Photo by: Russell Watkins/Department for International Development

‘Imagining’ again that education for all is within our grasps, sessions focused on overcoming the barriers international education recruiters/marketers, administrators, and alumni coordinators face when it comes to a mobile population. How can we value our prospective and current students and erase the dollar sign universities associate them with? How can we increase diversity on campus while ensuring students have all the services they need to succeed at their fingertips? In only a few days, participants left with imaginative answers, if not even more questions to guide their work.

Diversity has always been a focus of the work that CFHI has engaged in. We imagine a world in which there are no barriers to the enriching experience cross-cultural learning can give. Our many scholarships aim to address these barriers and we are proud of the breadth of diversity in our scholarship applicants and successful candidates and we are honoured to walk side by side with our partner organizations.

Wrapping up this event that saw over 5000 professionals from over 90 countries gather in the spirit of increased global cooperation, Melissa Fleming of the United Nations High Commissioner for Refugees (UNHCR) told stories of those that our work has not reached. These stories from some of the most dire situations of the world, where the hunger to learn is beyond any of our comprehensions, was the inspirational closing we needed. Melissa began her talk with an account of her experience taking her own daughter through the steps of studying in France. She then told us about Esther, a young refugee whose main aspiration is to become a neurosurgeon. The contrast, in terms of opportunities for these two equally young and motivated women, is evident. If education offers life opportunities, why are we failing to provide this to those who need it most? As Melissa put it: “my daughter’s future is in her hands, Esther’s is in ours.”