Author Archives: Guest Blogger

Applying Competency-Based Education to Global Health Electives

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For those who have participated in a service-learning trip abroad, you understand how life changing it can be. Visiting and learning from a community and culture different from your own can affect you in deep and meaningful ways. But programs and experiences vary widely. Some may claim opportunities for personal and professional growth, yet transparency and best practices are not always the reality on the ground. Also undermining quality, few programs provide true long-term benefits to the host community. One way that medical service-learning trips, or global health electives, can ensure quality is by applying a competency-based framework.alwar2

What is competency-based education?

Competency-based education (CBE) is not new, but the concept is receiving renewed attention in many fields, including global health and medical education. One distinguishing feature of CBE is that it begins with the end in mind. This means that the first priority when creating a competency-based curriculum is identifying the desired characteristics and qualities of a competent graduate. Once these characteristics are defined, they are broken down into building blocks, called competencies, which students master as they move through the curriculum. Unlike traditional education, competencies do not have to be course-specific or based on a specific number of course hours; instead, they integrate everything that the student is learning at a given time and build upon each other throughout their schooling. The amount of time required to master the knowledge, skills, and attitudes necessary to achieve each competency may vary, but competence must be demonstrated before students are able to progress in the curriculum.

The beauty of CBE is that it is fluid and flexible, promoting critical application of the course material with a focus on what students should be able to do, as opposed to a singular emphasis on knowledge. The ability of CBE to produce graduates who are competent professionals has made the approach increasingly popular among various health fields. In fact, The Association of Schools and Programs of Public Health (ASPPH), the Accreditation Council for Graduate Medical Education (ACGME), and the Canadian Medical Education Directives for Specialists (CanMEDS) have all developed core competencies for their programs.

 Competency-based education in global health:

CFHI Students with Local Physician

CFHI Students with Local Physician

Over the past decade interest in global health has surged. Many health professions have integrated global health into their curriculum by applying a competency-based framework. The ASPPH created a Global Health Competency Model that builds on their established core competencies and the Joint US/Canadian Committee on Global Health Core Competencies established a set of six competencies for medical graduates. Even as competencies for global health education become more prevalent, little attention is being paid to global health electives (GHEs). This is puzzling considering GHEs are the primary way students gain experience in global health and in 2013, 30.2% of graduating medical students participated in a GHE.

It is easy to understand why GHEs are increasing in popularity. GHEs provide benefits to students, improving cultural competence, strengthen clinical skills, and increased appreciation for prevention and providing care to the underserved. However, opportunities for growth are not always guaranteed as they are based entirely on program quality. Unfortunately, little effort has gone into determining the structure and educational objectives for GHEs. One way to ensure GHEs meet the needs of students and host communities is to apply a competency-based framework built around the health needs of the host community. Even though most GHEs take place in low and middle-income countries (LMICs), current global health competencies are primarily developed by professionals from high-income countries and little research has explored the effects of GHEs on local communities. In order to develop positive, reciprocal relationships with host communities, colleagues in LMICs need to be engaged in conversation to identify local health priorities and relevant competencies to address them. Students thinking about participating in a GHE can promote responsible global health education by choosing a program or organization, such as Child Family Health International, that has strong international partnerships and is dedicated to protecting the interests of host communities.

Bottom Line

Global health electives that promote cross-cultural partnerships and emphasize competencies addressing the health needs of the local community can provide incredible opportunities for personal and professional growth, while simultaneously offering benefits to the host community.

 

Special thanks to CFHI Intern, Emily December Latham, for authoring this blog.

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

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Advising Students on Health Experiences Abroad

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

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

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

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

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

CFHI Advising Health Students

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

 

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

Travel vs. Transformation: Career Impacts

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Travel and Cultural Intelligence

“Where are you from?” is often the hardest question for me to answer. Do I give the short answer, the long answer, or settle for “it’s complicated” like a provocative Facebook relationship status? Yet that dilemma is a small price to pay for all I’ve gained through experiences living and traveling around the world.

A study from the journal of Social Psychological & Personality Science found that those who engage in multicultural and international environments are more likely to be offered jobs. At surface value, this comes as no surprise; in any arena these days—school, job, socially, or otherwise—it is beneficial to set yourself apart, and “multicultural experiences,” are a great way to do so. But simply accumulating stamps in your passport is not enough. In an article on the study, David Livermore writes “If business travelers spend their time at international hotels and offices; and if study abroad students spend their free time on Skype and Facebook, travel may have little positive benefit for improving CQ (cultural intelligence) and career opportunities.”  Travel creates a possibility for transformation through exposure to new cultures and ways of life. But it is easy to pass up that opportunity and flock toward familiarity instead, to head to a Starbucks in a foreign country or find solace from strange surroundings amongst fellow visitors.

The Transformation: How You Engage

Transformative travel requires openness. As more and more and more people seek programmed multicultural experiences— study abroad, volunteering, or simply sightseeing—it is important to evaluate your own goals and the goals of the organization. Responsible international travel necessitates embracing the discomfort and challenges of unfamiliarity, and also willingness to let go of your own authority: to follow the leadership of the locals and see the positive aspects of a community rather than perceived negatives.  To me, the most striking overseas experiences have involved connecting with people through common humanness despite apparent differences. These experiences, not traveling itself, are transformative.CFHIMapWhite

I was drawn to work with Child Family Health International (CFHI) because their global health programs promote an immersive experience through community-based projects and perspectives. Interning here and learning about CFHI programs over the past month has made me reflect on my own international experiences. I was born in the U.S. but since age nine I have lived abroad in different countries with my family. Though I have spent much of my life overseas, some who go abroad for shorter periods of time have had more intensive and challenging cultural experiences than mine. It can be easy to entrench yourself in an expat community and become complacent about pushing beyond that.

The study suggests benefits of international travel for your career; I don’t see my experiences overseas as having made me marketable, though I can’t complain if that is a byproduct. Rather, I see travel as the defining aspect of my life that has provided more unique challenges and rewards than anything else. CFHI’s motto encourages students to “Let the world change you,” instead of trying to change the world. It has and will continue to change me throughout my life. And maybe even get me some jobs too.

 

Special thanks to our guest blogger and CFHI Summer Intern Karoline Walter for authoring this post.

Global Health Uncensored: Notes from Western Regional International Health Conference

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

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

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

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

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

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

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

 

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

Beyond International Women’s Day

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Women’s Empowerment Beyond International Women’s Day

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

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

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

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

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

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

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

 

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

Truth in the Spoof: Medical Voluntourism in The Onion

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Truth in the Spoof: An expose of voluntourism in The Onion.

By: Aditi Joshi, MD

Newsflash!  This week’s headlines report a new humanitarian organization ‘Doctors Without Licenses’ will start providing substandard care by putting together a group of “decertified physicians, pre-medical undergraduates, and ‘people just interested in the human body’.” The organization states it will be sending their staff to conflict zones and underserved areas to incorrectly provide medical care.

Image from The Onion satirical article

This news was reported in The Onion, a satirical weekly publication, so it is, of course, facetious. The sad truth is that it refers to a very real phenomenon.

Voluntourism and Medical Voluntourism – Repercussions

Searching ‘voluntourism’ on Google, one finds a number of hits for organizations that set up volunteer opportunities for well-meaning individuals to work in underserved communities. Medical voluntourism refers to doing medical care within these communities; these volunteers can be physicians, nurses, residents, medical students and a growing number of organizations offer hands-on opportunities for pre-medical students, as well. More and more research as well as anecdotal reports state that these short term volunteer trips do more harm than good to the local community.  (If you’re interested in a great contrast between voluntourism and global health—this article is a must read. The volunteers may be providing direct patient care, giving medications, and doing procedures. In cases where the volunteer has no formal training, and would not be allowed to do the same in their home countries, this type of care is unethical whether or not the results are disastrous.  Even for those who are trained and skilled, the lack of knowledge of local infrastructure, drug formularies, culture, language and historical frameworks can actually lead ‘good’ actions to having negative consequences.

Solutions and Social Responsibility

Proposed solutions vary as the scope of the problem is large and not fully realized. However, organizations such as Child Family Health International – CFHI, try to decrease harm by giving students the opportunity to immerse within the culture, focus on broad global health competencies, observe native health care providers who are dedicated to their communities long-term health. This prevents the student from being a short-term ‘band-aid’ health worker or trying to get patient care experience that they are not licensed to undertake. The students are able to understand health concerns in other countries while minimizing possible harmful outcomes.

Voluntourism is most likely here to stay, however the importance of finding ways to reduce harm while giving the local community the help it requires is an ongoing challenge.

 

Thanks to our guest blogger, Aditi Joshi MD, ER Physician and Former President IFMSA-USA for authoring this post.

CFHI Salutes Medical Director Dr. Raj on World Social Justice Day

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February 20th is World Social Justice Day. We would like to take this day to highlight one of our partners who has been working to achieve social justice. Dr. Rajagopal has been helping to reform the Hospice and Palliative Care laws in India through his organization, Pallium India.Through both personal visits to patients, and by building a strong system of doctors across the nation, Dr. Rajagopal has highly improved the state of Palliative and Hospice Care in India. Access to Morphine and Pain Killers is an enormous problem in India because of previous problems with morphine addictions. India has the highest amount of victims for mouth cancer, and it is estimated that less than 3% of cancer patients get proper pain relief. (1)

Dr. Raj conducting a home visit, Trivandrum Southern India

Dr. Raj conducting a home visit, Trivandrum Southern India

Fortunately, laws in India have been changed. Now, a policy has been set so that in Kerala, doctors with at least 6 weeks of training, such as Dr. Rajagopal, can prescribe morphine for palliative care. (2) The rule was introduced in June 1998 in Trivandrum, the capital city of the state of Kerala. Since then, the central government has recommended this new rule to all the states in India. The idea of easier access to morphine and other pain relieving drugs was initially recommended by organizations and committees such as WHO Collaborating Center for Policy and Communications in Cancer Care (Wisconsin, USA). The Center is currently attempting to simplify complicated state narcotic regulations to further improve the availability of opioid analgesics.

Through his organization, Pallium India, Dr. Rajagopal strives to provide Palliative and Hospice care to those that need it. Not only does Pallium India provide medical care to patients, but the organization also provides resources such as food and sewing machines to the patient’s family to help them get back on their feet. CFHI has partnered with Dr. Rajagopal to launch the Palliative Care In Southern India Program in Trivandrum, India that centers around Hospice and Palliative care. The CFHI participants involved in the program are given the opportunity to visit the patients and experience first hand how patients are treated and managed. Pallium India and CFHI have worked together to reform India’s Hospice and Palliative Care system.

(1), (2) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573467/

 

-Special thanks to guest bloggers Alexandria Tso and Nayanika Kapoor for contributing this article.

CFHI Voices: One Northwestern Med Student’s Summer in the Himalayas

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In July of this year five students from Northwestern University’s Feinberg School of Medicine traveled to rural India as part of a unique global health program organized by Child Family Health International – CFHI, the second trip organized through their unique partnership.  Funded by Northwestern’s  Center for Global Health we set out to learn about public health, increase our cultural competency, and develop clinical skills by participating in a four-week clinical shadowing experience across Northwest India. We rotated in different settings, from tiny villages like Patti tucked away in the foothills of the Himalayas to the bustling city of Dehradun, in both public and private healthcare sectors.  During our time in the clinics, on the wards, and in the field we witnessed healthcare disparities as they are manifested between rural and urban regions, between private and public sectors, and between different socioeconomic groups. We were able to see, for cultural and economic reasons, how differently medicine is delivered half a world away.DSC_0918

That month spent in India was an unforgettable and magnificent experience: the medicine we witnessed, the physicians and nurses we worked with, and the patients we got to interact with brought the kind of perspective to my medical education that only an actual, immersive experience that being abroad could bring. We didn’t stay in hostels or hotels – we lived with Indian families in their homes or in dormitories within the hospitals.

Nothing can beat that kind of immersion; nothing can beat waking up in a tiny mountain village everyday at 5:30AM with my fellow travelers to do yoga, or getting woken up in the hospital by a nurse to aid in a delivery or assist in the emergency department. We explored palaces and temples, hiked through jungles, and sampled the multitude of sights and smells, the cacophony of sounds, and the delicious and exotic foods.  India brought piece and calm to my mind and body, it gave me perspective on the doctor/patient relationship, and reminded me what medicine is really about – one component of the greater endeavor to help ameliorate human suffering in the world.

India left a lasting impression – one that no doubt will shape my medical career, but also my personal life. It left me wanting to return to the more disenfranchised parts of the world to practice medicine, it left me a with a firmer perspective and appreciation of my own upbringing, and it left me with fond memories of a country I would dearly love to visit and explore again in the future.

Jason Chodakowski

Northwestern University Feinberg School of Medicine

MD Candidate – Class of 2016

How it All Began: The Early Days of CFHI

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The Early Days of CFHI Featured at San Francisco Film Festivalfilmfest

This past July the documentary film “The Most Distant Places” was featured amongst others at the Bay Area Global Health Film Festival. This story, directed by Mike Seely, is depicted from the perspective of Ecuadorian doctor Dr. Edgar Rodas, then a medical school Dean in Cuenca, Ecuador. The film chronicled the importance of constructing a mobile surgical clinic and the team involved in bringing mobile care to remote communities in Ecuador.

The film festival was organized to shed light on a critical message in need of a strong voice: access to the most basic surgical care is a human right, not a luxury. Dr. Rodas shared his story and expressed an unwavering commitment to his fellow Ecuadorians. As the film came to an end and the audience allowed the weight of the story to settle, he delicately reminded everyone that every effort produces a result. These efforts would eventually result in CFHI- Child Family Health International as we know it today.

A Chance Meeting

A young Evaleen Jones, in Ecuador.

A young Evaleen Jones (right), in Ecuador.

As I sat across the table from Dr. Evaleen Jones, CFHI’s Founder and President, I marveled that even after twenty-one years, she tells the story of CFHI’s beginning with energy and excitement. She reminisced about her time in Ecuador as a third year medical student at Stanford University School of Medicine. At the time, Stanford University did not readily offer International Health opportunities abroad with a student focus. To best serve patients living in densely populated Latino communities within the Bay Area, Evaleen knew that Spanish language and cultural competencies were essential. And so, with only a modest amount of money she embarked on her first adventure abroad.

Once in Ecuador, Evaleen’s efforts to connect with local physicians led her to Dr. Edgar Rodas, the doctor who would be featured in the Distant Places film many years later.  She came to know him as a simple man who exuded a deep-seeded commitment to the well-being of his fellow countrymen.  As a surgeon he rejected the notion that a person cannot have an operation simply because they don’t have enough money. Regardless of the enormity of such an undertaking, he felt the status quo would not suffice.

As chronicled in the film, Dr. Rodas’ goal was to build a mobile surgical clinic. Evaleen, sensing the strength of his presence and understanding the value of his quest, jumped in headfirst and agreed to return to the States to arrange funding for construction of the mobile clinic.  According to Evaleen, “There are some people who you can sense very quickly are special individuals.” Even after only a week of knowing Dr. Rodas, she allowed her instincts to propel her forward.

CFHI Begins

The start of her fourth year in medical school Evaleen hit the ground running. Every conceivable connection was utilized- donations of all kinds– designing and constructing a surgical clinic, shipping the mobile unit. Evaleen’s fearlessness in asking gave her the edge that ultimately convinced others to help. Each someone told her “absolutely not Evaleen, this is impossible,” it motivated her to continue.

It was during this time that CFHI came to life. Approaching potential small-logo2_pngdonors as a recognized NGO lead to greater success. Evaleen had also not lost sight of her original intentions: CFHI was to be a platform to provide medical students (and later students of varying fields interested in health) with learning opportunities abroad, and to increase language and cultural competencies. Dr. Jones states again and again that the world is a classroom and students should pay for the privilege of learning.  Uniquely CFHI, she also saw that students could be a sustainable source of support for locally-run health care efforts that don’t breed reliance on Western ‘aid.’ While placed in the global classroom, students are encouraged to open their minds and listen well, and let the world change them. Even with the passing of time, Dr. Rodas and Dr. Evaleen Jones remain faithful to their belief that, “It has always been about the people, not the projects.”

 

–Lyndsey Brahm

Special thanks to CFHI alumna and volunteer Lyndsey Brahm for her work on this post.  Lyndsey will be attending the University of Copenhagen, School of Global Health in 2014.

Have some ideas and interested in blogging for CFHI?  Email info(at)cfhi.org for details.