Category Archives: study abroad

The LGBTQ+ Population in Uganda

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

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

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

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

For more information, please refer to the following sources:

The OSAC LGBTQ Guide to Travel Safety

The State Department’s Website for LGBTI Travelers

The Human Rights Watch

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

CFHI at the Forefront of Ethical Standards in Global Health Education

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As global health programs increase in popularity among students based in the Global North, an important conversation around “voluntourism” and intentionality in international health-related programs has emerged. Voluntourism often consists of students engaging in short-term volunteer work that they are not professionally, socially, or culturally equipped to take on, and – though well intentioned – often perpetuates hurtful stereotypes that low and middle-income countries need help from high-income countries. At their worst, global health voluntourism programs may offer students opportunities that end up harming patients and other community members. The pitfalls of voluntourism have been widely critiqued, including through popular satires such as the “Barbie Savior– The Doll That Saved Africa.”

How then, as an organization that promotes global health education, does CFHI make sure that our programs – as well as health-related global education programs more broadly – are ethical in theory, approach and practice? Part of the answer to that question is by getting global health organizations on the same page, ethically, and giving them the guidelines needed to run quality health education programs abroad.

CFHI Executive Director Jessica Evert, M.D. has recently co-authored two sets of internationally recognized guidelines for health-related experiences abroad which outline standards in programming that can improve global health programs for students and global partners. These guidelines shift the focus of global health programs away from hands-on clinical work (which can be dangerous and have long-lasting negative impacts for patients and visiting students) and toward cultural and contextual education of healthcare in different settings globally, as defined by local experts and community host partners. They also provide key frameworks for establishing long-term partnerships with host communities rooted principles like reciprocity, local leadership, and fair trade.

Guidelines for Undergraduate Health-Related Experiences Abroad was released by The Forum on Education Abroad, a conglomerate of US colleges and universities, organizations and foundations aimed at establishing standards of best practices in international education programs. Their newly updated set of guidelines is the first of its kind set forth by the Forum and is meant to be used along with the Standards of Good Practice for Education Abroad in order to promote ethical practices specific to health-related international education experiences.

In addition to the Forum Guidelines, Dr. Evert also recently co-authored the article “Guidelines for Responsible Short-Term Global Health Activities: Developing Common Principles” in Globalization and Health, which helps to summarize existing standards and guidelines in the field.  With the release of both sets of guidelines, Dr. Evert and colleagues focus on creating a common ground between institutions and organizations involved in global health education. With clear and concise standards of best practices in global health, organizations are given the opportunity to improve the ethical standards of their programs, and to keep the best interests of host partners and student trainees in mind.

By contributing to standards of best practice in global health education, CFHI is challenging the narrative around health-centered international experiences and pushing other global health organizations to do the same.

Student Spotlight: Ariel

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For our newest Student Spotlight we introduce CFHI Alumni Ariel from California. In June this year Ariel chose our program Healthcare Challenges with focus on Hospital & Inpatient Medicine, HIV/AIDS and Global Health Nursing. She went to Cape Town in South Africa for 5 Weeks. A few months after her return, we asked for a short reflection on her adventure:

 

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CFHI Alumni Ariel in South Africa

A little about Ariel:

I am a third year biological sciences major at UC Davis. After graduating from Davis I want to pursue a career in health by becoming a nurse practitioner or PA. Studying abroad was one of the experiences I was most excited for when I came to college. When I heard about an internship abroad opportunity through CFHI it seemed like the perfect fit.

 

Why she chose CFHI:

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I chose CFHI for a number of important reasons to me. First, I wanted to experience living in a new country to really understand the culture and daily lives of another part of the world. I chose Cape Town because the city seemed like such a lively place with so much to do and so much history to learn about regarding Apartheid. The best way to truly get a feeling for another way of life is to immerse yourself in the country’s culture. I had never been to Africa so I was super excited to learn about a new continent and compare the healthcare challenges with the ones we face in the States. Also, volunteering at Community Day Centers and observing procedures at a pediatric hospital in Cape Town were unlike any other opportunities I had had in the past. Through CFHI, I was able to witness healthcare first hand and be a part of a typical day for physicians right in the middle of the action.

What is next for Ariel:

Taking part in a CFHI program opened my eyes to the different fields of medicine and global healthcare. Before I went to Cape Town, I thought I was set on going into nursing. After going through rounds with med students, watching surgeries, and attending lectures and tutorials, the experience influenced me to consider a PA program. Also, it confirmed my inclination that I want to work in pediatrics. I plan on becoming involved with one of the student run clinics at UC Davis to get more experience with patients. If I was given the opportunity after I become licensed, I would definitely work in a hospital in another country for a longer period of time.

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

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

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

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

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

*Name has been changed to respect privacy. 

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

Alumni Spotlight: Q&A with Alana D’Onofrio

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

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

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

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

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

Q. How did the program impact you?

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

Q. What were the highlights of your experience?

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

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

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

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

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

Q. How has your worldview changed?

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

 

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

CFHI Convenes Pre-health Advisors for Workshop on Global Health Best Practices

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Advising Students on Health Experiences Abroad

On June 26th, I collaborated on a workshop entitled “Beyond the Basics: Advising Students on Health Experiences Abroad,” led by Child Family Health International (CFHI) Executive Director Dr. Jessica Evert and Tricia Todd, MPH, Assistant Director of the University of Minnesota Health Careers Center. The workshop coincided with the National Association of Advisors for the Health Professions (NAAHP) Annual Conference, held this year in San Francisco. Advisors arrived at CFHI’s San Francisco headquarters in to a full house with over 20 attendees representing 15 different colleges and universities. Small Liberal Arts colleges from Maine were particularly well represented, with advisors from Bates, Bowdoin, and Colby College in attendance.CFHI Advising Health Students Workshop

As a grad student of International Education Management, I was interested to observe the backgrounds represented amongst the attendees. Some were faculty in science departments, some staff from career development offices, and others from programs specifically geared towards global health. What everyone had in common was knowledge of issues relating to advising pre-health students, and all expressed worries regarding the growth of an “industry” to meet the rapidly growing demand from students seeking health-training programs abroad.

Health Students Doing Too Much, Too Soon – How to Choose Reputable Programs

The issue of the commodification of education abroad, which I was familiar with from graduate courses, took on greater significance when discussing health-related programs where issues of medical ethics and patient safety come into play. In such cases, not only are students being sold an education abroad “experience”, but unethical program providers tell students that they will be able to perform clinical work that exceeds their training and “change the world” through their work, effectively putting patients’ lives at risk.

Advisors were eager to discuss strategies for guiding students towards reputable programs and avoiding companies and experiences where students are encouraged to “do too much, too soon.” Case studies were presented, based on actual incidents from the field. Some were particularly alarming: undergraduates delivering babies, students conducting hospital rounds unsupervised, even instances of students scrubbing in for surgery! Unfortunately many students are under the erroneous impression that participating in this type of hands-on clinical experience will give them a leg-up in the competitive world of medical, nursing or other health professions school admissions. Part of the messaging to pre-health professions students therefore needs to focus on how performing clinical duties beyond what they are authorized to do here in the U.S. is highly unethical, and could jeopardize their own careers.

CFHI Advising Health Students

Before the evening was over, Dr. Evert, playing the roll of the advisor, and I, playing the part of a well meaning (but naïve) pre-med student, acted out an all too common scenario for the group. Fortunately, in our fictional advising session the student wasreceptive to ideas. The advisor convinces the student to re-examine motivations for wanting to go abroad, and suggests the right questions to ask when choosing a global health education program. The role-play emphasized the many tools available for students to examine their motivations for taking part in a health experience abroad. I think advisors in attendance left the CFHI – UMN Health Careers Workshop with new resources, a feeling of community, and a better sense of how to guide students to help them make better decisions for their global health education.

 

Special thanks to our guest blogger, CFHI Intern Alex Nichol, for authoring this post.

Travel vs. Transformation: Career Impacts

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Travel and Cultural Intelligence

“Where are you from?” is often the hardest question for me to answer. Do I give the short answer, the long answer, or settle for “it’s complicated” like a provocative Facebook relationship status? Yet that dilemma is a small price to pay for all I’ve gained through experiences living and traveling around the world.

A study from the journal of Social Psychological & Personality Science found that those who engage in multicultural and international environments are more likely to be offered jobs. At surface value, this comes as no surprise; in any arena these days—school, job, socially, or otherwise—it is beneficial to set yourself apart, and “multicultural experiences,” are a great way to do so. But simply accumulating stamps in your passport is not enough. In an article on the study, David Livermore writes “If business travelers spend their time at international hotels and offices; and if study abroad students spend their free time on Skype and Facebook, travel may have little positive benefit for improving CQ (cultural intelligence) and career opportunities.”  Travel creates a possibility for transformation through exposure to new cultures and ways of life. But it is easy to pass up that opportunity and flock toward familiarity instead, to head to a Starbucks in a foreign country or find solace from strange surroundings amongst fellow visitors.

The Transformation: How You Engage

Transformative travel requires openness. As more and more and more people seek programmed multicultural experiences— study abroad, volunteering, or simply sightseeing—it is important to evaluate your own goals and the goals of the organization. Responsible international travel necessitates embracing the discomfort and challenges of unfamiliarity, and also willingness to let go of your own authority: to follow the leadership of the locals and see the positive aspects of a community rather than perceived negatives.  To me, the most striking overseas experiences have involved connecting with people through common humanness despite apparent differences. These experiences, not traveling itself, are transformative.CFHIMapWhite

I was drawn to work with Child Family Health International (CFHI) because their global health programs promote an immersive experience through community-based projects and perspectives. Interning here and learning about CFHI programs over the past month has made me reflect on my own international experiences. I was born in the U.S. but since age nine I have lived abroad in different countries with my family. Though I have spent much of my life overseas, some who go abroad for shorter periods of time have had more intensive and challenging cultural experiences than mine. It can be easy to entrench yourself in an expat community and become complacent about pushing beyond that.

The study suggests benefits of international travel for your career; I don’t see my experiences overseas as having made me marketable, though I can’t complain if that is a byproduct. Rather, I see travel as the defining aspect of my life that has provided more unique challenges and rewards than anything else. CFHI’s motto encourages students to “Let the world change you,” instead of trying to change the world. It has and will continue to change me throughout my life. And maybe even get me some jobs too.

 

Special thanks to our guest blogger and CFHI Summer Intern Karoline Walter for authoring this post.

Internationalizing Medical Education: Shaping Healthcare Providers for Global Health

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Internationalized Medical Education: How do we develop competency-based education and realize its full potential?  UN-recognized NGO Child Family Health International (CFHI) has been running global health education programs for over 20 years.  We have seen a lot along the way since our beginnings in a small garage in the San Francisco Bay Area.

Global Health and Study Abroad See Upward Trends

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Fast forward to 2014.  Global health has become a buzzword, conjuring up images of Bill and Melinda Gates projects and Partners in Health initiatives.  Once a field that rallied for press, global health is receiving increasing limelight.  Take a look on the Kaiser Family Foundation webinar on U.S. spending towards global health initiatives or the entire Center for Global Development event devoted to discussing Best Buys in Global Health. Global health teaching in undergrad and medical curricula is also increasing and the 2013 Open Doors Report on International Educational Exchange, states study abroad by U.S. based students is steadily increasing and is at an all time high.   The Association of American Medical Colleges data demonstrates that 35% of US medical students participate in international experiences.  Spurred by increased participation, global health education is evolving from a phenomenon of one-off volunteer experiences to a field of educational theory and practice, shaping the world’s next generation of healthcare providers with skills demanded by an increasingly inter-connected world.

Looking at Competencies in Medical Education & How Students Engage

A study in the journal Academic Medicine shows the structure of global health programs, the degree to which they are imbedded in local health care systems, and having a capacity-building agenda, affects what students learn.  In an era where competency-based education is dominating pedagogy in medical education, we must leverage the richness of global health experiences to meet accreditation standards and competency-based outcomes.  Like studies have shown and CFHI’s 7,000 alumni can attest, global health exposure and international experiences make for better practitioners and global citizens.  CFHI’s approach leverages asset-based engagement and encourages students to “Let the World Change YOU.” stethescopeglobe

As we strive to meet demand and look at the nuances of programming, we must continue to examine students’ international experiences. This month thousands of international educators will gather at the NAFSA conference and discuss these topics at the Colloquium on Internationalizing Education for the Health Professions.  Here and on our own we must consider key questions—what competencies does a globalized health practitioner need?  What competencies are nurtured during global health programs? How do we wed international global health and what is taking place in our own back yards?  Just as important, not all global health experiences are created equal.  As educators and leaders in the field, we must advocate for socially responsible and ethically sound approaches to placing students in health settings abroad.

CFHI Commended in Chronicle for Higher Education Article

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From the Chronicle of Higher Education:

“Over the past decade, the number of American students in health fields going abroad has nearly tripled, with many opting for programs that take them out of the classroom and into clinics and hospitals. But as participation has increased, so, too, have educators’ concerns.

Far too often, experts say, students are providing patient care—conducting examinations, suturing wounds, even delivering babies—for which they have little or no training. Indeed, as competition intensifies for medical-school slots, some students may actually be going overseas for hands-on experience they could not get in the United States, in hopes of giving their applications a competitive edge.”

The article is entitled “Some Global Health Programs Let Students Do Too Much, Too Soon,” and here at Child Family Health International (CFHI) we couldn’t agree more!

CFHI India Student on ProgramCFHI programs are highlighted in the Chronicle article, including quotes and reflections from CFHI’s Executive Director encouraging students to think about ethical implications of their experiences, and shaping student expectations for what is ok to do abroad.

As the field of global health continues to grow, so too are programs and options available to health students of all fields, often promising opportunities to “help” and engage in hands-on experience beyond their training, skill level, or licensure.  From the beginning CFHI has used an asset-based approach for engaging with communities abroad, and encouraging students to “Let the world change YOU.” In this way we position participants of Global Health Education Programs to learn, reflect, and realize that many times the most powerful impact they have in their role abroad is to form connections and relationships with local expert physicians and patients that will serve them in their future careers, as well as learn about the multitude of health determinants and complex global realities that underlie global health challenges.  We’d like to extend a big thank you to the Chronicle of Higher Education for helping us spread the word and advocate for social responsibility in health and medical education.

What do you think should be students’ role in health settings abroad?  How can students balance enthusiasm for learning while respecting ethical boundaries in clinical settings?  Let us know your thoughts in the comments section below.