Category Archives: Global Health Elective

Elective opportunities in healthcare and public health for international students

The LGBTQ+ Population in Uganda

Homosexuality is illegal in Uganda, but homosexuality is also illegal in 69 other countries worldwide, and the practice of labeling individuals as homosexual, gay, or lesbian was traditionally not a part of Ugandan culture. This topic was not politicized, and Ugandans accepted different practices. Recently, however, LGBTQ+ Rights in Uganda have become a prominent issue in politics and in the international media. In 2009, MP David Bahati proposed the Anti-Homosexuality Bill and in February 2014, it was signed into law by President Museveni. The Ugandan constitutional court struck down the law in August 2014, but civil rights activists say the situation for LGBTQ+ Ugandans is still worse than it was before the law. LGBTQ+ individuals, numbering around 500,000 in Uganda, often face consequences if they reveal their identity, so discussions about sexuality are rare.

While in country, focus on your safety and trust your gut. It is usually best to avoid questions about your sexuality and be ambiguous if asked. Please respect the local culture and assess who you are speaking to. Also, remember that travelers to Uganda often don’t face the same discrimination that locals do. As someone with “tourist privilege,” you may have slightly greater freedom of expression, but your actions may have repercussions for the locals you engage with, so please take that into consideration.

Traveling is always challenging, and LGBTQ+ individuals often face additional levels of complexity. The followingresources will help you to educate yourself on the local culture and social context. There are a wide range of resources available that will allow you to better understand the political climate and cultural nuances of a country. Some resources to explore include: ilga.org, the US State Department, the Geert Hofstede Center for Cultural Insights, the CIA World Factbook, alturi.org, ilgta.org, and HSBC Expat Explorer. It is also a good idea to register yourself with the State Department so they’re in a position to advocate for you. Staying in touch with friends and family back home who know your identity often helps travelers as well. Skype, Whatsapp, and Viber are good options for this.  

We also want to make explicitly clear that CFHI does not agree with or condone any discrimination based on sexuality. Our partners in Uganda are welcoming and do not practice discrimination, and students have not experienced any issues in the past. However, understanding the local context regarding LGBTQ+ rights will help ensure that there are no incidents in the future.

For more information, please refer to the following sources:

The OSAC LGBTQ Guide to Travel Safety

The State Department’s Website for LGBTI Travelers

The Human Rights Watch

The International Policy Digest’s Article on the Origins of Uganda’s Anti-Gay Law

Seeing India Through New Eyes: An Indian-American Student’s Study Abroad Experience

In December 2014, I left the comforts of San Francisco to take part in the Public Health & Community Medicine in India program through Child Family Health International (CFHI). During my 4 weeks in northern India, I had the opportunity to engage with and learn from various non-governmental organizations that are tackling public health challenges like injection drug use, sanitation, and prostitution. For the first week, we worked with a WHO-recognized organization in Chandigardh that focuses on women and children’s health care. One of my fondest memories from this experience was being able to interact with the female sex workers that this NGO helps. I had the opportunity to sit down and talk with Aditi*, who told me how her hardships from back home forced her to become a sex worker in order to keep her children in school. Listening to Aditi’s story really put my life into perspective. Aditi, who is a mom, sister, wife, and daughter, was literally sacrificing her own body for the sake of her children, something only a strong individual would be able to do. I couldn’t help or stop Aditi from being a sex worker, however what I could do was be someone she could talk to, someone who would listen to her, even if only for a short amount of time. It was an exchange of hellos, an exchange of respect, and an exchange of appreciation that I could give Aditi, and ironically, in the end, what she gave me. This experience taught me that it is impossible to understand a public health issue like prostitution without understanding the human beings whom it affects.

DeepaWhen I embarked on this experience, it had been 6 years since my last visit to India. The transformation I saw in the country was phenomenal. I noticed improvements in infrastructure and cultural changes. Years ago, the topics of HIV/AIDS or sex workers were very taboo. No one liked to acknowledge any health risks and the government wasn’t doing much to spread awareness of such issues. Visiting the country now and witnessing the many programs the government has implemented within each state was inspirational. Programs such as NACO have made such a difference in the lives of countless people across northern India by providing necessary services and supplies to lead a healthier and safer lifestyle. Apart from HIV/AIDS, I also witnessed changes in the caste system in India. In this system, “untouchables” are deemed to be the lowest caste because of their occupation of being scavengers (individuals who clean up human waste from homes due to lack of toilets). This program gave us the opportunity to work with a UN-recognized social service organization based in Delhi that is committed to getting rid of the untouchables caste by creating a toilet complex system to implement in villages across the country.

Being an Indian-American, I was able to appreciate India in a manner I never had before. I had always heard about various problems in India, whether it was about the spread of HIV/AIDS or the controversial caste system, but I always felt helpless living more than 8,000 miles away. Through CFHI, I was lucky enough to meet people like Aditi, and listen to their stories to understand what really is going on in the world outside of our own bubble in America. Often times, I have heard my very own friends and family who are Indian-American comment on how “backwards” India is in terms of development and simple progressive ideology about issues pertaining to HIV/AIDS. By experiencing India first hand, I now have the knowledge and experience to educate my friends and family and help them be more aware of important public health issues. Reading and hearing the news about India is one thing, but actually being within India’s space and engaging with the people of that country helps put these issues in perspective.

UntitledAs a senior graduating college soon, I am at the crossroads where I have to choose what I want to pursue for the rest of my life. After my 4 weeks in India, I realized that this trip wasn’t coming to an end for me, it was just the beginning.  CFHI not only gave me clarity, but also a sense of direction. The CFHI program solidified my decision to pursue a career in the field of public health. Prior to the program, I knew that I wanted to obtain my MPH, however I wasn’t clear on what specialty to emphasize in. This trip exposed me to the world of global health and made me realize that it would be the perfect field within public health for me. CFHI not only helped me fall in Iove with India again, but it also helped give me a sense of purpose that I perhaps would not have found without this trip.

*Name has been changed to respect privacy. 

Special thanks to our guest blogger, CFHI alumna Deepa Mistry, for authoring this post.

Alumni Spotlight: Q&A with Alana D’Onofrio

Alana D’Onofrio participated in CFHI’s program Exploring HIV & Maternal/Child Health in Kabale, Uganda in September 2014. She is an aspiring physician assistant and recent graduate of Northern Arizona University, where she majored in Biomedical Sciences.

Q. How did you hear about CFHI? What attracted you to the Uganda program?

I heard about CFHI through the study abroad program at Northern Arizona University. CFHI was highly recommended to me. It had always been a passion of mine to volunteer in Africa and experience the culture there—that is what attracted me to the Uganda program.

Q. What were your goals going in to the program? How did CFHI help you in achieving those?

IMG_8705My goals going into the program were really to gain knowledge—whether that be medical or healthcare knowledge, or knowledge of a different culture and how people live, eat, dance, work, etc. in a country completely foreign to me. CFHI helped me accomplish these goals. Their partner organization in Kabale has some very special staff members who were willing to teach me so much. They allowed me to ask any question, explained everything about the people of Uganda and their culture, and made me feel very comfortable.

Q. How did the program impact you?

The program impacted me greatly. It solidified my goals of wanting to go into a healthcare career because I learned how much I love working with patients. I also feel more worldly. I now know so much about a country in Africa where very few Americans travel to. I know about the people, the food, the music, and the languages of Uganda. I saw how amazing the people that live there are, how simply they live, and how much they enjoy life no matter how hard it is. The people there inspired me to live my life like them and to never take anything you have for granted.

Q. What were the highlights of your experience?

I have so many highlights of my time in Uganda. One highlight would be heading down to the clinic everyday, excited to see the staff and looking forward to what I was going to learn or see that day. The relationships that I established with the staff are another highlight. We had amazing conversations and always had so much fun. Other highlights include traveling to villages for outreaches to treat people who could not make it to the main clinic in Kabale, hiking the Muhavura Volcano in Kisoro, and going on a safari in Queen Elizabeth National Park.

Q. How has the program changed your perception of health? 

IMG_9148I now understand the diversity of health. Health in Uganda is very different than health in America, yet there are many similarities. There are diseases unique to East Africa that I was able to see and study. There are also differences in the way people are treated and diagnosed for these conditions. The diagnostic tests in Uganda are much more limited, therefore many cases are not solved. Certain conditions and diseases that are treated easily in America are not easily treated in Uganda and are sometimes fatal because people do not have the money to pay for healthcare services or because they wait until that last minute to get checked out.

Q. Who was the most inspiring person you met on the program?

The most inspiring person I met was Allen. He is a medical officer who works under Dr. Anguyo at the KIHEFO clinic and he is the preceptor who I shadowed. He has such a passion to help and treat others. The clinic is very understaffed and Allen wants to go back to school to become more qualified in certain areas such as radiology, so that he can help the clinic even more. While he treated patients, he was so patient and always took the time to explain things to me. Overall, he was a great teacher and such a passionate healthcare worker.

Q. How has your worldview changed?

I knew so little of Uganda and even the continent of Africa before my trip. Africa is not at all like what is portrayed of it on the news. Obviously there are parts with war, disease, and extreme poverty, but there are also amazing things about Africa that I was able to see. I no longer associate one country of Africa with the whole continent. Each country is unique.

 

Special thanks to Alana D’Onofrio for allowing us to interview her for this post.

Applying Competency-Based Education to Global Health Electives

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

What is competency-based education?

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

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

 Competency-based education in global health:

CFHI Students with Local Physician

CFHI Students with Local Physician

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

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

Bottom Line

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

 

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

International Experiences: Witnessing the Merger of Public Health & Medicine

 

“Global Health is Public Health”

Nothing makes for fodder amongst academics and medial professionals like definitions.  In the case of global health there are more than a few.  One definition was put forth for the Executive Board of the Consortium of Universities for Global Health (CUGH) by Jeffrey Koplan, MD, MPH, a physician, author and academic.  Another definition, offering a challenge to the often idealized concept, was proposed by a physician from the Global South as “a concept fabricated by developed countries to explain what is regular practice in developing nations.”  During this, the 19th annual National Public Health Week, let’s consider the definition of global health that appeared in The Lancet, “Global Health is Public Health.”

Students in Ecuador Attending a Reproductive Health Information Fair

Students in Ecuador Attending a Reproductive Health Information Fair

Abroad, physicians and other practitioners in resource-restricted settings act simultaneously as caregivers for both individual patients and populations as a whole.  The marriage of public health, clinical medicine, and health systems is cost-effective, pragmatic, and successful.  Slowly the US is catching on, as primary care physicians start to look at their patients, not only individually, but also as panels with certain disease profiles that can be monitored for population-based perspectives.  Similarly, experts have called on medical schools to be accountable to their communities in the Social Accountability of Medical Education movement, suggesting schools success cannot be measured without considering impacts on their own community’s health status.

Discovering Public Health in International Experiences

As head of Child Family Health International(CFHI), students interested in CFHI’s Global Health Education Programs often approach me and ask “What programs are focused on public health?” or conversely, “I want a program solely focused on clinical medicine, not public health.”  What they soon learn upon beginning their CFHI experience, however, is the important reality that in many low and middle-income countries the lines between public health and biomedicine are very much blurred.   This is largely out of necessity demanded by sparse or finite resources, as well as evidence-based and systems approaches to health.

International experiences focused on global health such as CFHI’s have so many proven benefits—studies have shown increased cultural competency, better understanding of caring for people with limited supplies, and a nurturing of lifetime dedication to underserved care.  Importantly, they also increase board scores in public health.  So, rather than asking “how can I find an international experience focused on public health?” consider the question, “how can I find the public health in my international experience?”

How have you found the public health in your international experiences?  Let us know in the comments below.

CFHI Announces New Program in East Africa

CFHI’s Newest Programs in East Africa: Be Part of “An Activated Community” in Southwest Uganda

It is exciting when CFHI finds a partner so well aligned with its values of addressing broad determinants of health, engaging communities to help themselves, and strengthening local capacity for health care and community activation.  The Kigezi Healthcare Foundation (KIHEFO), a non-profit organization operating in Kabale, Uganda, is fighting disease, poverty, and ignorance by creating “An Activated Community.”  In partnership with KIHEFO, CFHI’s new Uganda programs HIV & Maternal/Child Health and Nutrition, Food Security & Sustainable Agriculture offer students from all academic backgrounds a firsthand learning experience addressing health, poverty, and education.CFHI Uganda Homepage Slide

Uganda is a country in Sub-Saharan East Africa facing many serious health problems and challenges, including high rates of maternal mortality (only 30% of women give birth in a health facility), HIV and child malnutrition. There is a shortage of medical professionals working in Uganda, along with equipment and medications. With the majority of the population living in rural villages and earning around less than $2 a day while subsistence farming, access to healthcare services is a severe challenge.

KIHEFO’s mission is to fight disease, poverty and ignorance in an integrated, sustainable manner. This means not only delivering healthcare, but helping communities deliver themselves out of poverty and reducing the problems causing sickness and disease. The team is large, “an activated community” made up of staff, former-patients and supporters worldwide mobilizing their communities for improved health and economic well-being.

CFHI Student’s Role in Uganda

Through CFHI, students from all academic backgrounds and levels have the opportunity to work closely to learn first-hand about child and maternal health, HIV, malnutrition prevention and rehabilitation, food security, sustainable agriculture, empowerment of women’s groups, micro-credit savings and community mobilization.

Students observe and learn from healthcare professionals working at the General Clinic, at the HIV/AIDS Clinic learn from counselors and former HIV positive patients about testing and counseling HIV+ patients, and participate in a monthly HIV outreach.

At the Nutrition & Rehabilitation Centre, students learn from social workers and nurses about preventing and rehabilitating malnourished children, and participate in nutrition assessments to measure patient’s growth and progress. Additionally, students learn about sustainable agriculture practices, including permaculture, and the importance of crop diversification and growing food closer to home.

KIHEFO believes there is no single cause of disease, much like there is no single solution.  Mirroring the CFHI approach they believe initiatives must be integrated, community-based and sustainable. Join CFHI’s Uganda Programs to learn from the people behind the “community activated” model for improving health and livelihoods.

Learn more.

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

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

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

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

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

Jason Chodakowski

Northwestern University Feinberg School of Medicine

MD Candidate – Class of 2016

Social Justice: Embracing Global Health Complexities

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.

The Power of IFMSA & The Global Health Placebo Effect

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!

Turning Dark Profits into Enlightened Transformation

From Skepticism to Hope: Turning Dark Profits into Enlightened Transformation

I’ve been a doctor now for 13 (lucky) years but I recently had the opportunity to reflect on my path towards becoming a physician and my involvement in Continue reading

CFHI & Northwestern University Students Impact Women’s Health in Mexico

A Global Team

Global Health Initiative (GHI) at Chicago Lake Shore Medical Associates is a nonprofit organization leading through philanthropic advocacy.  Funding from GHI provided medical students at Northwestern’s Feinberg School of Medicine (FSM) the opportunity to engage in a month-long global health experience in Oaxaca, Mexico with a lasting impact.  Beginning in 2011, Continue reading

How Can We Think Globally & Act Locally?

Phrases like “Think Global, Act Local” and “Global Health is Local Health” are catchy, but it’s sometimes difficult to figure out what they really mean. Continue reading

CFHI Featured at AAFP Global Health Workshop

Child Family Health International’s  Quito, Ecuador Medical Director Dra. Susana Alvear and Global Medical Director Dr. Jessica Evert were featured in the closing keynote address of the 9th Annual AAFP Global Health Workshop.  Nearly 300 attendees from 25 countries attended to share ideas, evidence, and inspiration on topics ranging from global health education at US institutions to the proliferation of family medicine around the world to the ethical challenges of global engagements.

Drs. Alvear and Evert presented on the realization of ethical aspirations- breaking down ethical concepts into practical topics and tangible actions.  The presentation was warmly received.  Dr. Dan Ostergaard,  AAFP’s Vice President for Health of the Public and Interprofessional Activities emphasized the application of CFHI’s motto “Let the World Change You” for all trainees, faculty, and physicians active in global health.  He also emphasized the concept drilled home by Drs. Alvear and Evert that we should really speak of “Toward Equity” rather than “Equity” itself given the gross disparities around the world.  Drs. Evert and Alvear emphasized the ability of institutions and individuals from developed countries to highlight the value of assets in developing country contexts—for example, richness of culture, strong traditional medicine practices, resourcefulness, rather than emphasizing the disparities of financial resources in order to ‘level the playing field,’ a concept originating from CFHI’s former Executive Director, Steve Schmidbauer.

Great respect and admiration were expressed for CFHI’s leadership, program structure, and partnership model.

Global Health Training Guidebook: 2nd Edition Out

Global Health Training in Graduate Medical Education: A Guidebook

Extra, Extra! Read all about it!  Just published, the second edition of the guidebook is edited by Jack Chase, MD and CFHI’s own Medical Director, Jessica Evert, MD.  The book builds upon the  first edition to provide an expanded, evidence-based perspective on curriculum and capacity-building in the global health workforce.

The guidebook contains relevant material for readers at many career levels, from college and professional students to medical educators and residency and fellowship training program directors.

The 2nd edition is now available in paperback and e-book from Amazon.com, and can be read from the GHEC website.

Congrats, Dr. Evert!

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Read more about CFHI’s Global Health Education Programs that provide global health training to 700 students per year.

 

Students Asking Difficult Questions on Global Health Engagement and Development

During the Western Regional International Health Conference I had the privilege of lunching with a group of inspirational and innovative undergraduate students from the University of Washington and University of British Columbia.  At University of Washington students have created the Critical Development Forum (CDF),  a think-tank creating Continue reading

CFHI Sexual Health in Ecuador Program Highlights Constitutional Priorities

In 1998 Ecuador was the first Latin American country to name reproductive and sexual health as constitutionally guaranteed human rights.  Continue reading

Celebrating 20 Years of CFHI

Happy Birthday, Child Family Health International!

2012 marks the 20th anniversary of CFHI’ s transformative Global Health Education Programs and Community Empowerment. This milestone gives us a chance to celebrate and to look back on the impact of CFHI. Continue reading

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

Oxford Handbook on Neuroethics

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

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.

CFHI Logo SmallLuckily, 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

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

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

Pallium India

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 Trivandrum, Indiapresence 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 Pallium India

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

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.