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.

By Dr. Jessica Evert
Executive Director, CFHI

As trainees are more and more senior (think resident physicians compared to pre-health undergraduate students), the questions around the content of their global health training, particularly in clinical settings, are more complex. As residents or young faculty we have more clinical skills and expertise, but does that mean we should use international opportunities to focus on clinical care? Is clinical care as a primary focus of global health activities a sustainable endeavor? What happens when we leave and our clinical skills leave with us? As Michelle Morse pointed out in 2014, residents undertaking global health training and service activities requires a new mind-set (read her great commentary: 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.

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!

By Lyndsey Brahm
Program Coordinator

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

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

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

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

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

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

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

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

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

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

Dr. Raj conducting a home visit, Trivandrum Southern India

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

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

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

Ms. Hema and Dr. Raj on home visits

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

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

Many thanks to Eric L. Krakauer and M. R. Rajagopal for drawing attention to this critically important issue that affects millions, and will become increasingly pressing as more of the world’s population lives longer and with a higher  number of non-communicable diseases.
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1. Eric L Krakauer, M R Rajagopal, www.thelancet.com, Vol 388, July 30, 2016, page 444
2. Economist Intelligence Unit. 2015 Quality of Death Index: ranking palliative care across the world. https://www.eiuperspectives.economist.com/healthcare/2015-quality-death-index

(CFHI Student, Madison, Pictured on the left)

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

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

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

by Robin Young
Assistant Director, Africa & Asia

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

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

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

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

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

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

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

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

by Lyndsey Brahm, Program Coordinator

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

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

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

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

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

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

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