What is Competency Based Education?
Competency-based education (known as CBE) has been all the rage in medical education for nearly a decade. Competency in this realm has been described as the “habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served” Continue reading
A Post From CFHI’s Medical Director:
I’m just returning from conducting a workshop at the NEGEA Regional Conference. NEGEA is the Northeast educator’s chapter of the AAMC – a gathering of the people who oversee medical student and resident education. Just like many in global health medical education, they are grappling with how to get their hands around the subject and figure out how to increase collaboration.
Continue reading
Global Health TV, based in London, recently visited one of CFHI’s Community Health Projects in India. The Catch Them Young Program is a health education program directed at youth ages 12-19 in a rural area outside the city of Pune. This is one example of a typical CFHI Community Health Project that originates at the local level and therefore has local ownership. CFHI has been happy to provide some of the funding to advance this project and to support the great dedication that local health professionals and community workers have to their own underserved communities.
The 5 minute short film can be seen on the Global Health TV website. We have posted it to the CFHI YouTube Channel as well. It also shows one of CFHI’s Global Health Immersion Programs in India. CFHI seeks to identify local community health professionals who are dedicated to local underserved communities.
GHTV Feature of CFHI Community Health Project in India
These unsung heroes are local experts and CFHI works with them to develop the 4-12 week Global Health Immersion Programs that international students of the health professions attend. The programs are empowering to the local community as the community sees their own health professionals instructing and mentoring international students. The film had its debut at the Canadian Conference on Global Health in Ottawa, November 1-3, 2010.
Stella Chiu who spent part of her summer on one of CFHI’s Global Health Immersion Programs in South Africa contributed to a blog on the IE3 Global Internships website. Her blog post
Coming Home with New Perspectives is an honest sharing of her thoughts as she is still in the re-entry process. Stella says, “I haven’t had any major problems re-integrating. However, the only difficulties I’ve encountered are through the new perspectives that I’ve gained.”
Stella reports that after being completely immersed in the South African culture and healthcare system, and especially with the warm welcome of her South African host family, she now finds herself, at times, ‘homesick’ for South Africa. Stella recommends to others who go abroad to build in time to reflect after coming home, to “sit down and think” so that you can become aware of how your perspective has changed “both personally and professionally” by what you have experienced. She says of her friends, “Sometimes it is hard for others to understand my outlook on certain things because they have not experienced what I have experienced.”
As part of her own reflection, Stella shares, “I am grateful for the opportunity CHFI-South Africa has given me in developing my clinical skills and finding my niche. I did rotations in surgery, pediatrics, ophthalmology, and in internal medicine and found an unexpected love for surgery. I grew to understand South Africa’s health care system, as well as its deficiencies, setting the groundwork for when I can return someday to work. I have built lifelong relationships with students in the program, and the families that I stayed with. I know that I will always have a home in South Africa.”
We wish Stella well as she continues her re-entry and we know that her host family and those who worked with her in South Africa were grateful for her presence and will never forget her.
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.
“It made me want to be a doctor a lot more, for sure,” she said. “Seeing doctors in action, they were really fantastic role models. It’s hard to get exposure shadowing doctors here (in the Bay Area). I’ve had a few opportunities at Stanford. The more time I got… the more inspired I am to become a doctor.” These are the words of Christina O’Neal, as reported in the Contra Costa Times by Correspondent Doug Mead. Christina, a Stanford University premedical student, spent part of her summer in the Cultural Crossroads in Health Program in 
Oaxaca, Mexico.
Christina told the Contra Costa Times in the article that her month on the CFHI program in Oaxaca, “was pretty life-changing. Everybody gets pretty much free health care there,” she said. “It’s interesting to see how things are run. There’s a lot of poverty, and the government, in terms of health care, has a lot of problems. But the infrastructure was good. I was impressed with how smooth it ran and how dedicated the doctors were. It was an awesome experience.”
The experience really improved Christina’s Spanish and Medical Spanish skills. “I’d say, before I got there, I was conversational (in Spanish),” she said. “Now, I’m borderline fluent. My comprehension, especially, skyrocketed. I’ve always had a pretty standard ability to speak. Now, I understand everything that’s happening. Even though my vocabulary didn’t grow as much, I can express myself better. Once you understand people better, it helps you to speak more correctly. We went over grammar and medical vocabulary every day (in class).”
We are very glad for Christina that her experience was so impactful and we greatly appreciate her kind words about the CFHI program as she ended her interview with the newspaper saying, “Everything was fantastic. It surpassed all my expectations. It was a phenomenal experience.”
CFHI students made the local press in Ecuador this summer. La Prensa, a local publication in the town of Puyo in the Pastaza Province of Southern Ecuador, carried a full page story of CFHI Students on the Amazon Indigenous Health Program, one of CFHI’s Global Health Immersion Programs.
CFHI Students Make New in Ecuador Summer 2010
Puyo, a city of about 25,000 people, with its close proximity to the Amazon Jungle, functions as the base for this program that allows students to see the interplay between the government Ministry of Health and the traditional medicine of indigenous populations living in the jungle much as they have for many hundreds of years. Dr. Wilfrido Torres, a local physician and the Medical Director of several CFHI programs, reports that international students coming to Puyo and to the Jungle Region, “help the local population see that local doctors and community health workers have important knowledge to share with the world.” CFHI is honored to have local experts like Dr. Torres who are eager to interact with international students.
This summer, the CFHI students were able to participate in a medical conference that CFHI helped support. The conference, a multidisciplinary conference on the latest treatments and testing for diabetes and hypertension, was part of a series of conferences to educate health professionals and paraprofessionals on these chronic diseases that are relatively new to the local population.
Australia site of Global Health Conference
CFHI is very happy to be at the Global Health Conference in Hobart, Tasmania that is being put on by the Australian Medical Students’ Association (AMSA). The conference running 1-4 July has a full academic program with impressive topics and excellent speakers. The entire conference is organized by and for students and the level of professionalism is truly outstanding. CFHI is very happy to be an NGO sponsor here and we find the interest and engagement of the students to be at a very high level. A CFHI alum from Perth, Samantha Mulholland (2009, Pediatric Health, La Paz), has been present and giving her first-hand descriptions of her CFHI experience.
UTAS Site of Global Health Conference Tasmania
The University of Tasmania in Hobart is the site for the conference as some 500 students gather from across Australia and New Zealand, and even from Asia and Africa.
Indeed students all over the world have a growing interest in Global Health. What is refreshing here is that so many of them are deeply informed on world issues, social determinants of health and many other areas. Panels of leading experts, student questions and discussions have all been engaging and enlightening.
Panel discussion at the Global Health Conference Hobart Tasmania July 2010
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
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…..”
Ann Oluloro and Stella Chiu, both students at the University of Oregon have received scholarships awarded by the IE3 Global Internships Program. Many other students from participating IE3 Schools will attend CFHI programs this year and will receive credit from their home institutions. Oluloro and Chiu, “…stood out among their peers…” according to the IE3 Field Blog Website.
Ann Oluloro Bound for Bolivia
Ann Oluloro will be participating in CFHI programs in Bolivia starting in July 2010. In her CFHI application she identified several reasons for seeking entrance to a CFHI program in Bolivia. Becoming a fluent Spanish speaker is important for her professional goals. “Being fluent in Spanish is an important part of my future career because I plan on working in public clinics. Currently, as a volunteer at White Bird Community Clinic, I often see the doctor communicate with patients in Spanish. By being able to speak another language, the doctor is able to break down a communication barrier that would have otherwise existed and is therefore able to provide the patient with the best care she possible can.” She dreams one day of working with Doctors Without Borders and she believes that her CFHI experience, “…will give me a deeper insight into international medicine…” and help her “…learn about a culture and a way of life that books and textbooks cannot provide.” She hopes that her time in Bolivia, “…will give me a glimpse and understanding of a culture that I may otherwise not have a chance to learn about first hand. In addition, the internship will teach me about the structure of public health systems and how such systems are implemented in under developed nations both in rural and urban settings. Ann has done her homework, reading about the challenges faced by many countries to provide healthcare to their populations. “I am highly interested in how some under developed nations are still able to find ways and means in which to implement effective public health systems.”
Stella Chiu will be participating in CFHI programs in South Africa. Stella’s goal is to become a doctor and also to have an impact on underserved populations. She sees being part of a CFHI program as, “…a perfect match for what I want to do with my future. I want to become a physician and gain clinical experience, but I also want to help underdeveloped countries with public health efforts.” For Stella, it is important to be immersed in another culture, “I hope to gain clinical experience in a setting that is different from that of the United States. I believe this would make me a better physician in the future because it will help me see beyond the privileged population and be more competent in serving the less privileged. I hope CFHI will provide me with opportunities to learn and experience things first-hand.”
Both Ann and Stella will be reporting on their experiences so we look forward to more in their own words. We wish these students well as they embark on a summer that they will surely remember forever, and good luck with the tremendous potential of career opportunities that await them in the future.
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.
One of CFHI’s newest programs is a Dental Program set in Quito, Ecuador.
CFHI Global Health Dental Program
CFHI is happy to partner with the Sonrie Ecuador Clinics to provide an outstanding program for pre-dental and dental students who want to understand how oral health is approached in a different culture and a different healthcare system.
The “Sonrie Ecuador Clinics” provide dental care and promote oral health in Quito and its surrounding neighborhoods. The clinics have been operating for over twelve years and continually strive to better the services offered to their patients give attention to the dental health. In general, the main dental problem seen by Ecuadorian dentists is cavities. Ecuadorians are considered to be concerned about their dental health, although adequate oral hygiene is not, in reality, reported amongst the majority of the population.
This program will provide a rich and diverse experience for pre-dentistry and dentistry students, allowing them to view local oral health practitioners providing close to world class care in a developing country while at the same time improving their cultural competency and broadening their public health knowledge. Ecuadorian dental professionals who work in a country are interesting and thought provoking as they give context to the real challenges of providing the best possible dental care to the different socioeconomic classes of Ecuador.
The May-June issue of International Educator, the magazine of the Association of International Educators (NAFSA), contains an article by Karen Legget entitled: Teaching Medicine Without Borders. Ms Legget traces the movement from “International Health” to “Global Health” and the impact this is having on medical education.
She looks at various programs from medical schools to organizations (including CFHI) and conducts interviews with students and administrators alike. Her article can be found through the NAFSA website.
One of CFHI’s newest programs, Sight for All- Ophthalmology Rotation is unique in that it is based out of just one organization- a local NGO located in New Delhi, India. CFHI participants rotate through the various departments, learning how programs and treatment are implemented to reduce preventable visual handicaps. Participants are exposed to mobile eye care clinics, ophthalmic procedures in the operating theater, and take part in advanced level classes at the institute.
The Sight for All program recently had its first participant, Melanie Mamon, and she shares a report on her experiences. To learn more about the program’s location, arrival dates, and clinical sites, click here.