Category Archives: Cultural Humility

Cultural competency or a cultural awareness and sensitivity

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

Oxford Handbook on Neuroethics

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

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

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

Read the full CFHI Press Relase and Chapter.

Empowerment Means Having a Voice

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Voices of empowerment from women in rural Northern India

About an hour outside of the north Indian city of Dehradun, the terrain starts to change as you begin to enter the foothills of the Himalayas. Paved streets give way to winding dirt roads, some seemingly carved into the incline of the mountain like the etches of a screw and only wide enough for one vehicle. Luckily almost no one in this area has a car, so we are usually sharing the road only with the monkeys and the goats. On this particular trip, the monsoons have not yet released India from their grip and our vehicle struggles on the loose dirt and gravel as the torrents of rain pour down. Oddly enough, here, about as far away from an urban setting as you can get, I’m reminded of a car wash because the sheets of rain are hitting the car so hard that you can feel their force on the hood of the vehicle like the power washes you can get back home.

Luckily, as we reach the village of Patti, the torrents subside and we are able to disembark without getting too wet. CFHI has supported the operation of a clinic in this area since the late 1990s –it is the base of the CFHI Rural Himalayan Global Health Immersion Program. In the last seven years, we have trained women elected from the surrounding villages as health promoters. Previous to these efforts, there was no organized healthcare happening in this area. Today is a meeting of the health promoters, some having walked as many as five hours for the event (a fact that always humbles me greatly). An initial three year training effort took women with little or no formal education and taught them the basic skills of health promotion. Many of them come from a long line of traditional birth attendants, so they already had some experience in the area of health. After the initial training, they have been able to monitor women throughout their entire pregnancy. Additionally, they instruct their communities on many topics: sanitation, nutrition, immunizations, hygiene, and family planning, to name a few.

As the rain began to intensify once again, we huddled around two tables pushed together on a porch, under a metal roof, next to a rice field. The sound of the rain caused everyone to move in closer and lean in to hear. My many previous visits over the years have been in more extreme dry heat when we sat spread out in the shade as we

CFHI Health Promoters Meeting in the Village of Patti, Northern India

talked. –Of course I need to stop here and say that since I have no capacity in Hindi, the CFHI India Coordinator, Ms. Hema Pandey, was gracious enough to do the translation, and her easy, relaxed, yet professional manner also contributed greatly to the level of the conversation. Maybe it was this more close huddling, or maybe it was just the product of seven years of meeting them once or twice a year, but for whatever reason, this time the conversation took a more intimate track. Over the years, our meetings have been about stories of the work the Health Promoters are doing, each in her own village. I’ve always been moved by their commitment and dedication as the women are all volunteering in this role and, at times, it can occupy a lot of their time and energy. We always talk about what they need and we try to line up successive training experiences for them. Today, however, I somehow felt like I could ask them more about themselves. Now, all these years into their work, I could see in them their own sense of being experienced –that they are really settling into their roles. It also helped that there was a young 18 year old woman who had joined us for the first time, as she now wants become a Health Promoter. The older women took her under their collective wing as she found it hard to answer any direct questions –not used to being asked her opinion. “Don’t worry, you’ll get used to it,” was the message as all the older women laughed. “We were all once like you,” one of them told her, “not knowing how to speak, not sure what to say … you’ll learn.” It was also touching to see the older women buoyed in spirit by her interest. There was more of a general feeling –not only of pride, but also of purpose, and an almost palatable sense of hope for the future in the smiles of the older women, broader than I have ever seen them before.

I asked the women what they liked most about their work. They answered with the stories of what they have been able to do. “And for you,” I asked, “what do YOU like about it.” There was some discussion amongst the group. They said that they like “feeling empowered.” “What does it mean,” I asked, “to feel empowered?” “It means that now I can speak,” said one, motioning to the new recruit whose personal growth and self confidence the women will now each personally see to. “It means I can teach,” said another. “It means improvement, progress for the whole village,” said another. This spawned a longer conversation of the feeling of satisfaction they have in seeing the results of their work. They see women having healthier pregnancies; they see children growing up stronger and healthier. One of the biggest changes, they report, is that now, even the men of the villages will listen to them in a way that never happened before. The women told me that the men have come to see the women as possessing knowledge and understanding as a Health Promoter that no one else has. What was even more remarkable than the statement itself was the body language, the tone of confidence, and the feeling of accomplishment that came through in these statements, none of which required the skills of a translator to be successfully communicated.

A Visit with The Father of Palliative Care in India

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Dr. Rajagopal Dispenses Needed Medicines and a Healthy Dose of Respect.

Pallium India

After a meeting with CFHI’s Founder, Dr. Evaleen Jones at Stanford University, Dr. Rajagopal (Dr. Raj), the Founder of Pallium India agreed to become one of CFHI’s newest partners in India. CFHI India Coordinator, Ms. Hema Pandey, and I had the privilege of spending three days with him in Trivandrum, Southern India as we work to develop a CFHI Global Health Immersion Program exploring Palliative Care.

As the monsoon season takes its time to come to a close, the beautiful, lush countryside around Trivandrum in Kerala –Southern India is as calming as the presence of Dr. Raj to his patients. We were given the great privilege of being allowed to shadow Dr. Raj during a day of home visits to various patients of Pallium India, the nonprofit he founded.

Who is Dr. Rajagopal

Dr. Raj is responsible for beginning the palliative care movement in India. He tells me that while the goal of palliative care might be the same in India as it is in England, where the modern hospice movement was started, the implementation is different. Dr. Raj feels that to simply pick up and transplant palliative care as it has been developed in the West can inadvertently have consequences that cause more suffering –when the main goal of palliative care is to reduce suffering. Dr, Raj is indeed a unique individual; he is both a visionary and a worker in the trenches. To follow him for a day doing home visits was inspiring. It was also a primer in how to do this kind of patient care.

Dr. Raj pointed out to me the four domains of patient care that were outlined by Cicely Saunders, the founder of the modern hospice movement. The four interlocking domains are Physical, Emotional, Social, and Spiritual. It is certainly a tall order for anyone to provide such comprehensive care, and to do it in low resource settings is even more challenging.

A Day in the Life– Implementing Palliative Care in India

As we drove into some of the poorest communities in Southern India, Dr. Raj and his team, a nurse, a social worker, and a driver went about their routine. Patient files are reviewed as we travel in the van. The size of the patient files is notable. After Dr. Raj read the file a bit, he begins to tell us the context of the family we are about to see. We get a succinct yet

Ms. Hema and Dr. Raj on home visits

thorough description of the family composition and history. The level of detail is impressive and we even had a few questions about the family that Dr. Raj answered from the record. I asked him when he last saw the family and he said that this was his first visit to them. There are three other teams conducting home visits and so the family has been seen by the other teams in the past. It is amazing to see the level of detail that is recorded from the home visit. From these notes, other services from nutrition, to physical therapy, to social work are provided –all driven initially from the teams’ weekly or fortnightly visits.

As we arrive, Dr. Raj gives warm and respectful greetings. He makes use of his reading of the chart right away to let the family know that he is up to speed on the situation even though this is his first time seeing them. Telling and retelling the story can be a help, at times, for a family but to have to do it with every healthcare worker that shows up, can become a burden.

In the home visit, Dr. Raj is totally in his element. Calm, positive, and respectful, he has a way of making the patient and the family feel that he has all the time in the world to spend with them –they have no idea that he has six more home visits to do. His careful touch, his undivided attention, his deep listening, his affirming comments are all the epitome of what a home visit should be. He listens and draws

Dr. Raj conducting a home visit, Trivandrum Southern India

out information to help him tweak the treatment plan based on what has happened since the previous home visit. As he leaves, he has given not only some medicines and ordered some more physical therapy but he has also given the family and the patient dignity, respect, and acknowledgment through his manner, his interactions, and his presence.

And, of course, as we make it back to the van, it’s time for Dr. Raj to write page after page of notes so the follow-up treatments can be done and so the next home visitor can pick up right where he left off.

New US Census Data Shows Diversity of US Population Increasing

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“We are approaching a new highpoint in the prevalence of US residents who were born outside the country.” This is part of a message on the Director’s Blog of the US Census Bureau website that is aimed at the marketing industry, at advertisers of goods and services, but we at CFHI believe it is also important information for current and future health professionals.

While the Census Bureau is providing this new data, none of the basic trends of an increasingly diverse population for the United States should be a surprise to us. Forward thinking health professionals and medical educators have seen the indications of these trends for many years. Health science students (including medical students, nursing students, and public health students) have not waited for courses to be developed by the data that is now beginning to be analyzed, but have taken the initiative to seek out medical electives and rotations that would give them first-hand experience of different cultures and the different ways people view health around the world.

Source: US Census Bureau -Director's Blog

With some 6,000 alumni of CFHI Global Health Immersion Programs to date, we hear over and over again from them how their CFHI experience gave them insight into the role that culture plays in health and healthcare. Tenny Lee, a 2010 CFHI Mexico alum, reports: “My experience in Mexico has given my medical career a foundation to help underserved communities and break though language and cultural barriers.” You can read more about her CFHI experience in her review posted on the website Great Nonprofits. The ability to competently serve a more widely diverse patient population will clearly become the expectation for health professionals, as we can see from the wealth of information that the US Census Bureau is releasing.

One of the most important data points released so far is that the Hispanic population of the US now exceeds 50 Million, a 43% increase since the last census as reported by CNN. And it is not just in border states in the south. The CNN article quotes demographer Jeffrey Passel at the Pew Hispanic Center as saying, “Previously, the Hispanic population was concentrated in eight or nine states; it is now spread throughout the country.”

Medical schools, organizations, and institutions of higher learning have also recognized these trends, and CFHI has been happy to work with many of them to design specific programs. The Patient Advocacy Program at the Stanford Medical School began a program abroad with CFHI in 2007. The University of California at Davis has partnered with CHFI for over five years now to offer a Bi-National Health Quarter Abroad program for undergraduates in special arrangement with the Chicana/o Studies Department at UCD. Both of these programs also make use of CFHI’s built-in Spanish Language and Medical Spanish Instruction. Students are also living with host families so they are immersed into the culture during the program. Guided journaling and weekly meetings help students reflect and integrate what they are learning from their daily interactions. CFHI is also working with others, including Northwestern University, The Student National Medical Association (SNMA), -which you can read more about in an earlier posting– and the Public Health Institute in association with the Global Health Fellows Program. CFHI has been able to partner with each group and use our 20 years of experience working at the grassroots level in underserved communities abroad to design programs that meet specific learning objectives that are achieved in real life settings with the help of local health professionals who have the unique expertise of the local healthcare system and the best understanding of the local culture.

Jessica Brown, a 2010 CFHI Ecuador alum, pulls it all together in her reflection about her CFHI experience:

“… [I] learned a wealth of information about health that extended beyond the Reproductive realm.” Jessica goes on to say, “I learned a lot about Ecuador’s healthcare system by discussing health care access, education, socioeconomic class and ethnic background with my mentors and preceptors. I learned about how religion, education and customary social/cultural schools of thought (i.e. machismo) weigh heavily on Ecuador’s society, and individual minds; I saw how the cultural “way” dictated the population’s attitude towards healthcare, especially in Women’s Reproductive Health.

The moments that caused me to question belief systems in place within myself really stretched me beyond limits I never knew possible. And it is these reflections upon the state of health care in Quito that can broaden my understanding of client needs, beliefs and culture here in the states.”

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

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Ukwanda Logo

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

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

Avain Park Old Clinic

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

Freight container being prepared at Cape Town Water Front

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

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

Avian Park New Clinic 2011

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

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

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

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

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

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

Familiarity That Melts Away Mistrust -Michelle Obama

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First Lady Howard University Jan 2011

As part of the official visit of President Hu to Washington, First Lady, Michelle Obama spoke to a captivated audience at Howard University saying that when you go abroad, “you are shaping the image of America projected to the rest of the world.” While Mrs. Obama was trying to promote a campaign to increase the number of students going to China, many of her comments are applicable to any cross cultural learning experience:

“…studying abroad isn’t just an important part of a well-rounded educational experience. It’s also becoming increasingly important for success in the modern global economy. Getting ahead in today’s workplaces isn’t just about the skills you bring from the classroom. It’s also about the experience you have with the world beyond our borders — with people, and languages, and cultures that are very different from our own.”

Last Spring, her husband, President Barack Obama, spoke to students at the University of Michigan saying: “As our world grows smaller, more connected. You will live and work with more people who don’t look like you, or think like you, or come from where you come from.” And almost in a response to these words by her husband, Mrs. Obama went on to say:

“That’s why it is so important for more of our young people to live and study in each other’s countries. That’s how, student by student, we develop that habit of cooperation, by immersing yourself in someone else’s culture, by sharing your stories and letting them share theirs, by taking the time to get past the stereotypes and misperceptions that too often divide us.

That’s how you build that familiarity that melts away mistrust. That’s how you begin to see yourselves in one another and realize how much we all share, no matter where we live. ”

CFHI programs have always focused on immersion into a culture, into a different helathcare system. Rather than staging impressive extraordinary displays for students, CHFI’s Global Health Immersion Programs give students a real slice of life, giving the participant and authentic experience of what it is like to be a health professional in that country. Some days may be very low key, other days in a hospital may be overwhelming. Regardless of the program, the bonds that students have made with professionals, with host families and with each other are very strong and lasting.

CFHI Convenes UN Forum on MDG 3 Empowerment of Women

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Earlier this month on September 15, 2010, CFHI convened a Forum on the Empowerment of Women, at the United Nations in New York. The purpose of the event was to increase awareness of the United Nations Millennium Development Goal #3, to Promote Gender Equality and Empower Women.

Ambassador Anwarul K. Chowdhury, former Under-Secretary General and High Representative for the Least Developed Countries, moderated a panel of women representing a cross section of leadership roles. As world leaders met this past week to discuss the MDGs, this Forum, held a week in advance, provided an opportunity for the voices of women from everyday life t be heard. Co-sponsoring NGOs included the NGO Committee on Spirituality, Values and Global Concerns, The International Center for Good Business, The Institute of International Social Development, and The Spiritual United Nations. Panelists included M. Christine MacMillan, Commissioner, Director of the International Social Justice Commission of the Salvation Army, Monika Mitchell, Executive Director, Good Business International, Hema Pandey, India Coordinator, Child Family Health International, and Jessica Evert, MD, Medical Director, Child Family Health International.

The Title of the Forum was Successes and Challenges of Women in Leadership Roles in Traditionally Male-Dominated Environments. As women are increasingly taking on leadership roles, it becomes important for them to share their experience. The panelists spoke with examples from their own lives and the audience was invited to share their comments and life experience as well.

We were especially happy to welcome our India Coordinator, Ms. Hema Pandey who was visiting from New Delhi. Hema is responsible for coordinating six CFHI Global Health Immersion Programs taking place in Mumbai, Pune, Delhi, Dehradun, and Rishikesh, as well as multiple ongoing community health projects. In the course of this work, she manages a group of five local CFHI Medical Directors, all of whom are men. Ms. Pandey spoke of using a cooperative style of working that invites the participation of those she works with thus creating a joint feeling of ownership. This being her first trip outside of India, Ms Pandey said she was surprised to find that women in the United States also felt that they were still struggling to achieve gender equality.

As the Forum drew to a close, there was a common expression of the panelists and the audience that this Forum should become and annual event until 2015, the target year for the Millennium Development Goals.

CFHI Medical Director Blogs on Day 2 of CUGH Conference

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This is the second of two guest blogs by Jessica Evert, MD, CFHI Medical Director, blogging from the CUGH Annual Meeting in Seattle. Be sure to leave a comment.

Ann Dower of University of Washington’s I-TECH Center said today “we must practice the art of partnership” in order to be successful in global health. Additionally, I was struck when Kevin De Cock MD, Director of the Center for Global Health at CDC, candidly reflected on his early career immersion experience in Nairobi, Kenya, saying, “I wish I was more humble.” I think this humility and the ability to form meaningful partnerships go hand-in-hand.

This idea of ‘partnership’ has come up countless times at the CUGH meeting over the last 2 days. Many seasoned global health experts have lamented over the lack of partnerships and failures of global health attempts due to this shortcoming. How can we learn from this history? How can we build training and educational programs that prioritize partnership? It seems that many times our process (the process of US based individuals, universities, and organizations) of global engagement is not necessarily the best approach to foster partnership or humility. We often have our own ideas of how to solve problems based on our views and our skills, rather than based on the voice of communities abroad. In academia, there is the nagging issue of faculty, and sometimes students, having to demonstrate personal accomplishments and quick outcomes which often trump the empowerment of communities to own the accomplishments and guide the outcomes. To find the answer to these important questions we need to look at how we frame introductory global health experiences for health science trainees (pre-health, medical, nursing, public health, allied health, dental, and other students) and how our academic institutions approach global engagement. The first experience abroad (a stepping stone experience) or first visit to a region or country is pivotal to frame how future global engagement occurs. If individuals go abroad and set-up a tent clinic outside the local healthcare infrastructure, an appreciation for local capacity, systems, and workforce is not realized. If students go to a hospital with faculty from their US institution who displace local physicians and assumes US clinical expertise translates immediately into similar expertise in an international setting, the student sees the glorification of US faculty, rather than the appreciation of unique practices, language, and expertise of local, native practitioners. It is time we recognize that the skills necessary for partnership need to be fostered from early levels of engagement and need to be modeled by our US teaching institutions and mentors.

How do we teach health science students and trainees about partnerships? What skills does partnership require? To delve into these questions, we must define partnership. The Partnering Initiative, an NGO that specializes in partnership training, defines partnership as follows: “a cross-sector collaboration in which organisations work together in a transparent, equitable and mutually beneficial way towards a sustainable development goal and where those defined as partners agree to commit resources and share the risks as well as the benefits associated with the partnership.” This is no simple task. They also define the partnering principles as follows- equity, transparency, mutual benefit. If partnership is fundamental to the success of global health activities, then we must judge global health activities in part based on these fundamental principles. The need for trust, mutual respect, and communication are presupposed in the process of building partnerships.

We can teach the principles and precursors to partnership through thoughtful global health immersion programs. I am proud to be a part of CFHI. I think CFHI is setting a standard for both academic and NGO based immersion programs. I liken CFHI immersion programs to participant-observation techniques I utilized during my thesis work. In anthropology the mechanism of understanding a culture, community, and executing research is participant-observation. Participant observation involves gaining an understanding of another social group or community, by inserting yourself into that community in a way that is agreeable to the community, while observing the practices and learning about the culture, social structure, systems, and other behaviors. CFHI immersion experiences provide an opportunity for participant-observation. I would argue that such participant-observation, done in the context of long-term CFHI partnerships, lay the groundwork and start fostering skills necessary to form meaningful partnerships with individuals and organizations abroad. The local health care providers are the experts who teach CFHI participants what their communities are facing. We have received feedback from partners that patients consider their local providers more capable because they are teaching western health science students (rather than Western physicians or students providing the expertise in patient care at the international setting). This dynamic is very important and very powerful. The first step in the cycle of partnership, as defined by The Partnering Institute, is “scoping.” In essence we are teaching our students and trainees how to scope, which includes listening, observing, and appreciating a local reality before trying to change it.

If partnerships are key to the success of global health programs and interventions, it is time we look at what it takes to impart the skills necessary to foster partnerships. These skills include observation, humility, and restraint so we can give voice to the local community and engage in truly mutually beneficial ways. By providing stepping stone global health immersion programs that prioritize the “scoping” necessary to form partnerships, we can engender a new generation of globally-active professionals who understand from early in their exposure and interaction with global communities the fundamentals of partnership and humility that Dr. De Cook and others wish they knew from the start. It reminds me of a quote by Nietzche, “When one has finished building one’s house, one suddenly realizes that in the process one has learned something that one really needed to know in the worst way – before one began.” We can provide these lessons before students build their proverbial global health houses through conscientious global health immersion.

CFHI Board Member Appointed by White House to Bi-National Board

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The Chair of the Board of Directors of Child Family Health International (CFHI), Mr. Gunjan Sinha, was appointed this summer to the US Endowment Board on Science and Technology during the US-India joint commission meeting of the White House Office of Science and Technology.

The Volunteer Board of Directors of CFHI functions far from the limelight but plays an essential role in the success of CFHI. We congratulate Gunjan on this accomplishment! Gunjan’s expertise as an entrepreneur has been indispensable to CFHI over the years, and we are sure he will be viewed the same way in his new role.

The Governments of the United States and India held the meeting of the Joint Commission on Science and Technology cooperation in Washington, D.C. on June 24-25 at the Smithsonian Institution’s National Museum of Natural History. CFHI’s Board Chair, Gunjan Sinha joined the meeting as part of the U.S. delegation lead by Dr. John Holdren, Assistant to the President Barak Obama for Science and Technology and Director of the White House Office of Science and Technology Policy. The Indian delegation was lead by Sri Prithviraj Chavan, Minister of State for Science and Technology and Earth Sciences. As part of the overall focus on science and technology policy, Mr. Sinha was appointed on the US Endowment Board, set forth between US and India to foster Science and Technology cooperation between the two largest democracies in the world.

The meeting follows the June 3rd discussion between US Secretary of State Hilary Clinton and India’s External Affairs Minister Shri Krishna that focused on the importance of facilitating cooperation in strategic and high technology sectors as a key instrument to achieve the full potential of the strategic partnership between the two largest democracies in the world.

Mr. Sinha is also Chairman of MetricStream, a market leader in Enterprise-wide Governance, Risk, Compliance (GRC) and Quality Solutions for global corporations, based in Palo Alto, California.

The delegates at the commission include senior officials from various US federal agencies and departments including the Office of the Chief Technical Officer, Office of International and Tribal Affairs, US Environmental Protection Agency (EPA), US National Institutes of Health (NIH), US Department of Energy (DoE), National Science Foundation and Bureau of Oceans, Environment and Science.

The joint commission between the two countries and the US-India Endowment Board will look to inspire public good and economic prosperity in US and India, through science and technology cooperation, greater public-private partnerships, promoting innovations and entrepreneurship and creating appropriate policy environment for greater bilateral co-operation. Areas of focus of the Endowment Board will include such significant areas like Food Security, Climate Change, Energy Policy and Healthcare among others.

In line with the mission of the White House Office of Science and Technology Policy, the commission’s aims to ensure that Federal investments make the greatest possible contribution to economic prosperity, public health, environmental quality and national security, and to foster professional and scientific relationships with government officials, academics and industry representatives for providing policy-relevant advice, analysis and judgment for the President on major policies, plans and programs of the Federal government

CFHI Convenes Forum on the Empowerment of Women

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CFHI is proud to convene a Forum on the Empowerment of Women to be held at the United Nations Church Center on September 15, 2010, in conjunction with the opening of the 65^th Session of the United Nations General Assembly.

The Forum, entitled Successes and Challenges of Women in Leadership Roles in Traditionally Male-Dominated Environments, is an effort to shed light on the global effort to achieve Millennium Development Goal Number Three.

In government and NGO organizations worldwide, women are increasingly taking on leadership roles. What are women finding as they assume these roles? From the grassroots level to the executive level, women are succeeding in roles heretofore held only by men. Are there common experiences across these different levels? Are there common challenges? What cultural issues need to be considered? What strategies are most successful?

Join the audience along with a distinguished panel including CFHI Medical Director, Jessica Evert, MD, and direct from New Delhi, CFHI India Coordinator, Hema Pandey, as these topics and others are discussed in this lively forum. Gain insights and share your own story. Join us September 15^th at 1:00 PM at 777 UN Plaza (44th Street between 1st and 2nd Avenues) 8^th floor, Boss Room. The forum is free and open to the general public but we do ask that you RSVP. Please click here to see more information here and the email address to RSVP.

Expectations –When Helping is Complicated

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Kim McLennan, an accomplished physical therapist, and long-time CFHI volunteer, is now in Haiti and has been communicating to us some of the complexities of just trying to help. A veteran of many humanitarian missions, Kim knows that to lend a helping hand is not always as easy as it looks on the surface. The crisis in Haiti, and the

Some of the many peopel who have volunteered their time going to Haiti in the aftermath of the 7.1 earthquake

This is a U.S. Navy photo of some of the many vounteers who have gone to Haiti to help after the great earthquake

outpouring of volunteers to give assistance has amplified the Grey Areas of coordinating and managing international aid. The questions of culture, ethics, passion, compassion, and the realities of unexpected complexities are raised in her moving, first-hand account. Dr. Evaleen Jones, CFHI’s Founder and President, asked Kim if we could share her writings through this Blog. Kim gives us her experience alongside her on-the-spot reflections which are informed by her years of cross-cultural work in some very challenging situations.

We are grateful to Kim for her permission to present her observations and thoughts here. Unfinished and raw, they give us an unvarnished view of reality with no easy answers –much as the real situations in Haiti, and elsewhere in the world. You are welcome to click on the “Read More” button to leave a comment.

“Expectations

Here in Haiti, 5 months after the devastation of a 7.1 earthquake, volunteers are coming in droves. I am one of them. By the end of my stay, I will have been here 7 weeks. Most of my fellow volunteers come for one week or two if they’re lucky. Professionally, the greatest number are doctors, nurses, emergency room specialists, pediatric and wound care specialists, prosthetists and physical therapists. The majority have never been to a developing country or to Haiti before they arrive.

They come with the expectation of being welcomed for their concern and service, everyone paying their own expenses and hoping their week of selflessness will do some lasting good. Most leave, probably feeling that their mission was accomplished, even if in some small isolated way. This morning, at the hospital I’m working in, there are 20 American doctors, nurses and other hopeful people wanting to do something useful. They’re surprised when they realize how different the system is here, how charts and notes and procedures that are standard in the US are hardly used here. They are surprised that the Haitian nurses don’t speak English or seem happy to share their small desk or coveted stash of medical supplies. Many come with their own supplies of state of the art medical technology and toys and blankets and shoes. Most of it is very useful and appreciated by the patients. The Haitian staff seems to disappear when the volunteers arrive to see the rare and unusual patient injuries that have occurred here.

There have been many surgeries and interventions that would have never occurred without the volunteers being here. External fixators and wound vacs are found throughout the hospital, and the meticulous care given to the patient’s wounds is without parallel. But this is precisely the problem. The nurses here do not have the training to change the dressings or change the wound vacs and no one is training them. There will be no physical therapy or discharge planning when the NGOs pull out for good. For all their good intentions, the volunteers seem to ‘take over’ when they arrive and then complain that the Haitian staff doesn’t seem interested. Cultural differences aside, who likes it when someone new arrives on the scene, walks in, starts to do your job and then leaves, making you feel less than adequate after witnessing such expertise.

As you know, this is a touchy subject. Everyone who comes here has the best intentions, simply wanting to help. The problem is when they come, they come in groups with their own comfortable systems in place, just in a new setting. Most of the Haitian hospitals are not equipped to house or feed these additional visitors and the plumbing in Haiti already is barely serviceable. They often don’t seem to try to learn a few words of Creole, or go outside the compound to meet the Haitians and share a local meal. It probably feels like a vacation except that the food is scarce and the air-conditioning doesn’t work.

The first time I went overseas to volunteer 12 years ago in South Africa, I stayed for one month and it took me almost three weeks to feel I was accepted a little by the local staff and they still did not seem keen to have me in their midst. I have been looking ever since for better ways to interact and contribute to poor people in need of basic healthcare. I believe the answer is recognizing the potential of the local people….

It truly does no good to ‘do your thing” as a volunteer, no matter how much it is needed if you don’t teach someone else how to do it also. Volunteering in Haiti can contribute to the Haitian infrastructure only if we volunteers think about the consequences of us being here. Are we willing to be patient and work alongside someone whose future may improve from our training? Are we willing to trust that they may know a better way than the way we’ve been taught? We are influencing an entire system by our presence and we should be including them every step of the way…..”

Service World -A Bold New Initiative in International Volunteering and Service

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On June 23, 2010, the Brookings Institute hosted a forum on international volunteering and service and the launch of Service World: Strategies for the Future of International Volunteer Service.

Ambassador Elizabeth Frawley Bagley at Brookings 23 June 2010

Ambassador Bagley at Launch of Service World Effort

CFHI is proud to be one of the organizations endorsing this effort that is a call for increased international cooperation at all levels. We know that as the world effectively grows smaller, the health of the world’s population will depend more and more on our ability to share knowledge, understanding and efforts across boarders and continents. Improved understanding of how culture impacts health and the global sharing of current best practices along with traditional proven interventions will benefit all of our efforts at improved health for all populations. This is the intersection of modern medicine, that builds on science and technology, and the cumulative wisdom of ancient cultures that builds on a deeper knowledge of the earth and the human mind, body, and spirit. CFHI students experience this today in the Amazon jungle and the foothills of Himalayas. To increase the ability of future health professionals to to have these transformational experiences in a manner that is socially responsible to the host communities, can only improve the health of the world community, and our progress as people toward global citizenship.

Ambassador Elizabeth Frawley Bagley, Special Representative for Global Partnerships in the Office of the Secretary of State, gave the keynote, inspiring those present to work collectively toward the goal of increased opportunities for people of all ages and walks of life to volunteer service internationally. 2010 marks the 50th anniversary of the birth of the idea of the Peace Corps. As the celebratory events for this anniversary happen this coming October, our nation will have the opportunity to reflect on this great idea and the great accomplishments that have come from it. Service World recognizes that the positive impacts have come not only from the government sponsored Peace Corps but also from the many private and nonprofit organizations that have taken up this global vision and provided opportunities for so many people from the United States and many other countries.

CFHI’s Founder and President, Dr. Evaleen Jones, has often recounted that the Peace Corps was an inspiration for her as a young medical student at Stanford University,when she began the creation of CFHI . More information on Service World will be posted on the Blog over the coming months.

Interview with CFHI’s Medical Director –Audio Post

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I had the chance to sit down with CFHI’s Medical Director, Dr. Jessica Evert, at our offices in San Francisco, just before she was honored with an award from the Global Heath Education Consortium (GHEC) at their annual conference in Cuernavaca, Mexico. Dr. Evert began her role as CFHI Medical Director in January. Her education career includes studies at Emory University, The Ohio State University College of Medicine, and the University of California at San Francisco, where she continues to serve as a clinical faculty member of the Department of Family and Community Medicine.

We spoke about her introduction to Global Health, how she integrates her work as a physician in the San Francisco Bay Area with her Global Health Activities, and what attracted her to CFHI. She talks about how CFHI’s model is one that changes the dynamic by empowering local communities through actively building on their strengths in ways that lead to sustainable solutions.

Please click on the links to listen to our conversation and you are invited to join the conversation through adding your comments below.

CFHI Medical Director Receives Special Award -Final Report From Curenavaca

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Dr. Jessica Evert, the Medical Director of Child Family Health International, received the Christopher Krogh Award at the GHEC – INSP Conference today.

Dr Jessica Evert Receiving Special Award at Global Health Conference in Mexico

Dr Jessica Evert Receiving Special Award from Dr Anvar Velji GHEC Co-Founder and Dr Richard Deckelbaum GHEC President at Global Health Conference in Mexico

The award, honoring the memory of Dr. Krogh, a founding member of GHEC, who died in 1994 in a plane crash while traveling as a physician for the Indian Heath Service, is given to an individual who shows dedication to serving the undersered both domestically and internationally.

Dr. Evert has worked in various places around the world, and also works on a daily basis treating patients in several underserved communities in the San Francisco Bay Area. Prior to becoming the organization’s global Medical Director, she volunteered with CFHI for several years so we are well aware of her talents and her dedication. CFHI extends a hearty congratulations to our new Medical Director as she receives this distinguished honor!

Communication Skills for Medical Students and Other Health Science Students

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Empathic Listening Training for Health Professionals

Professionalism as a component of medical education is something we all know is important but can be hard to effectively impart and even harder to measure. Students who want to improve their professional skills report that it can be difficult to find effective ways to do so.

One of the most obvious ways that the professionalism of a doctor or medical professional is seen by his or her patients, is through the communication skills that are used on a daily basis. Effective communication is a two-way street and becomes ever more challenging each day as our societies become more multicultural. Empathy spans culture, gender, race, age, and socioeconomic factors that can become barriers to effective communication. The need to be understood is a universal human trait and with the right tools, the medical professional can use that energy to charge the healing process in a positive way instead of just letting that energy create stress, confusion and possibly frustration.

Over the years, many CFHI students have commented that the time spent immersed in another culture, has increased their awareness of others and also their awareness of self. Being in a foreign culture and a foreign healthcare system makes a person aware, sometimes awkwardly aware of themselves and of their assumptions about how healthcare should be delivered. Many of the things that we might take for granted on a daily basis are suddenly removed. The experience is one that is new, different, challenging, perhaps uncomfortable and, at the same time, an amazing opportunity for learning. Here too empathy can play a role. The practice of self empathy can help transform the experience to be one of learning and not just stress.

CFHI is thrilled to present, in collaboration with the Center for Nonviolent Communication CNVC, a two-part training focusing on empathy. This will be a live phone-in training. We encourage CFHI alumni and students preparing to go in CFHI programs to register for this free training.

Choose Your Words Professional Edition by Mel Sears

The Professional Edition of Choose Your Words by Mel Sears

Melanie Sears has been a Registered Nurse for more than 25 years and a certified trainer in effective communication since 1991. Her book, Choose Your Words: Harnessing the Power of Compassionate Communication to Heal and Connect, is an excellent workbook designed to help health professionals be more effective in their communication with both patients and colleagues. Joining her as co-trainer will be John Kinyon, also a certified trainer in communication skills since 2000. John has worked in a number of international settings and has worked with many groups to address the challenges of cross cultural communication.

CFHI is honored and grateful to have Mel and John offer their expertise to CFHI participants.

Everyone Pitching in to Help Haiti and Some Old Lessons Re-Learned

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It is true that Child Family Health International does not have any programs in Haiti. It is also true that we are part of the world community and, in a situation like this, if there is a way for us to help, we will do all that we can do, as we did in the Asian Tsunami and have done in other events over the years. CFHI has actually worked in the past with our friends at VIDA and a Haitian partner, the Consortium for the Development of Haiti, to send medical supplies to a number of grassroots clinics and hospitals. It was a very successful endeavor. And so when news of the earthquake came, we tried to re-initiate our successful partnership and get disaster relief supplies to Haiti as quickly as possible. We sent out a message to CFHI supporters, who were already contacting us to find ways to help, and they responded generously.

Our great friends at VIDA (Volunteers for Inter-American Development Assistance) were also right on it, and within about 24 hours of the Tuesday quake, they had assembled over one million dollars in urgently needed first aid and disaster medical supplies. Being on the West Coast, we found ourselves at a disadvantage as the access to the airport and other avenues to get supplies in were quickly clogged. It was also only later, by late Friday and Saturday, that the impact of the earthquake on the functionality of the airport and the seaport were really known. Once it was obvious that all avenues to get supplies in would have to go through the military (directly or indirectly) and staging areas in Florida and other close points, we realized that there was no way to get a shipment directly to Haiti.

We found great support from another wonderful NGO, MedShare, which recently opened a warehouse on the West Coast. They were dealing with the same issues, and through their East Coast connections, were able to get shipments into the pipeline for Haiti. We are grateful for all this collaboration and happy to be in such good company. Our role is very small but, as we are seeing, if we all pitch in and do what we can, a big difference can be made.

On a personal note, having spent some time in Haiti in the early ’90s, when I worked for Food For The Poor, I was moved by the earthquake through the memories that I carry. My visits to Haiti gave me an experience that has stayed with me ever since. The overall work of Food For The Poor was refreshingly simple: provide for basic needs, and develop ways for people to pull themselves out of poverty. Expecting to find people beaten down by poverty, I was challenged to reevaluate my assumptions. Sure the poverty was there, and it was among the worst I have seen anywhere in the world, and some of the people were caught in its clutches in a way that made it hard for them to break free. But, as I have seen in other places, that wasn’t the whole story. By and large, I saw, in Haiti, people who did not let poverty define them or their happiness. These are the people that don’t make the news but carry on their lives as best they can. I gained deep respect for people who perhaps had a better sense of the important things in life than I did. It was a lesson I have tried never to forget and one that I am reminded of again as I see images that trigger forgotten memories of sadness and beauty, despair and hope all mixed and juxtaposed in a society so abused by history, and so full of potential. The people of Haiti re-taught me lessons of never making assumptions, of never writing anyone off, and of the richness that comes from allowing another person, another culture, to change the way I think. I carry these lessons to my work today, even as I carry the memories and, too, the hope that the resounding resilience of the Haitian people and their great joy in living will raise them up, once again, from being dealt a terrible blow.

CFHI South Africa Alum in the News

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

David Liskey photo by Jan Sonnenmair

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

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

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

Learning From South-South Collaboration, April 2010, Cuernavaca, Mexico

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Alliances for Global Health Education: Learning from South-South Collaboration, has been announced as the theme for an upcoming conference to be held April 9-11, 2010, in Cuernavaca, Mexico. The joint collaboration represents the 19th annual conference on Global Health Issues for the Global Health Education Consortium (GHEC), based in the United States and the 1st Latin American and Caribbean Conference on Global Health hosted by the Instituto Nacional de Salud Publica (INSP), based in Mexico.

A White Paper and call for abstracts can be found on the GHEC website here.

This promises to be an exciting conference addressing current issues and even leading edge ideas, research, and practice. The Call for Abstracts is through November 1, 2009. The website reports that all aspects of Global Health and Global Health Education are welcome for submission and there is a special request for “progressively-minded projects that take into consideration the ideals of global health that embrace: Social Justice, Ethical Practices, Community Ownership, Equity and Fairness, True Partnership, and Bilateral Exchange.”

CFHI Granted Consultative Status at the United Nations

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

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

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

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

Flags of the CFHI Global Family now including the United Nations

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

A Definition of Global Health

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Defining global health has been a challenge. This has been especially true in recent years with the increased interest in science, philanthropy, and politics related to global health. In the June 6, 2009 issue of The Lancet, a multidisciplinary and international panel brought together by the Consortium of Universities for Global Health (CUGH), and led by Jeffrey P. Koplan, MD, has taken a bold step in offering the world a definition.

The article entitled Towards a Common Definition of Global Health, represents an important step in bringing together the work, “and priorities for action between physicians, researchers, funders, the media, and the general public.” A thoughtful process is outlined considering the origins of global health in the areas of public health and international health.

The attempt is to be broad rather than limiting, and emphasizes multidisciplinary approaches and mutuality, as well as equity and collaboration.

We applaud CUGH for this effort and recommend this article to all CFHI students. We greatly appreciate that an effort has been made across continents and cultures to find common ground for the advancement of the study and the work of Global Health.

In recent years, at conference after conference, speakers have noted that there is no real agreement on just what is involved in Global Health. This long-awaited work is welcome, especially in its tone –it is not forceful or proprietary but open, inviting, and humble. We hope that it serves as a good starting point for people from all aspects of Global Health to find a workable construct that will be helpful to collaboration in our work and research.

Please go the The Lancet website and find the article.