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
“We are approaching a new highpoint in the prevalence of US residents who were born outside the country.” This is part of a message on the Director’s Blog of the US Census Bureau website that is aimed at the marketing industry, at advertisers of goods and services, but we at CFHI believe it is also important information for current and future health professionals.
While the Census Bureau is providing this new data, none of the basic trends of an increasingly diverse population for the United States should be a surprise to us. Forward thinking health professionals and medical educators have seen the indications of these trends for many years. Health science students (including medical students, nursing students, and public health students) have not waited for courses to be developed by the data that is now beginning to be analyzed, but have taken the initiative to seek out medical electives and rotations that would give them first-hand experience of different cultures and the different ways people view health around the world.
Source: US Census Bureau -Director's Blog
With some 6,000 alumni of CFHI Global Health Immersion Programs to date, we hear over and over again from them how their CFHI experience gave them insight into the role that culture plays in health and healthcare. Tenny Lee, a 2010 CFHI Mexico alum, reports: “My experience in Mexico has given my medical career a foundation to help underserved communities and break though language and cultural barriers.” You can read more about her CFHI experience in her review posted on the website Great Nonprofits. The ability to competently serve a more widely diverse patient population will clearly become the expectation for health professionals, as we can see from the wealth of information that the US Census Bureau is releasing.
One of the most important data points released so far is that the Hispanic population of the US now exceeds 50 Million, a 43% increase since the last census as reported by CNN. And it is not just in border states in the south. The CNN article quotes demographer Jeffrey Passel at the Pew Hispanic Center as saying, “Previously, the Hispanic population was concentrated in eight or nine states; it is now spread throughout the country.”
Medical schools, organizations, and institutions of higher learning have also recognized these trends, and CFHI has been happy to work with many of them to design specific programs. The Patient Advocacy Program at the Stanford Medical School began a program abroad with CFHI in 2007. The University of California at Davis has partnered with CHFI for over five years now to offer a Bi-National Health Quarter Abroad program for undergraduates in special arrangement with the Chicana/o Studies Department at UCD. Both of these programs also make use of CFHI’s built-in Spanish Language and Medical Spanish Instruction. Students are also living with host families so they are immersed into the culture during the program. Guided journaling and weekly meetings help students reflect and integrate what they are learning from their daily interactions. CFHI is also working with others, including Northwestern University, The Student National Medical Association (SNMA), -which you can read more about in an earlier posting– and the Public Health Institute in association with the Global Health Fellows Program. CFHI has been able to partner with each group and use our 20 years of experience working at the grassroots level in underserved communities abroad to design programs that meet specific learning objectives that are achieved in real life settings with the help of local health professionals who have the unique expertise of the local healthcare system and the best understanding of the local culture.
Jessica Brown, a 2010 CFHI Ecuador alum, pulls it all together in her reflection about her CFHI experience:
“… [I] learned a wealth of information about health that extended beyond the Reproductive realm.” Jessica goes on to say, “I learned a lot about Ecuador’s healthcare system by discussing health care access, education, socioeconomic class and ethnic background with my mentors and preceptors. I learned about how religion, education and customary social/cultural schools of thought (i.e. machismo) weigh heavily on Ecuador’s society, and individual minds; I saw how the cultural “way” dictated the population’s attitude towards healthcare, especially in Women’s Reproductive Health.
The moments that caused me to question belief systems in place within myself really stretched me beyond limits I never knew possible. And it is these reflections upon the state of health care in Quito that can broaden my understanding of client needs, beliefs and culture here in the states.”
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
CFHI and SNMA have teamed up to present this new and specialized program that offers participants the opportunity to participate in a 2-week global health program in the city of Oaxaca Mexico!
The Student National Medical Association (SNMA) is the oldest and largest, student-run organization focused on the needs 
and concerns of medical students of color. For over 40 years SNMA has been dedicated to ensuring culturally sensitive medical education and services. For 20 years, CFHI has been offering Global Health Immersion programs designed to help students appreciate the role that culture plays in health and healthcare. By teaming up, CFHI and SNMA hope to make a Global Health experience accessible to more students. This special 2-week program, previously open only to SNMA members, is now open to all health science students. Space is limited so apply early.
The SNMA-CFHI 2-week Urban Primary Care in Oaxaca program aims to introduce students to the cultural competencies that are crucial for effective health care professionals. This program is tailored for those who wish to increase their cultural and linguistic competency as well as their understanding of the health factors affecting Latinos.
Oaxaca is an excellent setting for studying the healthcare system of Mexico and the healthcare practices of the population. Students often hold the false assumption that the healthcare is available to all, but find in Oaxaca that poor and rural populations are increasingly unable to compete for scarce health resources.
CFHI programs offer participants the opportunity to learn more about health issues that transcend national borders, class, ethnicity, and cultural divisions. By participating in CFHI’s global health education you will gain a unique insight into healthcare systems of developing countries and increase your cultural competency. Increasing one’s awareness of other cultures (cultural competency) is becoming increasingly relevant for healthcare professionals as industrialized countries become more ethnically, culturally and linguistically diverse. Click here to read an article and learn more about why cultural competency is important for today’s healthcare workforce.
The program dates are June 3rd to June 18th. Please visit the CFHI website to learn more.
We look forward to having you join our grassroots work to build a global community in support of better healthcare for underserved communities and more globally aware health professionals!
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
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.
Report from the Student National Medical Association 2010 Conference
SNMA Conference 2010 Chicago
It is early Spring in Chicago and this is my first visit to the Student National Medical Association (SNMA) annual conference. The SNMA is the oldest and largest independent student-run organization focused on the needs and concerns of medical students of color. CFHI has supported this conference in the past and we have been happy to have the help of the SNMA in increasing awareness of CFHI programs to more and more students. We have been looking forward to actually being here this year and as the conference begins, it is clear that the students who have assembled on this balmy weekend in Chicago have a great deal of interest and wonder about Global Health.
From the CFHI Table at the 2010 SNMA Annual Conference in Chicago
It is only the first day of the conference and the stream of students who have come to learn about CFHI programs has been almost nonstop. This medical education conference carries the title Healthy Impact 2010: Educate, Advocate, Empower. The goal is to further the SNMA mission to support the pursuits of current and future underrepresented minority medical students and successfully train clinically excellent, culturally competent, and socially conscious physicians. The organization of the conference and its program are as impressive as the seriousness of the students.
Not even 24 hours on the ground here in Chicago, and already I have met CFHI alumni from CFHI programs in Bolivia, South Africa, and India. I look forward to the coming days and the sharing of ideas and experiences.
Today, I had the good fortune to be at the Oregon Student Nurses’ Association Convention 2010 at the University of Portland. CFHI was happy to be one of the sponsors for the event. Approximately 300 nursing students from across the state assembled for their annual meeting. It was a great reminder for me of the importance of nursing in our own healthcare system and it made me think of the pivotal role of nursing in so many of the countries where CFHI works.
CFHI local Medical Directors from Mexico to India have often taken great care to point out to me the specific and vital contribution of nursing in their own healthcare systems. In New Delhi, for example, CFHI Medical Director Dr. Vimarsh Raina has made a great commitment to raising the awareness of the Indian youth to nursing as a career and for advancing the skills of nurses. CFHI has been happy to assist Dr. Raina in providing some scholarships over the years to help make nursing education available to young people who might otherwise not be able to afford such an opportunity. Then, of course, there is our own CFHI Medical Director in Cape Town, South Africa, Mrs. Avril Whate, who herself is a Nurse Practitioner and a Certified Midwife. With an impressive long career in a healthcare system that has faced many significant challenges, she is very adept a helping international students of all health professions process the profound experiences that they have while on CFHI rotations in Cape Town. She actually has the fan club to prove it. Recently, Avril and the CFHI Local Coordinator for Cape Town, Marion Williams, were able to visit the United States. During a multi-city, cross-country tour, there was an outpouring of CFHI alumni –many who are now nurses and doctors— who turned out to welcome and reconnect and to say thanks.
Back to Portland, where today’s convention carried the theme: The Future or Nursing,
The Future of Nursing Oregon Student Nurses Association Convention
and clearly, I was able to meet and talk with a real slice of the future of nursing and I was very happy to see a healthy appetite among them for all things related to Global Health. CFHI’s Global Health Immersion Programs have had many many nursing students over the years and we are happy to welcome the new generation. If the passion, motivation, and commitment I saw today in Portland are any indication of the level of interest in Global Health among today’s nursing students in general, then it is indeed a good day for Global Health.
CFHI’s program in rural areas of Northern India will expand in 2010 and our student programs will support a local doctor’s dream of increasing access to healthcare in this region. Dr. U.S. Paul has been working in the surrounding areas for many years and he knows well the needs of the people in rural villages. We are happy to help him in this new effort to serve thousands more people in the foothills of the Himalayas who have little or no access to healthcare. The effort is being conducted by a local nonprofit, the Indian Global Health and Education Forum. The village of Sirasu will be one of the areas served. The villages are accessible on foot after crossing the great river. This photo shows the crossing point at Gullar on the River Ganges, about 45 minutes drive north of Rishikesh.
Ganges Crossing Point at Gullar
As we made the drive along mountain roads tracing the edge of the gorge, with sheer drop-offs right next to you that are not for the faint of heart, Dr. Paul spoke of his excitement at being able to operate regular health camps for this remote population. The area around Sirasu is one of several village groupings that will be served Sirasu and its grouping have a population of about 1,500 people. Each village has its own identity and Dr. Paul is an expert at providing care that is respectful of the cultural differences that may exist even from village to village.
Crossing to the East side of the river Ganges in a simple rowboat, I looked over and saw Dr. Paul beaming with joy because he knows how important these services are to the people.
Crossing The River Ganges --Mr. Mayank Vats, CFHI Local Coordinator, and Dr. U.S. Paul board a boat to cross to the East side of the Ganges river
Once across the river, it is a 20-30 minute hike up the East side of the gorge to Sirasu. Dr. Paul meets with village leaders to discuss recent developments. An initial camp was held in November during which Dr. Paul saw more than 150 people in one day. The people ask Dr. Paul to schedule the camps as often as possible. With many other villages to cover, Dr. Paul says he will plan to make monthly visits. While they would wish for more, the people are very happy and express their gratitude.
Local School that serves as a site for the health camp
The camps are conducted at the few local schools as these are natural gathering points and are the largest structures around.
Everything is built on relationships. The local formalities of introductions and meetings to discuss the different aspects are a time to build trust and gain the valuable support of village leaders. These meetings over cups of tea are important times to size everyone up and get a feel for each other. It is the oral culture’s way of completing an application form.
Every meeting has to have tea
We look forward to these additions to our program and to developing these new relationships.
After meeting with local leaders of Sirasu to discuss health camps
David Liskey (in a photo by Jan Sonnenmair), was a 2008 CFHI South Africa participant that came to us through our Oregon partner IE3.
David Liskey photo by Jan Sonnenmair
David was featured recently in the Oregon State University President’s report. Read about his experience and “how race, culture and poverty affect health care in a country with one of the highest HIV infection rate in the world.”
David participated in an 11 week program with CFHI and received credit from his home institution. From his first-hand experience, he wrote a University Honors College senior thesis. David was perceptive and able to see how culture impacts health.
In the president’s report, he reflects, “The different experiences and topics I studied had an effect on how I see the world.”
Dr. Ebrahim Khan is a family practitioner with a private practice in the Kwazulu-Natal Province of South Africa and serves as Medical Director of the CFHI program based out of Durban. As with most doctors in South Africa, the demands on his time are great. Dr. Khan’s daily schedule is easily enough for two or three men. His long and distinguished career has earned him the respect and confidence of the local community, and even at this point in his career, his desire to be of service and give back is as vibrant as I have seen in twenty-year-old students, so he is a good match for the many CFHI students from around the world who choose the Durban program. I especially sensed a love for teaching medicine in a way that guides the students to make their own discoveries.
Among the many hats Dr. Khan wears is that of being the Vice President of the Islamic Medical Association of South Africa. In the early 1970’s, a few Muslim Doctors, noting with concern the disparate health services under the Apartheid government of South Africa, embarked upon the establishment of a modest Sunday clinic on the south coast of Natal in Eastern South Africa, where there were virtually no services for the black rural community. This was the birth of what would be called the Islamic Medical Association. With such a deeply personal mission, it did not fade away after the end of Apartheid. Now almost 40 years later, IMA has set up various healthcare and crisis relief centers operating full time in various places in the country where there is dire need for such facilities; social work and counseling are happening for families and children as well. The IMA mission challenges them as healthcare professionals to “establish and project a value system that is a living entity in our own lives, and in the practice of health care solely for the service and the pleasure of the Almighty. ” The health professionals who give their service are truly dedicated to improving primary care for the underserved.
Avril Whate, Vusi Ngcobo, Steve Schmidbauer
One of the many programs that IMA provides here is a small community clinic in Marianhill outside of Durban, a favorite site for CFHI students. One of the services that has been happening for some time now is voluntary counseling and testing (VCT) for HIV. Vusi Ngcobo is the counselor who is responsible for the success of the VCT program here. In an area with such a high prevalence of HIV, it is important that voluntary testing happens so that the virus can be detected as early as possible. For those found to be HIV-negative, they will still receive valuable information about HIV prevention.
The clinic here and the many other projects of IMA are the continuation of a very long tradition of providing healthcare and teaching medical students. I learned that in ancient times, medical education was flourishing in Islamic society as evidenced by written case studies for teaching that date to the seventh century!
During a program visit to South Africa, I continue to be amazed by the dedication, commitment, and resourcefulness of the healthcare workers. I find examples everywhere I go –this one, I wasn’t ready for:
With HIV rates among the highest in the world, you’d think there may be no higher priority in South African health services than addressing this disease and working to prevent it. Meet the new menace, “Tik.”
Dr. Adam has been head of G. F. Jooste Hospital for a little more than a year and in his short tenure, he has witnessed an explosion of drug use in the surrounding community that at times has crippled the functioning of this district hospital. These are the Cape Flats, just ten minutes from the beautiful city center of Cape Town, and there is a real fight here to stop this menace from spreading. The drug is crystal meth, and the impact is devastating. Dr. Adam has had a long and distinguished career as a practicing physician and in more recent years, adding a degree in public health, he has been the doctor/administrator at various facilities in South Africa but he has never seen anything quite like this. They thought they had a challenge seeing 40 or 50 patients per month in the ER who were out of control, high, and totally unpredictable, but now these patients number more than 180 per month, and this is in addition to all other patients seen in the facility. The psychiatric effects of tik (which gets its name from the noise made when the crystalline structure is heated) are severe, and Dr. Adam explains that the ER is not a psychiatric ward. Instead of adding medical equipment, they have been forced to add bullet-proof glass and a metal detector to the entrance area. Patients can arrive in a wild state, combative, and completely noncompliant. “The only choice we have is to sedate them until they calm down and we can begin to help them,” Dr. Adam says, noting that recently one female doctor had to be rescued from underneath a male patient who simply jumped on top of her. This 184-bed hospital is already stretched beyond capacity most every day, and sees 4,500 patients in its emergency room every month. But the evidence suggests things may get even worse. In today’s edition of the Cape Times newspaper, a story by Anso Thom reports that “Tik is the most commonly abused recreational drug in Cape Town…,” and that a new study shows one in ten pregnant women are using tik.
“Tik is holding us hostage in this hospital,” proclaims Dr. Adam. But he is not sitting still. He has formed strong alliances with neighborhood and community groups to help coordinate a positive response from within the community to reclaim its streets and build a network of neighborhood watch and support. He opens the hospital auditorium on Saturdays for community meetings and to provide a safe place for children to come for organized activities. He is most proud of getting approval and funding for an outpatient substance abuse program that will begin very soon. The relentless cycle of treating patients, releasing them, only to have them return in a worse state in only a few days can finally be stopped. Armed with a psychiatrist, an addiction recovery expert, and a local public health masters student to document the progress, Dr. Adam is putting together a team that will take a stand against the menace. Dr. Adam knows that the only way to really fight this new epidemic is to break the cycle of addiction. A holistic approach will aim to help strengthen the family unit as well as the patient. Strengthening the community by strengthening individual families is a plan for wellness in the face of an almost hopeless situation.
“We’ve got to start somewhere,” says Dr. Adam. Reflecting on the toll it has taken on his hospital, Dr. Adam says it would be tempting to say that the hospital is simply not equipped to treat these patients and send them elsewhere. But there is really nowhere else, and Dr. Adam is not the kind of person who could turn a blind eye to a problem like this. You can sense the conviction and commitment in his voice as he says, “Our core business is the health of the community.”
Computer being received at Hospital Civil in Oaxaca, Mexico
CFHI is proud to announce the donation of a Macbook computer to one of our partner sites in Oaxaca, Mexico– the teaching department of Hospital Civil. The donation to the subdireccion de ensenanza department came after the hospital requested this equipment from CFHI as a useful tool in improving operations there. The replacement for the manual typewriter, also in the picture, is a welcome addition to this very busy facility.
The computer will serve in many capacities including logging various activities occurring within the department and in managing the coordination of medical residents working at Hospital Civil. In the photo above from left to right: CFHI Oaxaca Medical Director Dr. Tenorio, Dr. Gabriel Augustin Velasco, the head of Hospital Civil’s teaching department, and CFHI Program Manager Nick Penco, alongside the new computer. CFHI would like to thank the participants of our Global health Education programs as well as support from our donors in making such contributions possible.
Hospital Civil is an outstanding facility with a dedicated staff. CFHI has enjoyed a long relationship with this excellent teaching hospital. This municipal facility is an anchor of the community and has seen everything from the increase of chronic diseases, to the fallout of civil unrest. And Oaxaca was one of the initial detection points of the Novel H1N1 Virus this past year. We commend them on their quick and professional response to what was an unknown crisis. The quality of their work has helped to blaze the trail for everyone working to treat and stop this pandemic.
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.