By Victoria Sevilla

Victoria Sevilla was a Virtual Global Health Practicum Intern for CFHI Philippines in February 2022. She was mentored by Associate Medical Director Paolo Victor Medina, MD. Victoria received her Bachelor’s in Global Health from the University of Southern California (USC), and will earn her second degree in Biological Sciences this year. She credits GlobeMed at USC for catalyzing her dedication to health equity and social justice, but the scope of her activism has since expanded. Victoria holds positions in Right to Health (R2H) Action, a grassroots health policy organization, and the American Medical Women’s Association (AMWA). She is also a member of the American Medical Student Association (AMSA) and the American Public Health Association (APHA). 

For years, I’ve longed to work with CFHI due to their sustainable model with fair-trade partnerships and asset-based community engagement. My undergraduate work with GlobeMed at USC emphasized the importance of responsible global health collaborations, especially avoiding volunteer tourism or “voluntourism.” Despite ramifications to the local communities, traveling to lower- or middle-income countries to “help the less fortunate” is a swiftly growing trend.

Having native Tagalog fluency, I knew my capacity to contribute a culturally-sensitive impact was expanded should I participate in CFHI’s Global Health in the Philippines program. I also understood, however, that my experiences greatly differed living in the United States. In addition to limited financial resources as a student, I did not feel qualified to travel to and volunteer in a country I had not visited since childhood. So upon learning of CFHI’s virtual programs, I was excited for the opportunity to broaden my global health competencies without infringing ethical dilemmas.

Voluntourism is not limited to eager tourists and also extends to the medical community. Historically, medicine has been used to biologically justify racial supremacy.¹ As a result, colonizers excused medical research on native populations and the eradication of their history, culture, and language.¹ Today, healthcare professionals could perpetuate this colonial legacy by performing medical procedures typically beyond their scope of practice.¹ For pre-medical students, volunteering abroad is part of the “pre-med” checklist to look better on medical school applications, all while gaining clinical experience not otherwise allowed in the United States. These undergraduates, untrained and unqualified based on American standards, capitalize on the opportunity with minimal or no accountability.

Though “voluntourists” claim altruistic intentions, a “White Savior,” capitalist-colonial subjectivity remains.² Voluntourism not only reinforces distorted power-dynamics between countries and disrupts local economies, it coerces those already resource-strained to adapt.⁴ Medically, cultural differences and language barriers severely compromise patient safety, especially in rural communities where access to care is scarce.¹ Pre-health students are most dangerous, some having been allowed to diagnose patients, write prescriptions or perform medical procedures by themselves.³ And with more and more natural disasters and extreme weather, the demand for these “humanitarian expeditions” is predicted to increase.⁴ Another layer of complexity are the growing concerns about the misuse of technological advances where “virtual volunteerism” could become another mode of exploitation.⁴ For these reasons, voluntourism is really a form of neocolonialism.

So where does this leave global health students? How do we gain real-life experiences without partaking in the unethical practices we advocate against? We are not excused from “intellectual tourism” simply because of our academic status.⁵ Thus, Withers et al. (2018) and the Association of Pacific Rim Universities (APRU) identified the major obstacles faced in academic practicums and established best practices in response.⁵

Major Challenges:⁵

1. Sending vs Host Institution Disputes
2. Language and Cultural Differences
3. Intentional or Accidental Misconduct
4. Unequal Benefits from Partnership
5. Inadequate Mentorship
6. Student Financial Disparities
7. Practicum Value
8. Physical Safety

Best Practices Recommendations:⁵

1. Competitive Student Selection
2. Transparency on Objectives and Expectations
3. “Pre-Trip” Orientation
4. Pre‐requisite Training
5. Financial Aid
6. Mutual Benefit and Reciprocity
7. Pertinent Mentorship
8. Program Assessments

CFHI’s model ensures these challenges are addressed and best practices maximized. With the help of ​​Dr. Juliana Araya Amador (CFHI Practicum Coordinator) and Dr. Paolo Victor Medina (CFHI Philippines Associate Medical Director and Practicum Preceptor), I was confident my actions were not only ethical and sustainable, but also exemplified the cultural humility CFHI values.

In addition to practicing and teaching Community Medicine as an Assistant Professor at the University of the Philippines College of Medicine, Dr. Medina is the faculty liaison officer to the town of Ternate under the MAGNAMARTE-UP Community Health Partnership Program. With guidance from Ternate’s Municipal Health Officer and based on the town’s current needs, Dr. Medina designed my project to study vaccine hesitancy. The practicum objectives, key responsibilities and expected deliverables were clearly communicated, and all of my questions immediately addressed. At the “pre-trip” orientation stage, online modules included analyses of my cultural profile and intercultural effectiveness, identifying the cultural differences I should be most attuned to. Most valuable of all is Dr. Medina’s impeccable mentorship. His patience and thorough guidance ensured my academic, professional, and personal development surpassed its potential.

Contributing to equitable healthcare delivery to vulnerable populations is an indescribable honor. Currently, there is minimal literature on Filipino COVID-19 vaccine hesitancy, and rural communities are especially at the margins. Working with the citizens of Ternate, we hear their causes for concern and factors in decision making. Promoting open discourse allows us to strategize the best, next steps forward with the local government. Though the 16-hour time difference minimizes direct resident interactions, Dr. Medina and I are able to use it to our advantage. Completing the investigative analysis in my time zone maximizes the field team’s reach in the community. We are literally working around the clock! This efficiency is made possible by the virtual platform and has promising applications for interdisciplinary collaborations.

As Dr. Mellissa Withers’s (APRU Global Health Director) former student, I have had the privilege of her instruction and guidance. Discussing virtual global health practicums and the applicability of APRU’s Best Practices, she supports the expanded accessibility for students. She does not believe it perpetuates neocolonial volunteerism because performative tourists driven by a savior mentality will prefer traveling in-person. Dr. Withers concludes that the ultimate gauge on responsible global health engagement depends on the hosts’ investment and if it strains their resources.

CFHI’s virtual programs allowed international partnerships to progress at a time where borders were closed, but global health collaboration even more dire. This innovative response to the pandemic demonstrates how ethical and sustainable practices can be maintained despite society’s thrust into survival mode.

Learning from esteemed leaders such as Dr. Medina, Dr. Withers, and Dr. Araya is an unbelievable privilege, and I am beyond grateful for the opportunity CFHI has enabled. This practicum experience is a comprehensive application of the competencies I’ve learned, and I hope to participate in an on-site rotation in the future. For students concerned with the wider implications of their global health involvement, CFHI’s well-established infrastructure is a testament to their mission towards responsible engagement.

References:

1. Eichbaum, Q.G., Adams, L. V., Evert, J., Ho, M-J., Semali, I. A., & van Schalkwyk, S. C. (2020). Decolonizing Global Health Education: Rethinking Institutional Partnerships and Approaches. Academic Medicine, 96(3), 329–335. https://doi.org/10.1097/ACM.0000000000003473
2. Everingham, P. & Motta, S. C. (2020). Decolonising the “autonomy of affect” in volunteer tourism encounters. Tourism Geographies, 1–21. https://doi.org/10.1080/14616688.2020.1713879
3. Evert, J., Todd, T., & Zitek, P. (2015). Do you GASP? How pre-health students delivering babies in Africa is quickly becoming consequentially unacceptable. The Advisor, 61-65.
4. Ong, F., Lockstone-Binney, L., King, B., & Smith, K. A. (2014). The Future of Volunteer Tourism in the Asia-Pacific Region: Alternative Prospects. Journal of Travel Research, 53(6), 680–692. https://doi.org/10.1177/0047287514532365
5. Withers, M., Li, M., Manalo, G., So, S., Wipfli, H., Khoo, H. E., Wu, J. T., & Lin, H. H. (2018). Best Practices in Global Health Practicums: Recommendations from the Association of Pacific Rim Universities. Journal of Community Health, 43(3), 467–476. https://doi.org/10.1007/s10900-017-0439-z

“My name is Shirley Yang. I am a CFHI intern, working virtually with CFHI’s Ugandan partner organization, KIHEFO. In this op-ed, I explain the importance of nutrition education in breaking the cycle of malnutrition and clarify misconceptions about causes and effects of malnutrition. After providing a brief overview of active nutrition programmes, run by both the Government of Uganda and international humanitarian organizations, I offer suggestions about how to improve the system based off of my own research and meetings with my supervisor, Dr. Geoffrey Anguyo. “

The role of nutrition education in promoting healthy diets cannot be underestimated. Malnutrition is not characterized solely by lack of food, but also lack of knowledge of available food. Malnutrition, especially in childhood and pregnancy, can have detrimental consequences on one’s long-term well being. The negative effects are not confined to an individual; they will eventually seep into the community and country, affecting human capital availability, economic productivity, and national development. 

In recent years, Uganda has made strides in reducing poverty levels and undernutrition rates. However, malnourishment continues to threaten the Ugandan population as half of children under five and one quarter of child-bearing age women are anemic. To add on, more than one third of all young children suffer from stunting, a consequence of inadequate nutrition and care. There are many factors that drive malnutrition in Uganda, including early motherhood, lack of family planning, lack of access to clean water and sanitation, child diarrhea and malaria, and poor infant and young child feeding practices. 

To break the cycle of malnutrition, organizations are focusing on addressing the nutrition needs of the young child from conception through about 24 months and ensuring the nutritional well-being of the mother before she becomes pregnant. There are numerous movements, initiatives, and campaigns sponsored by the Government of Uganda as well as international humanitarian organizations addressing malnutrition in Uganda, such as the Scaling Up Nutrition (SUN) Movement, Comprehensive Africa Agriculture Development Programme (CAADP) Compact, and Preventing Child and Maternal Deaths: A Promised Renewed. 

As outlined in the Uganda Nutrition Action Plan (UNAP), the Government of Uganda is implementing a multi-faceted approach to eradicating malnutrition by addressing nutrition, agriculture, and food security simultaneously. UNAP focuses on improving maternal, infant, and child nutrition, increasing production of and community access to micronutrient-rich foods, and advocating for increased resources dedicated to nutrition intervention. 

Various USAID programs focusing on improving nutrition in Uganda are also utilizing a multi-faceted approach. For instance, HarvestPlus Meals for Nutrition in Uganda (MENU) focuses on increasing production and consumption of high-yielding iron-rich food such as beans and pearl millet. Such programs operate in rural areas as 84% of the population reside in rural areas and agriculture continues to be the main source of income for the majority of Ugandans.

Nutrition educational practices that directly involve the target audience, whether that be children, their caretakers, or pregnant women, have proven successful. For instance, a program promoting exclusive breastfeeding of infants that included peer counseling for mothers before and after giving birth resulted in increased rates of exclusive breastfeeding for children whose mothers received counselling compared to children whose mothers did not receive counselling. This sentiment is shared by my host organization KIHEFO. 

As shared by former KIHEFO interns through blog entries, “What’s on Your Plate” is an interactive hands-on activity built from KIHEFO’s Nutrition Guide. By inspiring participants, ranging from primary school students to caretakers, to diversify their diets by incorporating locally accessible foods that belong to the five different food categories quintessential for a balanced diet. Additionally, during our meeting this week, Dr. Geoffrey shared an instance in which a young child was severely malnourished and the KIHEFO nutrition center successfully rehabilitated the child using a vegetarian-diet. By telling this case, Dr. Geoffrey emphasized the importance of clarifying misconceptions; in this instance, he clarified that nutrition rehabilitation does not require meat, which most households only consume two to three times per year. This instance reinforced the importance of nutrition education — specifically, the importance of recognizing the importance of eating foods from different food groups to acquire sufficient macro- and micronutrients. 

The multi-sectoral strategy that the Government of Uganda and various humanitarian organizations are undertaking is very comprehensive. However, research has shown that postpartum counselling on breastfeeding is lacking. Although three-quarters of women delivered in a health facility in 2016, only 35% received postpartum counseling on breastfeeding. The disparity indicates that the health system is not taking full advantage of contact points to deliver high quality services. This trend could also extend to other health services provided by health professionals. 

During our meeting this week, Dr. Geoffrey continuously reinforced the importance of reaching out to churches, as the majority of Ugandans rely on spiritual leaders. Outreach is a critical component of ensuring the general public is properly educated on nutrition. Allocation of sufficient funds to outreach and communications is critical. Increasing points of communication, such as at churches and delivery centers, between health professionals and nutritional programme personnel with the general public is quintessential. By connecting with community hubs, nutrition education can be more readily available to the general public.

Every year, dozens of students and trainees head to Ghana to participate in CFHI’s Hospital Medicine in Coastal Ghana program, where they are immersed in a new culture while participating in observational clinical rotations at the Cape Coast Teaching Hospital under the supervision of a team of local preceptors. This post chronicles the experience of four CFHI trainees who participated in this program in 2019 and 2020. During their time in Ghana, they shadowed medical professionals in various departments within the hospital, visited historic landmarks, and broadened and enriched their medical and socio-cultural knowledge. 

Shashank Singh

Shashank Singh, an Undergraduate Environmental Public Health student at Ohio State University, rotated in four different departments at the Cape Coast Teaching Hospital. This experience gave him a great introduction to the Ghanaian healthcare system and its many different facets. He noticed that lack of access to clean water was a recurring problem within the hospital, and this disparity made Shashank realize that water quality is an urgent public health issue that still afflicts many regions of the world and helped to deepen his understanding of determinants of health. He also got the chance to participate in an outbreak event where he accompanied local healthcare workers into the community to provide pop-up clinic services and assisted in health education campaigns. He thought that going into the community was a great intervention and appreciated the opportunity to learn about locally-based initiatives to provide care to those who usually do not have access to health care.

Ka’la Drayton

Ka’la Drayton is a fourth-year medical student at the Medical University of South Carolina. During her first couple of weeks at the Cape Coast Teaching Hospital, Ka’la rotated in both the OB/GYN and internal medicine departments. During her rounds with OB/GYN specialists, she shadowed local healthcare professionals as they tended to emergency room visits, cesarean sections, removal of fibroids, ovarian cancer treatments, and more. While rotating in the internal medicine department, Ka’la was able to witness a variety of different cases such as a hemorrhagic stroke, Mallory-Weiss tear, cirrhosis, spontaneous bacterial peritonitis, and HIV encephalopathy. Her experience gave her a better understanding of the local and global burden of disease as well as how communities are able to remain resilient despite scant resources and  innovate to address local issues such as sanitation, water supply, and electrical outages. Ka’la wrote, “Though their resources are limited they know exactly what to do and how to do it but unlike home, all of those things aren’t laid out beautifully in our Pyxis bin.” Learning more about the healthcare system in a different country allowed Ka’la to compare and contrast her experiences with those in America. 

Even though Ka’la is a trainee from the US, she felt right at home in Ghana. She wrote, “I went from being the only African American during rounds in America to now being the only African American amongst Ghanaians here, and it’s life-changing. Being among people who look like me and are treating people who look just like them, made me so proud.” The local healthcare professionals and staff made her feel very welcomed, shared stories, and bonded over how they share the same issues when it comes to getting consults or referrals from other hospitals. 

Kristin Forkapa

Kristin Forkapa is a fourth year medical student at Ohio University Heritage College of Osteopathic Medicine. During her program in Ghana, she spent two weeks in the pediatric ward and two weeks in the internal medicine ward. Kristin noticed many differences in the healthcare system between Ghana and the US. For example, she noted that in Ghana, one pays for treatment before receiving care, whereas in the US, care is  administered first and then the bill comes after. She also noticed that the relationships between students/residents and attending physicians is much more relaxed in Ghana and has forged lasting friendships with her mentors and fellow trainees. 

Her CFHI experience allowed Kristin the chance to learn the history of Ghana and culturally immerse herself in the local community. On a weekend trip, Kristin visited the Cape Coast Castle — an important landmark in Ghana and where roughly 214 million Africans had been held during the slave trade. A lot of her free time was spent going to the local markets almost daily or visiting her friends family members who live in Ghana. She particularly enjoyed the food – especially the jollof, kenkey, stew, and kebabs.

Jerica Gibson

Jerica Gibson is a Medical Student at Philadelphia College of Osteopathic Medicine. She spent one week in Internal Medicine, one week in a CHPS compound (Community-Based Health Planning and Service) and two weeks in the Pediatric Ward at Cape Coast Teaching Hospital. During her time at the CHPS compound, she shadowed the local staff on  family planning sessions, general consultations, and pediatric check-ups and vaccination. While shadowing residents in Internal Medicine, she came across many ailments such as Deep Vein Thrombosis (DVTs), Malaria, HIV, and Meningitis. This was a new experience for her, as the U.S. has a very different burden of disease and many of these communicable diseases are less present.

Jerica also visited the Cape Coast Castle where she was able to learn about the history of Ghana during the 1600s. In her blog she writes: “It shed light on the slave trade from a different perspective that is not often taught appropriately in the US.” Seeing the Cape Coast Castle in person was very impactful for her and allowed her to learn a lot more about the transatlantic slave trade from a different viewpoint.

Like other CFHI participants in Cape Coast, Jerica witnessed and confronted challenges within the healthcare system such as unsafe water quality, lack of hospital funding, and inadequate access to health services. As someone who has spent a lot of time advocating for better healthcare in the US, this experience opened her eyes to the inequalities that exist elsewhere too. She hopes to continue learning and advocating not just for equality of healthcare in the US, but around the world. 

While each participant’s experience is different, CFHI global health programs in Ghana provide a rare chance for students and trainees in the health and medicine fields to learn and experience what health looks like in a different context and learn from local health leaders while culturally immersing in the communities that they serve. Participants emerge from their programs with a better understanding of health and its determinants, a network of peers and mentors, and a deepened sense of self and service.

CFHI’s programs in Ghana are now being offered virtually- check out virtual internships and virtual practicums here. All of CFHI’s Virtual Opportunities can be found here: https://www.cfhi.org/virtual-opportunities

We love hearing from CFHI Almuni about how their global health immersion experience impacted them as health providers.  This month we’re sharing the reflections of Magdalene Kuznia. Maggie   participated in the Tropical Medicine & Community-Based Care on the Coast of Mexico program in Puerto Escondido.  She’s currently a clinical nurse at Stanford University, and a graduate of the University of Michigan School of Nursing.

As a nursing student I had the opportunity to travel to Puerto Escondido with CFHI. I was looking to broaden my nursing education experience. Faculty at my school recommended that I spend a summer working with CFHI so that I can better understand community health in nursing and improve my Spanish. The other CFHI scholars on my program were two physician-assistant students, and one student applying to medical school. It was fun for me to work with other pre-health students, especially ones that were going into different fields in medicine. We each had varying levels of Spanish and knowledge of medicine, so we were all able to learn from each other.

The first few weeks we rotated at different primary care clinics or “Centros de Salud.” I was in a nearby clinic that usually had two doctors and two nurses. The nurses would triage the patients, and then the doctor would see about 10 to 20 patients for about 20 to 30 minutes. The nurses there had autonomy to decide which patients saw the doctor that day, which streamlined the process for the doctor. I loved watching how the healthcare providers interacted with their patients. Appointment time was crucial, since most patients only came in to see the doctor when something was wrong. The doctor had minimal time to provide teaching on the ailment and healthier lifestyle practices. The nurses were able to compliment the doctors sick-care with wellness counseling.

My last few weeks my colleagues and I were together in the hospital. I think some of my favorite experiences were in the labor and delivery unit. The people of Puerto Escondido do not celebrate birth in the hospital like Americans do – the unit had about 10 beds all in one line with each other. The nurses’ station faced the beds, and the doctor would come by and assess down the line which patient was ready to give birth next. There were no men allowed, and the only private room was where the patient was transported to for the actual labor part. The mother hoisted herself on the delivery table, and hoisted herself off when the baby arrived. None of the healthcare workers celebrated outwardly when a baby was born; the mother later received her baby and went on with her day. However, one man was so excited to have his first child, he snuck on to the unit to visit his wife and baby. The new parents were so excited and burst into tears of joy. The nurses allowed them to have their time together and then promptly shooed the man away to give the other patients their privacy. Their touch of excitement broke up the hustle and bustle of the day.

In nursing school, we discussed often the importance communicating on the same level as our patients. While we are educated in medical terminology, many people are not. As nurses, it is our focus to translate the medical language and apply it to our patients’ world. Puerto made this layer an important challenge for me. My Spanish skills were put to the test as I did my best to understand the common language of the people and the medical language of the health care practitioners. My Spanish going into the trip was purely conversational at best. My first weeks in Puerto I was able to physically see the affects of the disease or trauma on the patient, but later I became much better at listening to how the ailment affected the patient personally. CFHI offered us medical Spanish classes in the afternoons, which helped us piece together some of the issues we saw in the clinic or hospital earlier that day. I definitely saw an improvement in my Spanish-speaking skills by the end of the trip.

To this day, I still dream of the food that I ate and the beaches I ventured. Additionally, my time in Puerto ensured how I much loved taking care of different populations. It was a challenge taking care of people with a different language than myself. As a nurse today, I am constantly humbled by what I have to learn from others, and I am so happy my time in Puerto helped open me up to what the world can teach us.

CFHI is honored to receive interns from around the world at our offices in San Francisco. This summer we have the pleasure of welcoming Alessandra Khodaverdi from the University of San Francisco. Alessandra is a Master of Public Health student who is deeply passionate about traveling and ensuring global health equity. During and after her internship, she hopes to integrate CHFI’s guiding principles of sustainability, humility, and reciprocity into her own work on community and global health disparities to build a better future for all.

Greetings! I am Alessandra Khodaverdi, an MPH student from the University of San Francisco. I am currently in my final program semester, and am finishing my current capstone project on health equity and access from the lens of undocumented migrant workers in host countries. Recently, I participated in an internship through the United Nations-mandated University of Peace in Costa Rica. This short-term experience in global health (STEGH) made such a profound impact on my life not only as a student, but also sharpened my public health lens as a professional. The first-hand knowledge and education about the integrative aspects of culture, human rights, environment, and sustainable health practices are immeasurable, and I will carry them with me forever.

Benefits and Drawbacks of Short-Term Experiences in Global Health

While high-income countries (HIC) student trainees are embarking on global health experiences in low-and middle-income countries (LMIC) in growing numbers, the perceived benefits and disadvantages for host communities are not well captured. An obvious interest and increased demand for global health education has directly expanded educational programs and STEGHs. However, despite positive intent to gain knowledge and make an impact in developing communities, such STEGHs may actually exacerbate global health inequities. “In the absence of clear definitions, standards, impact data, and appropriate conducts, STEGHs may represent a suboptimal use of time and resources, harm the host community, and even perpetuate global health inequities” [4]. Frequently, an array of ethical issues arise when trainees volunteer or are asked to perform tasks beyond their scope of training. Other factors such as  false advertisement by unreliable volunteerism programs, vague admissions criteria, and lack of program and student oversight contribute to an unethical nightmare. This is a particular problem when HIC trainees travel to under-resourced communities where patients are completely unaware that these pre-health students are not actual health professionals, despite the trappings of white coats and scrubs.

A plethora of studies have well-exemplified and highlighted the various benefits of STEGHs for student trainees. Such benefits include increases in skills and confidence, better understanding of the social determinants of health, and dedication to underserved communities back home. As supplemental studies into the underrepresented LMIC voices are desperately needed, a recent CFHI study conducted in La Paz, Bolivia and New Delhi, India revealed important insights into the perspective of LMIC host community members with regards to STEGHs. Benefits for hosts included improvements in job satisfaction, rise in local prestige of physicians and their practices, resource enhancement, and opportunities for global connectedness, leadership skills, and improved local networks and leadership development. Adversely, reported drawbacks for hosting HIC trainees were the perceived hesitancy and apathy of student trainees, unfulfilled promises, lack of cultural sensitivity and equal opportunity. Additionally, the costs of host undertakings continue to go unrecognized despite best practices outlined the Working Group on Ethics Guidelines for Global Health Training (WEIGHT). These WEIGHT guidelines outline and advise the importance of recognizing the true costs in terms of labor, time, and resources for host communities in educational student immersions. [2]

CFHI: Ensuring Reciprocity and Sustainability through Asset-Based Community Engagement and Development

CFHI was designed to prioritize strength-based partnerships, sustainable reciprocal benefits, and clear recognition of costs incurred by host communities. Being that reciprocity and sustainability are central to CFHI’s organizational approach, programs and reciprocal investments in host communities center on the asset-based community engagement/development approach.

With this model, the outsider supports community empowerment by enabling local asset mapping, organizing assets around a mutual agenda, and building consensus toward a shared development goal. The emphasis for support is placed on a community’s existing strengths and potential as the building blocks for success, rather than rewriting the entire script.

As CFHI’s motto is “Let the World Change You,” the organization highlights students as learners, rather than agents of change—as it is imperative that trainees must first understand culture, reality, and context before initiating change. As a future public health professional, these concepts of health equity and sustainability are immensely important, especially in my past work with undocumented women and migrant workers, and future endeavors with vulnerable populations. The most important point I have taken away from both internships so far is the importance of respect —especially for host marginalized communities that invite us to learn. When a mutual respect and cultural understanding is established, it paves the way for open communication, positive leadership, and a true appreciation for the complex challenges and solutions in global health.

Sources:

[1]  Cherniak, W., Latham, E., Astle, B., Anguyo, G., Beaunoir, T., Buenaventura, J.H., DeCamp, M., Diaz, K., Eichbaum, Q., Hedimbi, M., Myser, C., Nwobu, C., Standish, K., & Evert, J. (2017) Host perspectives on short-term experiences in global health: a survey. The Lancet Global Health, 5(9). DOI: http://dx.doi.org/10.1016/S2214-109X(17)30116-X

[2] Evert, J. (2015) Teaching corner: child family health international: the ethics of asset-based global health education programs. Journal of Bioethical Inquiry, 12(1), p. 63-67. DOI:10.1007/s11673-014-9600-x

[3] Kung, T.H., Richardson, E.T., Mabud, T.S., Heaney, C.A., Jones, E., & Evert, J. (2016). Host community perspectives on trainees participating in short-term experiences in global health. (2016). Medical Education, 50, p. 1122-1130. DOI: 10.1111/medu.13106

[4] Melby, M. K., Loh, L.C., Evert, J., Praterm C., Lin, H., & Khan, O.A. (2016). Beyond medical “missions” to impact-driven short-term experiences in global health: ethical principles to optimize community benefit and learner experience. Academic Medicine, 91(5). DOI:10.1097/ACM.0000000000001009

By Lyndsey Brahm
Program Operations Manager

There is a certain energy that is felt walking through the doors of the United Nations (UN) in New York City. It’s inspiring being surrounded by so much diversity, in a place where cultures collide for the common good.

As a long time partner of the United Nations Economic and Social Council (UN ECOSOC), Child Family Health International (CFHI) had the honor of being invited to the 2017 Partnership Forum  to engage in the promotion of opportunities to increase prosperity and sustainable development for all. The forum’s theme was “taking action to improve lives”. CFHI has long been a part of this movement and is recognized for its unique approach to community engagement, prioritizing local empowerment through ownership and recognition of expertise, and utilizing an asset-based approach, which draws attention to strengths within the community rather than weaknesses.

Mrs. Mary Robinson, former President of Ireland and High Commissioner for Human Rights, stressed in her keynote speech that, “we cannot achieve anything without partnership. It simply won’t happen.” In conversation amongst foreign diplomats and UN members, the importance of inclusive, bold and innovative partnerships was discussed in order to strive for resilient infrastructure and to honor the Sustainable Development Goals (SDGs), with special regard to vulnerable countries and a changing climate.

CFHI seeks to bridge the gap between the global north and south through sustainable partnerships that allow for communities to take ownership over their own development and to provide a means for those with great promise to remain within and dedicated to their communities. CFHI’s global health education programs highlight local expertise and encourage program participants to understand and value what it means to be a guest in a community other than their own. This approach has the power to shape future collaboration for the better and instills hope in achieving important global initiatives, such as the SDGs.

By Dr. Jessica Evert
Executive Director, CFHI

As trainees are more and more senior (think resident physicians compared to pre-health undergraduate students), the questions around the content of their global health training, particularly in clinical settings, are more complex. As residents or young faculty we have more clinical skills and expertise, but does that mean we should use international opportunities to focus on clinical care? Is clinical care as a primary focus of global health activities a sustainable endeavor? What happens when we leave and our clinical skills leave with us? As Michelle Morse pointed out in 2014, residents undertaking global health training and service activities requires a new mind-set (read her great commentary: http://www.pih.org/blog/dr.-michelle-morse-a-new-mindset-for-global-health-training). Its no longer acceptable or desirable for resident physicians from High-Income Countries to use large volume patient opportunities in Low and Middle Income Countries to bolster their clinical encounters or surgical case requirements. We have to do better. Even though residents are still in ‘training’ they have skills that can contribute to the capacity of resource-limited health settings, and often these capacities have little to do with directly providing clinical care to patients.

A new article in the Journal of General Internal Medicine walks residency programs through a thought process on how to create opportunities for residents to engage in global health. The approach is based on four fundamental questions.

Who are you teaching?

How are you teaching?

What are the goals of your Global Health program?

What are your resources?

The last question is an important one. While many programs aspire to build a wide breadth of opportunities in global health for trainees and faculty, the administrative support can be lacking. For programs with limited resources, it is suggested that partnering with an organization, such as Child Family Health International, as an ‘extender’ of the personnel, relationships, quality improvement, and curriculum necessary to provide thoughtful and impactful global health education and engagement. Residency programs grappling with the opportunities and challenges presented by Global Health are well served by this new publication and the thought process it outlines. Here’s to developing the fundamentals and collaboration necessary for safe and impactful global health training and service!

By Lyndsey Brahm
Program Coordinator

AIDS 2016 began in earnest as public health officials, policy makers, civil society leaders, persons living with HIV/AIDS and others committed to ending the pandemic, converged to collectively assess the global AIDS response and to roil the assembly into accessing equity rights now, the conference theme that resonated throughout the Durban International Convention Centre for five eventful days. Those in attendance, including UN Secretary-General Ban-Ki-Moon, UN AIDS Director Michel Sidibé, KwaZulu-Natal Premier Willies Mchunu, and His Royal Highness Prince Harry, were called to redirect attention to vulnerable populations and scale up prevention and treatment for women, girls and youth.

Child Family Health International (CFHI) is a fierce advocate for local capacity building within our partner communities across the globe. One mechanism used to support this effort is through funding of professional development opportunities for our international partners. CFHI Local Medical Director in Kabale, Uganda, Dr. Geoffrey Anguyo, and Founder of Kigezi Healthcare Foundation (KIHEFO), CFHI’s partner organization in Kabale, attended the conference along with his colleague, Martin Ngabirano, Volunteer Projects Coordinator at KIHEFO.

Dr. Anguyo specializes in HIV/AIDS. In more than twenty years of practicing medicine in Uganda as a primary care physician, in private and government hospitals and through non-profit healthcare delivery, he has devoted himself to the cause and inspired his team at KIHEFO, as well as members of his local community, to join the march. Dr. Anguyo is pursuing a Doctorate of Public Health at Bath University in the United Kingdom with a specialization in HIV/AIDS.

“It was a very great opportunity for me to attend the 21st international conference on AIDS supported by CFHI. I was able to interact with many international scientists and organizations on the KIHEFO version of community engagement in managing HIV/AIDS using integrated and sustainable approaches,” remarked Dr. Anguyo.

UNAIDS (http://www.unaids.org/en/regionscountries/countries/uganda) reports that 7.1% (% of population ages 15-49) of Uganda’s population in 2015 suffered from HIV, nearly 1.5 million people, 96,000 of whom are children aged 0-14 living with HIV. 28,000 people in Uganda have died of AIDS and 660,000 children (age 0-17) were orphaned due to AIDS.

“I was honored to be able to connect the leading industry decision makers and get their commitment to join our efforts to step-up public health through volunteering among others. Dr. Anguyo and I were able to learn trending research findings and targets and share KIHEFO’s renewed commitment to contribute to ending this deadly disease by 2030,” commented Martin Ngabirano, reflecting on his experience during the conference.

The conference has provided Dr. Anguyo and Martin with a unique set of tools and an expanded network within the global HIV/AIDS community to continue their efforts with renewed strength and a fresh perspective back home in southern Uganda. They plan to engage CFHI participants in these efforts, which will prove to be a valuable learning opportunity for those who take part in either of the two program tracks offered in Kabale (link to programs).

“I was involved in discussions to promote comprehensive sexuality education as a tool in decreasing HIV risk factors in adolescents and young, including creating demand for sexual reproductive health. I am now applying this knowledge to create youth groups and use peer approach to get more young people involved in decreasing HIV risk factors. We plan to engage more CFHI students in this activity to promote cross-cultural approaches in decreasing HIV risk factors in young people in the coming months,” said Dr. Anguyo.

Martin commented excitedly, “The conference has renewed my confidence in working with available resources both local (our nature and wildlife) and beyond borders, like CFHI participants, to inspire us to change our lives.”

“Modern medicine’s focus on mastering each part of the human body and the diseases that make them malfunction has generated remarkable power to sustain life. But this focus… has neglected the dying and their suffering, as if repressing a shameful secret.” (1)

Dr. Raj conducting a home visit, Trivandrum Southern India

This “shameful secret,” revealed in the 2015 Quality of Death Index (2), is

no secret to Dr. M. R. Rajagopal, co-author of a new piece in the Lancet that reviews the 2015 Index. As the founder and Chairman of Pallium, India, he has brought palliative care to the fore in India through education, advocacy, and service provision. Through various initiatives, he has dramatically expanded access to palliative care in India’s state of Kerala and beyond.

Dr. Rajagopal and Pallium, India, are CFHI partners and offer CFHI students the opportunity to learn firsthand about palliative care in Kerala.

Ms. Hema and Dr. Raj on home visits

The 2015 Index findings indicate that poor countries can, under the right circumstances, offer effective palliative care. The authors point out that while most of the top scorers in terms of palliative care provision are high income countries, several low and middle income countries (for example, Mongolia and Uganda) did score much better than certain high income countries such as Russia and Saudi Arabia. Findings in the report also indicate that investment in palliative care can actually save money for healthcare systems in the long run.

Despite notable limitations in the 2015 Index (lack of a comparable instrument for validation; the fact that it excludes countries from the study which offer no palliative care services whatsoever, to name two), the authors offer this conclusion: “The 2015 Quality of Death Index is an insightful and credible effort that laudably calls attention to the woefully inadequate care for some of the neediest and most vulnerable patients across the world, those near the end of life.”

Many thanks to Eric L. Krakauer and M. R. Rajagopal for drawing attention to this critically important issue that affects millions, and will become increasingly pressing as more of the world’s population lives longer and with a higher  number of non-communicable diseases.
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1. Eric L Krakauer, M R Rajagopal, www.thelancet.com, Vol 388, July 30, 2016, page 444
2. Economist Intelligence Unit. 2015 Quality of Death Index: ranking palliative care across the world. https://www.eiuperspectives.economist.com/healthcare/2015-quality-death-index

(CFHI Student, Madison, Pictured on the left)

A little about Madison:
I graduated from Washington University in St. Louis and will be starting medical school this August at Upstate Medical University. I heard about CFHI as an undergraduate when a representative from CFHI came and spoke at my school. After deciding to take a gap year between my undergraduate years and medical school, I thought a CFHI program could be a perfect way to bridge the gap between my undergraduate experience and the beginning of medical school.

Why she chose CFHI:
I chose the Primary Care and Social Medicine program in Córdoba, Argentina because of both the location and the focus of the program. My time working in the Emergency Room during my gap year had made me acutely aware of the necessity of learning Spanish and the importance of primary care. Everyday, I saw patients who used the Emergency Room in lieu of a primary care provider, patients who were born into a system where structural violence had stripped them of access to quality preventative care. The Primary Care and Social Medicine program in Córdoba allowed me to explore primary care in another country while simultaneously improving my Spanish. The one-on-one Spanish lessons combined with complete Spanish immersion greatly improved my ability to communicate in Spanish. I left Argentina with a deeper commitment to medicine, to global health, and to communication.

Reflection on what’s next:
As an Anthropology: Global Health and Environment major at Washington University in St. Louis, I enjoyed applying an anthropological lens to global health issues and studying the complexities of global health issues and policies played out on a local level. CFHI gave me a valuable opportunity to immerse myself in another culture and see those complexities firsthand. Ultimately, my hope is to be involved in initiatives that will reduce the number of premature babies, combat the many adversities associated with prematurity, and improve medical care for people with disabilities. I know I will take what I learned from CFHI with me as I continue along the path to become a physician and work toward those goals.

by Robin Young
Assistant Director, Africa & Asia

Medical students often tell me that they are focusing so intensively on the science of health that they forget to see the person behind the pathology.

That won’t be a problem when you complete CFHI’s Remote Island Medicine program in the Philippines.

I recently returned from a visit to this program, and it was clear that while you are in the Philippines, every day and every moment spent interacting with patients and healthcare providers will remind you that clinical and public health are inextricably linked; that social factors so often determine health outcomes.

As a program that focuses on remote and rural healthcare, these links are intrinsic to the work, but it’s the local team that really provides the insight and reflection for CFHI’s participants in this program. The CFHI Philippines team is a group of passionately committed doctors, all of whom are currently or have in the recent past served as medical officers on remote islands. In many cases, they have served as the only doctor for miles; though they will be the first to tell you that their teams of nurses and midwives are highly skilled and serve as a critical first line of care and response for the local community. They believe firmly in the right to free, high quality healthcare for all, and they have devoted their lives to bringing that reality closer, both in the clinical setting and also by participating in advocacy work with the International People’s Health University, and the People’s Health Movement..

Before traveling to the remote islands, you’ll spend a week in Manila visiting the WHO offices, local NGOS, and other sites that provide context for the healthcare system in the Philippines. You’ll visit the public hospital in Manila where healthcare is meant to be freely available to all, but in reality, most people have to pay for elements of their care. In the hospital, you’ll learn how changing diet and a more sedentary lifestyle are leading to a dramatic increase in non-communicable diseases (NCDs) including diabetes and heart disease, reflecting a global trend. You’ll see the effects of public health initiatives that require breastfeeding and institutional birth. Through your local team, you’ll learn that many people at the hospital in Manila have come from far away to seek care and treatment: Sometimes, whole families make the trip to Manila, in order to support a sick relative. Often, they come all the way from one of the 7,000 islands in the Philippines.

Next, you’ll head out to your assigned island, either Quezon, Quezon, or Tablas, Romblon. In these remote settings, accessible only by boat or air, you’ll work alongside the Municipal Health Officer to learn about key public health initiatives including immunization and deworming campaigns, breastfeeding, and education to help families recognize danger signs during pregnancy. You’ll also shadow nurses as they treat patients at the health center or health station, managing everything from labor and delivery, to diabetes and heart disease, to severe trauma. You’ll experience every stop along the referral chain, learning about the possibilities and limitations of the system as you go.

By the time your wrap up your weeks on the island, you will have heard many stories that remind you of the links between clinical and public health work. You’ll see families who have to spend their small savings to travel to the mainland for treatment. You’ll observe the highly effective tuberculosis treatment centers, which are structured to help people complete their treatments (even after they feel better, and might be inclined to stop taking their medicine), and has drastically reduced TB on many islands in the Philippines. You’ll see cases that are intimately linked to the realities and the livelihoods of island life, such as farming and fishing. You’ll learn about traditional healers and beliefs, and how the healthcare system has made strides toward including traditional healers and birth attendants in its work, rather than alienating them.

I think Jennifer Harter, a recent participant in the program, summed it up best when she said: “There is a visible connection between all aspects of the healthcare system from public health at the international level (WHO) to the rural barangay health stations at the community level. I saw how each sector interacts and the roles each play. It is hard to explain, but trust me when I say it is truly fascinating.”

by Lyndsey Brahm, Program Coordinator

You could feel the afternoon heat of Puerto Escondido’s tropical sun blazing through the open-air patio that overlooks a precious slice of Oaxaca’s coastline. The fans provided little relief from the thick air, nor did the ocean breeze coming off of Puerto’s infamous Playa Zicatela. But the heat and subsequent lethargy were no match for 37 practicing midwives (parteras tradicionales), 6 medical students from Northwestern University Feinberg School of Medicine, CFHI participants and staff, and clinical and public health officials from the Oaxaca Ministry of Health who joined forces for the 7th Annual Traditional Midwife Training in Puerto Escondido, Oaxaca, Mexico.

This CFHI community health project is a shining example of the value of reinvesting in host communities and the importance of collaboration, welcoming diversity in our interactions, and connection amongst people of different cultures; all of which represent values CFHI has long held in high regard. The curriculum for the training is prepared by the coastal region branch of the Oaxaca Ministry of Health and addresses safe birth techniques, detection of warning signs, knowing when to refer to a physician, appropriate care for a newborn, etc. The training is then delivered by Northwestern University medical students entirely in Spanish. Even though the midwives are receiving the training they are also very enthusiastic about sharing their expertise and the traditions that have maintained their virtue across generations.

It is an extraordinary opportunity for each midwife to take part in the 4-day training in Puerto Escondido, especially those traveling from remote villages of Oaxaca’s coastal region. This year 37 midwives attended, several of whom returned from previous years and quickly showed leadership within the group. The midwives are selected according to location, the goal being to invite those spanning a large geographic area, and the number of births they attend to, a statistic reported to the Ministry of Health by a practicing physician within each community. The midwives are often leaders within their communities and held in high esteem. They return to their villages and share knowledge and resources gained during the training.

Two of the midwives braved the Oaxacan sun and traveled on foot for 4 hours to reach Puerto Escondido after catching a bus from their villages. You could see the determination on their faces to make the most of this professional development opportunity.

It is programs such as this that CFHI takes pride in supporting year after year. One that impacts the community by giving them the tools to take ownership of their own future.

Child Family Health International is pleased to welcome Keaton Andreas as Director of Outreach.  Keaton brings to CFHI a passion for advocacy and community organizing having honed his skills as Campus Campaigns Organizer for Universities Allied for Essential Medicines. CFHI Board Chairman, Gunjan Sinha, reflects “it’s exciting to hire someone with a community-building approach to our outreach position.  Keaton’s unique point of view will allow CFHI to expand the thought leadership community that CFHI has been nurturing for nearly 25 years.”  

Keaton will expand CFHI’s advocacy training for CFHI scholars and alumni in order to meet CFHI’s mission of creating changemakers through programs that emphasize the strengths in communities abroad often noted for what they are lacking. Keaton received his Master’s in Intercultural Studies from Fuller Seminary in 2011.  Fuller Theological Seminary is one of the United States most influential institutions of its kind with over 4,000 students representing 90 different countries.

CFHI is proud to have worked with many talented and empowered women in global heath, who are inspiring change in their local communities. Please join us in celebrating some of these truly remarkable women.

Dr. Isabel Saucedo
CFHI Medical Director Puerto Escondido, Mexico
Dr. Isabel Saucedo has been a vociferous champion of women’s reproductive health throughout her medical career. A consummate health professional and mother of two, Dr. Saucedo manages domestic violence training programs for women, as well as maternal care. She was also the catalyst for kick starting the Traditional Midwives Training program in Oaxaca, set up in collaboration with the local Ministry of Health. We are grateful to have her as a partner and friend and wish to see her continue her work in the local community.

Hema Pandey
CFHI India Director
Hema recently celebrated her 10-year anniversary with CFHI, and what a journey it has been. She has been instrumental in expanding CFHI’s programs across India, and today she manages 8 thriving programs that address health topics such as maternal and child health, traditional medicine, chronic disease, and palliative care. She has worked tirelessly to gain the respect of her peers and excel in what is a highly male-dominated profession. We are very fortunate to have worked with Hema throughout the years – and here’s to ten more years to come.

Dr. Cecilia Uribe
CFHI Medical Director La Paz, Bolivia
A dedicated pediatrician, Dr. Cecilia Uribe has been committed to serving the underserved women and children in her local community. Observing an unfortunate trend in La Paz for single mothers to fall into a vicious cycle of poverty, Dr. Uribe responded by creating a safe haven for young mothers. The Young Mother’s Empowerment Center (EMJ) is a place of hope where these women can get back on their feet through easy access to education, vocational training, and child-care. Dr. Uribe has left an indelible mark on the well being of her community and we are so proud of her achievements.

Dr. Susana Alvear
CFHI Medical Director Quito, Ecuador
Dr. Susana Alvear is a family physician from Quito who has dedicated her life to improving the local healthcare system in Ecuador and creating equitable access to healthcare, especially in poor, underserved communities. As a CFHI partner, she has been a staunch advocate of empowering local medical professionals, and giving them the training and resources they need to better serve their people. We are truly inspired by Dr. Alvear’s passion for helping those who suffer extreme poverty, discrimination, hunger, and illness and we hope that you are too.

Avril Whate
CFHI Medical Director Cape Town, South Africa
Avril Whate is a Nurse Practitioner who supervises one of CFHI’s most popular programs in Cape Town, South Africa. She has been with CFHI since 2004, has worked with the Provincial Health Department for over 20 years, and remains a strong advocate of public health programs. Avril makes a tremendous effort to ensure that our students have a fulfilling experience during their time in Cape Town, and enjoys learning about global health concerns and their impacts on the community. We have really enjoyed working with Avril, and her commitment to our students and health programs is truly admirable.

Dr. Magaly Chavez
CFHI Medical Director Oaxaca City, Mexico
Raised in a small rural town in Oaxaca, Mexico, Magaly cherished the seemingly impossible dream of one day becoming a female physician. However, through hard work and perseverance, she went on to become the first doctor in her family, as well as the first female doctor in her hometown. Today, Dr. Magaly Chavez manages CFHI’s Health Access and Inequities program in Oaxaca. Dr. Magaly’s strength and determination serve as an inspiration to so many women so are striving to achieve gender parity in male dominated societies and professions.

Sophia Alvarado is a pre-medical student at Diablo Valley College and a member of the American Medical Student Association (AMSA). Sophia received a scholarship to participate in CFHI’s Global Health Intensive Program, Hospital Medicine in Latin America, in January 2016. The following is an excerpt from her blog. This post was originally published on January 15, 2016.

Everyday in the hospital was a new and fun experience for me and I am so happy that I decided to come to Córdoba and participate in the Hospital Medicine program through CFHI. I have had the opportunity to see and learn things now that back home I might not have seen until the end of medical school or even until residency. All the people I got to meet and talk to have been so great and helpful. Overall, my time in the hospital surpassed all my expectations and I hope that I can come back soon.

I want to say thank you to everyone at CFHI in California and everyone at ICC and the Hospital de Urgencies here in Córdoba. This experience was so amazing and I will cherish the time that I have had here for the rest of my life. Leaving Argentina is really bittersweet but this is definitely not the last time that I will travel to this amazing place. Again, thank you to everyone involved in this program – words cannot fully express how much I have enjoyed my time here and how truly sad I am to go.

Read more from Sophia’s blog at http://californiatocordoba.blogspot.com/.

Courtney James is a Senior Resident in Baton Rouge, LA and a member of the American Medical Women’s Association (AMWA). Courtney received a scholarship to participate in CFHI’s program Exploring HIV & Maternal/Child Health in Kabale, Uganda in November 2015. The following is an excerpt from her blog “CFHI Uganda Experience.” This post was originally published on December 29, 2015. 

I visited the Traditional Healer during my stay. You can’t fully understand health in Kabale without discussing the Traditional Healer’s role. I believe they quoted a percentage of about 90% of Ugandan natives have utilized the traditional healer at some point in their lifetime. The healer is sought for a multitude of ailments such as malnutrition, allergies, arthritis, GI issues, sexual dysfunction (hahaha). He has so many different herbal remedies that he prescribes for each issue.

KIHEFO has respectfully bridged a partnership with the healer in hopes that the two entities can coexist without disregarding the other. KIHEFO has provided education to the healer regarding complex cases that should be referred for medical intervention, especially Malnutrition. So many people believe that malnutrition is due to a curse and therefore they seek the healer’s herbal remedies in hopes of curing the child. This is very dangerous and unfortunately some families seek medical treatment when things are severe. Since KIFEHO has started communicating with him the healer does sometimes refuse to treat complex cases and KIHEFO has seen a reduction in the severe cases that present to the Nutrition center.

Read more from Courtney’s blog at https://cjglobalhealth.wordpress.com/.

This past year, CFHI opened new programs in Ghana, Tanzania, India, Uganda and the Philippines. We welcomed new staff members, collaborated with like-minded organizations like Better Volunteering, Better Care and Network of WHO Intern Alumni, and presented at conferences across the US. Here’s a look back at our many accomplishments in 2015.

This blog was written by Caity Jackson, Co-Founder & Communications, Women in Global Health and Director of European Engagement, CFHI. It summarizes Panel 4 from the GHLS 2015 Symposium titled Young Global Leaders Reflect – How Will I Shape the SDGs? It was originally published on Global Health Council’s Young Global Leaders Blog on November 23, 2015.

The 2015 Global Health Landscape Symposium’s final panel, ‘Young Global Leaders Reflect: How will I shape the SDGs,’ challenged today’s leaders to institutionalize young peoples’ involvement in the Sustainable Development Goals (SDGs).  Three themes guided the discussion, including recognizing the important role the enormous population of youth have in ushering in these goals, ensuring young voices are heard in these discussions and invited to the decision-making tables, and encouraging true collaboration at all levels, with a focus on capacity-building and training in this skill for young leaders.

Moderated by Kyle Peterson of FSG, the stage was alive with ideas and energy as all the panelists considered on their own experiences as young leaders and what they see as the role they can play in the SDGs. Sahil Angelo from the Center for Strategic and International Studies (CSIS) started out the discussion focusing on the immense number of young people in the world – almost 2 billion between the ages of 10 and 24. This is in-part due to the successes of past global health efforts, but as a community, we have not really considered or planned for the implications of these strides. What does 2 million young people (and rising) mean in the context of the SDGs? Nowhere in the “Means of Implementation” section of the SDGs’ text does it mention that youth would be the ones to usher them in.

Many panelists commented on the comprehensiveness of the goals and saw them as tangible objectives that address the root causes of inequity in health outcomes, even as a chance to do it ‘right this time’, referring to the previous Millennium Development Goals (MDGs). Yet in terms of young leader involvement, Oliver Anene of the New York City Department of Health commented that young leaders need to be invited to the decision-making table and their voices need to be heard – especially since they are currently on the receiving side of the policies created by today’s leaders. Anne Heerdegen of the Global Health Fellows program echoed this thought, commenting on how young leaders should be invited to speak at conferences and events alongside their experienced colleagues.

Read the complete blog post here.

CFHI would like to thank Hema Pandey for her 10 years of outstanding service with CFHI! Since joining as India Coordinator in July 2005, Hema has grown into the role of India Director while leading CFHI’s growing presence in India. Today, there are 8 thriving programs in India, located throughout the country and offering a variety of health topics to meet participant interests. Hema has played an integral role in program development by establishing and maintaining strong partnerships with a wide and diverse network of health professionals and NGOs in India. Her professional interests include rural and urban healthcare, water and sanitation, gender, and social development. She holds a Bachelors in Business and Commerce from Kurukshera University and a PG Diploma in Fashion Design from the International Institute of Fashion Technology.

Hema explains that her work with CFHI is always exciting, and that she learns something new from every student she encounters. Working with CFHI has been a learning process, and every student adds to her understanding of different cultures and worldviews, including perspectives on health and health care systems. Since working with CFHI, she shares that “instead of looking straight, I’ve started to look in all directions for answers. I am still learning with every student, so it’s as enjoyable as it was on day one.”

Hema represented CFHI at the Forum on the Empowerment of Women at the United Nations in New York in September 2010, and experience that she says was “The highlight of (my) 10 years at CFHI.” At the conference, she spoke alongside CFHI’s Executive Director, Dr. Jessica Evert, on a panel that highlighted their experiences working and leading in male dominated professions. Hema spoke about her successes using a collaborative approach to get the work done. Hema also represented CFHI at the 5th International Symposium on Service-Learning at Stellenbosch University in Cape Town, South Africa in 2013.

Hema is very appreciative of the years she has spent with CFHI, giving her the opportunity to improve herself while improving the communities around her. She reflects that her role as India Director allows her a path to help so many people. Hema is very supportive of her local staff and as an individual, she receives immense satisfaction when connecting grassroot organizations with aspiring students. She explains that this is her way of giving something back to society at large.

Robin Young, Assistant Director Africa & India, shares, “Hema is a force of energy and vision for CFHI’s programs in India. She has built our engagement in India into what it is today- 8 strong programs with 2 more coming very soon- each offering a unique perspective on health and public health, from maternal and child health, to traditional medicine, to chronic disease and palliative care. Here’s to ten more years!”

By Robin Young, CFHI Assistant Director, Africa and Asia

I just returned from a month-long site visit to India, where I delved deep into CFHI’s 8 programs in that most captivating of countries. It was a whirlwind journey that took me from a small village clinic in the foothills of the Himalayas, to a bustling OB/GYN unit in a hospital in Pune, to the home of an 80 year-old woman receiving palliative care from a team of nurses and doctors in the Southern state of Kerala.

India is a dazzling, intense place. With a population of 1.25 billion people, the scale of its cities; the ease with which so many people co-exist, struggle, and thrive; and the fascinating public health challenges, triumphs, and pitfalls, are enough to make any visitor want to stay much longer than a month.

But one month in India is enough to take in plenty of new information about health and medicine in a country that has so much to teach us. CFHI’s India programs offer an array of topic areas, clinical rotations, and geographical settings to choose from—there is truly something for everyone. Each of our programs is grounded in deep and longstanding local partnerships and a commitment to ethical practice—two key components that guarantee a rich and unique experience for CFHI scholars.

Under the leadership of CFHI’s India Director, Hema Pandey, we are finalizing exciting new partnerships and integrating program enhancements that will make our programs in India even stronger and more impactful. Here’s a sneak peek at a few of the exciting developments you can expect from CFHI’s programs in India:

• In Delhi, we are finalizing a new research program that will welcome students with an interest in completing research in India on a variety of topics in global health, biomedicine, and beyond.

• In Mumbai, we are opening a new program that offers students an up-close look into hospital medicine and infectious disease in this glittering, world-class city. Observe hospital medicine in urban and rural settings and learn about infectious diseases in a variety of locations, from outpatient clinics to small, family-run practices, to non-governmental organizations.

• Also in Delhi, our “Public Health Delivery Innovations and Community Medicine” program will have an increased focus on three themes, around which all rotations and non-governmental organizations will center: water and sanitation, social services safety net, and programs for marginalized populations. As always, this program will provide an inspiring and eye-opening look into public and community health efforts in Delhi, working with populations ranging from young children who are addicted to drugs to women formerly considered “untouchable” who now prepare crafts and food for their communities.

• All India participants can expect expanded pre-departure training and orientation in the form of webinars, question and answer sessions, and more. A recent addition to CFHI’s pre-departure training is Aperian Global’s online cultural intelligence tool, GlobeSmart, which provides detailed information on how to engage effectively with people from India and around the world. Competencies based on the new roadmap for global health training will frame each program and articulate the learning outcomes that you can expect to come away with after participation in our programs.

For a complete list of India’s programs in India, review our website. Learn about the wide offering of programs—from traditional and alternative medicine and Rural/Urban Himalayan Rotation in and around Dehradun, to Maternal and Child Health in Pune; and from End-of-Life and Palliative Care in Thiruvananthapuram (Trivandrum) to Ophthalmology in Delhi.

CFHI’s programs in India are the best way to come and experience the magic of India while immersing yourself in the intricacies of the health system and the social determinants of health in this fascinating country. Having just visited these programs myself, I am already excited for my next visit!