Category Archives: Global Health Education

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

A Doctor Walks Into a Community..

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

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

Two Approaches to Global Health aamcacademicmed

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

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

Humility and Knowledge Key

CFHI Student with Local Doctor, India

CFHI Student with Local Doctor, India

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

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

How it All Began: The Early Days of CFHI

The Early Days of CFHI Featured at San Francisco Film Festivalfilmfest

This past July the documentary film “The Most Distant Places” was featured amongst others at the Bay Area Global Health Film Festival. This story, directed by Mike Seely, is depicted from the perspective of Ecuadorian doctor Dr. Edgar Rodas, then a medical school Dean in Cuenca, Ecuador. The film chronicled the importance of constructing a mobile surgical clinic and the team involved in bringing mobile care to remote communities in Ecuador.

The film festival was organized to shed light on a critical message in need of a strong voice: access to the most basic surgical care is a human right, not a luxury. Dr. Rodas shared his story and expressed an unwavering commitment to his fellow Ecuadorians. As the film came to an end and the audience allowed the weight of the story to settle, he delicately reminded everyone that every effort produces a result. These efforts would eventually result in CFHI- Child Family Health International as we know it today.

A Chance Meeting

A young Evaleen Jones, in Ecuador.

A young Evaleen Jones (right), in Ecuador.

As I sat across the table from Dr. Evaleen Jones, CFHI’s Founder and President, I marveled that even after twenty-one years, she tells the story of CFHI’s beginning with energy and excitement. She reminisced about her time in Ecuador as a third year medical student at Stanford University School of Medicine. At the time, Stanford University did not readily offer International Health opportunities abroad with a student focus. To best serve patients living in densely populated Latino communities within the Bay Area, Evaleen knew that Spanish language and cultural competencies were essential. And so, with only a modest amount of money she embarked on her first adventure abroad.

Once in Ecuador, Evaleen’s efforts to connect with local physicians led her to Dr. Edgar Rodas, the doctor who would be featured in the Distant Places film many years later.  She came to know him as a simple man who exuded a deep-seeded commitment to the well-being of his fellow countrymen.  As a surgeon he rejected the notion that a person cannot have an operation simply because they don’t have enough money. Regardless of the enormity of such an undertaking, he felt the status quo would not suffice.

As chronicled in the film, Dr. Rodas’ goal was to build a mobile surgical clinic. Evaleen, sensing the strength of his presence and understanding the value of his quest, jumped in headfirst and agreed to return to the States to arrange funding for construction of the mobile clinic.  According to Evaleen, “There are some people who you can sense very quickly are special individuals.” Even after only a week of knowing Dr. Rodas, she allowed her instincts to propel her forward.

CFHI Begins

The start of her fourth year in medical school Evaleen hit the ground running. Every conceivable connection was utilized- donations of all kinds– designing and constructing a surgical clinic, shipping the mobile unit. Evaleen’s fearlessness in asking gave her the edge that ultimately convinced others to help. Each someone told her “absolutely not Evaleen, this is impossible,” it motivated her to continue.

It was during this time that CFHI came to life. Approaching potential small-logo2_pngdonors as a recognized NGO lead to greater success. Evaleen had also not lost sight of her original intentions: CFHI was to be a platform to provide medical students (and later students of varying fields interested in health) with learning opportunities abroad, and to increase language and cultural competencies. Dr. Jones states again and again that the world is a classroom and students should pay for the privilege of learning.  Uniquely CFHI, she also saw that students could be a sustainable source of support for locally-run health care efforts that don’t breed reliance on Western ‘aid.’ While placed in the global classroom, students are encouraged to open their minds and listen well, and let the world change them. Even with the passing of time, Dr. Rodas and Dr. Evaleen Jones remain faithful to their belief that, “It has always been about the people, not the projects.”

 

–Lyndsey Brahm

Special thanks to CFHI alumna and volunteer Lyndsey Brahm for her work on this post.  Lyndsey will be attending the University of Copenhagen, School of Global Health in 2014.

Have some ideas and interested in blogging for CFHI?  Email info(at)cfhi.org for details.

Exploring the “Family” in Child Family Health International

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

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

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

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

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

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

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

 

Social Justice: Embracing Global Health Complexities

Internationalizing Medical & Health Education

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

Importance of Social Justice in Health Evolving

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

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

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

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

Student Essays Reflect Realities and Impact of Global Health

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

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

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

The Power of IFMSA & The Global Health Placebo Effect

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

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

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

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

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

CFHI Global Health Approach Shared & Praised at IFMSA

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

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

 The ‘Global Health Placebo Effect’

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

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

International Women’s Day- A Story From CFHI India

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

January 31.  Today we visited Continue reading

CFHI: Asset-Based Community Engagement

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

What Makes CFHI Different?

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

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

Not Just Talking the Talk, But Walking the Walk

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

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

CFHI Welcomes new Director of Research and Evaluation

In the rapidly growing field of global health education, looking at the effects and effectiveness of global health immersion on participants, host communities, and the larger health equity movement is essential.

Dr. Gieseker with CFHI Medical Director Dr. Jessica Evert

Karen Gieseker PhD, MS joins Child Family Health International (CFHI) with a passion for 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.

New MCAT Means Greater Need for Global Health Exposure

The New MCAT – Shaping Future Physicians for the Better

For pre-medical students their life choices are often defined by the MCAT—the often-dreaded U. S. medical school entrance exam that determines whether their professional dreams are dashed or realized.  Rarely do we consider that what we test and emphasize on such exams determines what is prioritized in undergraduate education and consequently Continue reading

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.

 

Trends in Global Health Education: UT Health Science Center, San Antonio

UT Health Science Center, San Antonio Houses Global Health in the Center for Ethics

It’s interesting to consider where a university or medical school chooses to house their Global Health efforts and how this affects the focus and framework of global health activities.  Continue reading

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