Category Archives: CFHI Model

The LGBTQ+ Population in Uganda

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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

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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

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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

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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.

Toward Planetary Health

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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

CFHI Impacts: How Local Communities are Transformed

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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!

Making Sure Global Health Education Doesn’t Perpetuate Disparities

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“Global health education is at a crossroad. The landmark Commission on Education of Health Professionals for the 21st Century highlighted the substantial disparities in health education worldwide and proposed reforms to enable all health professionals to “participate in patient and population-centered health systems as members of locally responsive and globally connected teams”.

This quote was taken from the Lancet article entitled ‘Equitable access for global health internships: insights and strategies at WHO headquarters.’ The Lancet Global Health article highlights the need for broadly accessible global health internships— ones that allow for exposure to community-engaged programs by students from a variety of socioeconomic and professional school backgrounds.  The barriers to access to global health educational opportunities are real and require the global health education community to embrace novel approaches, alliances, and funding mechanisms.

CFHI Ecuador Global Health

CFHI global health interns with local physician in Ecuador.

Child Family Health International– CFHI a leader in global health education programs for over 20 years, is mindful of these barriers. As a nonprofit running global health internships that advocate for ethics and social responsibility, we recognize there are significant costs associated with global health internships and provide fair compensation to local communities and professional mentors that shape the intern experience through their time, energy and expertise. This follows best practice guidelines set out by the Working Group on Ethics Guidelines for Global Health Training (WEIGHT).  However, program fees needed to provide resources for host communities and to support and educate interns can be a barrier to equitable access to reach beyond students from resource-rich backgrounds.

Like the WHO, CFHI utilizes scholarships in an effort to seek out candidates that may have greater financial need, limited opportunity to travel abroad, and those whose are under-represented in our programs. Scholarships and funding initiatives such as these are key to making real strides in south-to-south participation in global health internships and reducing their exclusivity as the domain of the wealthy.  In addition, CFHI provides a crowdfunding platform to make it easier for students to raise funds through friends, family, mentors, and wider social media networks. Crowdfunding is growing, and is a powerful tool that should be considered by WHO and other global health internship providers.

“For sustainable improvements in internship access and improved global health education, academic and professional institutions need to partner with the public sector and foundations, donors, and governments to channel resources to achieve this aim. However, the scale of this task necessitates the involvement of multiple stakeholders. Who else will step up and contribute to a growing movement towards equitable access for training, educational, and networking opportunities in global health? And who should lead this transition and monitor its success?”

The article is ‘right on’ with its call to arms.  If global health education programs and internships to not focus on equity, access and diversity, we risk perpetuating the same power imbalances and disparities that the global health community strives to eliminate. Child Family Health International commends WHO and the Lancet article authors for highlighting this issue and remedying it with action and advocacy.

 

How can we ensure that more students have access to global health and other professional and international internships?  Comment on the Lancet blog or tell CFHI what you think below!

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.

Internationalizing Medical Education: Shaping Healthcare Providers for Global Health

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

Global Health and Study Abroad See Upward Trends

CFHI Uganda Program Photo Woman

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

Looking at Competencies in Medical Education & How Students Engage

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

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

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 Commended in Chronicle for Higher Education Article

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From the Chronicle of Higher Education:

“Over the past decade, the number of American students in health fields going abroad has nearly tripled, with many opting for programs that take them out of the classroom and into clinics and hospitals. But as participation has increased, so, too, have educators’ concerns.

Far too often, experts say, students are providing patient care—conducting examinations, suturing wounds, even delivering babies—for which they have little or no training. Indeed, as competition intensifies for medical-school slots, some students may actually be going overseas for hands-on experience they could not get in the United States, in hopes of giving their applications a competitive edge.”

The article is entitled “Some Global Health Programs Let Students Do Too Much, Too Soon,” and here at Child Family Health International (CFHI) we couldn’t agree more!

CFHI India Student on ProgramCFHI programs are highlighted in the Chronicle article, including quotes and reflections from CFHI’s Executive Director encouraging students to think about ethical implications of their experiences, and shaping student expectations for what is ok to do abroad.

As the field of global health continues to grow, so too are programs and options available to health students of all fields, often promising opportunities to “help” and engage in hands-on experience beyond their training, skill level, or licensure.  From the beginning CFHI has used an asset-based approach for engaging with communities abroad, and encouraging students to “Let the world change YOU.” In this way we position participants of Global Health Education Programs to learn, reflect, and realize that many times the most powerful impact they have in their role abroad is to form connections and relationships with local expert physicians and patients that will serve them in their future careers, as well as learn about the multitude of health determinants and complex global realities that underlie global health challenges.  We’d like to extend a big thank you to the Chronicle of Higher Education for helping us spread the word and advocate for social responsibility in health and medical education.

What do you think should be students’ role in health settings abroad?  How can students balance enthusiasm for learning while respecting ethical boundaries in clinical settings?  Let us know your thoughts in the comments section below.

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

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A Doctor Walks Into a Community..

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

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

Two Approaches to Global Health aamcacademicmed

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

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

Humility and Knowledge Key

CFHI Student with Local Doctor, India

CFHI Student with Local Doctor, India

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

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.

Exploring the “Family” in Child Family Health International

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You may have heard people refer to CFHI and those involved in the organization as part of a global family.  Our ‘family’ is made up of wonderful volunteers, health care providers, devoted  staff (stateside and abroad), as well as the fastest growing part of our family– more than 7,000 CFHI alumni and counting!India-Hands  We have been growing our family and projects for over 20 years.

CFHI is not only a global family, but we serve families.  Two projects that come to mind when I think about how our work affects families are projects that target the long-distance trucking industry in India and the illegal sex workers that support this industry.

In India, young men, and boys barely out of school, travel the highway system connecting the most distant corners.  The work is hard, the hours long, and the travel dangerous on the over-crowded highways connecting coast to coast.  While away from home for 2-6 months at a time, many truck drivers engage in sexual activities with prostitutes.  Two National Aids Control Organization (NACO)-based foundations that target this population are the Society for the Promotion of Youth and Masses (SPYM) and SWACH (Survival for Women and Children Foundation).

Actors performing skit on STD awareness at truck stop in New Delhi, India.

Actors performing skit on STD awareness at truck stop in New Delhi, India.

Both do amazing outreach and fieldwork with peer educators, some once truckers themselves. They captivate the young audience by performing skits (see photo, right), playing card games, leading monthly health camps, and offering the men free hair cuts and shaves while they talk about safe sex.  SWATCH peer educators target the high-risk female sex workers~ often widowed women (some still in their teens) who have been forced into sex work to support their children. Their main activities include teaching why condom use is important, the importance of regular HIV testing and resources are available if they test HIV positive.  They even teach the woman how to put on a condom on men in the dark by demonstrating how to put a condom on a model blind-folded!  Challenges ahead include rehabilitation training for the sex workers.

The family in Child Family Health International is both our global family of staff and local health care providers that make CFHI Global Health Education Programs the amazing experiences they are, and the network of folks, our alumni, who have been touched by CFHI’s transformative programs, as well as the families served by CFHI programs and reinvestment in host communities.

 

Social Justice: Embracing Global Health Complexities

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Internationalizing Medical & Health Education

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

Importance of Social Justice in Health Evolving

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

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

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

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

Student Essays Reflect Realities and Impact of Global Health

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

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

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

The Power of IFMSA & The Global Health Placebo Effect

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

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

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

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

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

CFHI Global Health Approach Shared & Praised at IFMSA

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

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

 The ‘Global Health Placebo Effect’

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

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

International Women’s Day- A Story From CFHI India

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alwar2Evaleen Jones, MD is the founder of Child Family Health International (CFHI) and Clinical Faculty at the Stanford University School of Medicine.  Today, on International Women’s Day we feature an experience from her recent visit to CFHI partner sites in India, and a story from a woman she met while there.  Her story  carries the message of community empowerment that CFHI embodies.

January 31.  Today we visited Continue reading →

CFHI: Asset-Based Community Engagement

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

What Makes CFHI Different?

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

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

Not Just Talking the Talk, But Walking the Walk

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