New US Census Data Shows Diversity of US Population Increasing

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“We are approaching a new highpoint in the prevalence of US residents who were born outside the country.” This is part of a message on the Director’s Blog of the US Census Bureau website that is aimed at the marketing industry, at advertisers of goods and services, but we at CFHI believe it is also important information for current and future health professionals.

While the Census Bureau is providing this new data, none of the basic trends of an increasingly diverse population for the United States should be a surprise to us. Forward thinking health professionals and medical educators have seen the indications of these trends for many years. Health science students (including medical students, nursing students, and public health students) have not waited for courses to be developed by the data that is now beginning to be analyzed, but have taken the initiative to seek out medical electives and rotations that would give them first-hand experience of different cultures and the different ways people view health around the world.

Source: US Census Bureau -Director's Blog

With some 6,000 alumni of CFHI Global Health Immersion Programs to date, we hear over and over again from them how their CFHI experience gave them insight into the role that culture plays in health and healthcare. Tenny Lee, a 2010 CFHI Mexico alum, reports: “My experience in Mexico has given my medical career a foundation to help underserved communities and break though language and cultural barriers.” You can read more about her CFHI experience in her review posted on the website Great Nonprofits. The ability to competently serve a more widely diverse patient population will clearly become the expectation for health professionals, as we can see from the wealth of information that the US Census Bureau is releasing.

One of the most important data points released so far is that the Hispanic population of the US now exceeds 50 Million, a 43% increase since the last census as reported by CNN. And it is not just in border states in the south. The CNN article quotes demographer Jeffrey Passel at the Pew Hispanic Center as saying, “Previously, the Hispanic population was concentrated in eight or nine states; it is now spread throughout the country.”

Medical schools, organizations, and institutions of higher learning have also recognized these trends, and CFHI has been happy to work with many of them to design specific programs. The Patient Advocacy Program at the Stanford Medical School began a program abroad with CFHI in 2007. The University of California at Davis has partnered with CHFI for over five years now to offer a Bi-National Health Quarter Abroad program for undergraduates in special arrangement with the Chicana/o Studies Department at UCD. Both of these programs also make use of CFHI’s built-in Spanish Language and Medical Spanish Instruction. Students are also living with host families so they are immersed into the culture during the program. Guided journaling and weekly meetings help students reflect and integrate what they are learning from their daily interactions. CFHI is also working with others, including Northwestern University, The Student National Medical Association (SNMA), -which you can read more about in an earlier posting– and the Public Health Institute in association with the Global Health Fellows Program. CFHI has been able to partner with each group and use our 20 years of experience working at the grassroots level in underserved communities abroad to design programs that meet specific learning objectives that are achieved in real life settings with the help of local health professionals who have the unique expertise of the local healthcare system and the best understanding of the local culture.

Jessica Brown, a 2010 CFHI Ecuador alum, pulls it all together in her reflection about her CFHI experience:

“… [I] learned a wealth of information about health that extended beyond the Reproductive realm.” Jessica goes on to say, “I learned a lot about Ecuador’s healthcare system by discussing health care access, education, socioeconomic class and ethnic background with my mentors and preceptors. I learned about how religion, education and customary social/cultural schools of thought (i.e. machismo) weigh heavily on Ecuador’s society, and individual minds; I saw how the cultural “way” dictated the population’s attitude towards healthcare, especially in Women’s Reproductive Health.

The moments that caused me to question belief systems in place within myself really stretched me beyond limits I never knew possible. And it is these reflections upon the state of health care in Quito that can broaden my understanding of client needs, beliefs and culture here in the states.”

Making Global Health Knowledge a Requirement for MD Students

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A Post From CFHI’s Medical Director:

I’m just returning from conducting a workshop at the NEGEA Regional Conference. NEGEA is the Northeast educator’s chapter of the AAMC – a gathering of the people who oversee medical student and resident education. Just like many in global health medical education, they are grappling with how to get their hands around the subject and figure out how to increase collaboration.
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CFHI Teams Up with SNMA for Special Global Health Experience

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CFHI and SNMA have teamed up to present this new and specialized program that offers participants the opportunity to participate in a 2-week global health program in the city of Oaxaca Mexico!

The Student National Medical Association (SNMA) is the oldest and largest, student-run organization focused on the needs and concerns of medical students of color. For over 40 years SNMA has been dedicated to ensuring culturally sensitive medical education and services. For 20 years, CFHI has been offering Global Health Immersion programs designed to help students appreciate the role that culture plays in health and healthcare. By teaming up, CFHI and SNMA hope to make a Global Health experience accessible to more students. This special 2-week program, previously open only to SNMA members, is now open to all health science students. Space is limited so apply early.

The SNMA-CFHI 2-week Urban Primary Care in Oaxaca program aims to introduce students to the cultural competencies that are crucial for effective health care professionals. This program is tailored for those who wish to increase their cultural and linguistic competency as well as their understanding of the health factors affecting Latinos.

Oaxaca is an excellent setting for studying the healthcare system of Mexico and the healthcare practices of the population. Students often hold the false assumption that the healthcare is available to all, but find in Oaxaca that poor and rural populations are increasingly unable to compete for scarce health resources.

CFHI programs offer participants the opportunity to learn more about health issues that transcend national borders, class, ethnicity, and cultural divisions. By participating in CFHI’s global health education you will gain a unique insight into healthcare systems of developing countries and increase your cultural competency. Increasing one’s awareness of other cultures (cultural competency) is becoming increasingly relevant for healthcare professionals as industrialized countries become more ethnically, culturally and linguistically diverse. Click here to read an article and learn more about why cultural competency is important for today’s healthcare workforce.

The program dates are June 3^rd to June 18^th. Please visit the CFHI website to learn more.

We look forward to having you join our grassroots work to build a global community in support of better healthcare for underserved communities and more globally aware health professionals!

Celebrate 50 Years of Peace Corps –Sign the Service World Declaration

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CFHI is happy to celebrate the 50th anniversary of the start of the Peace Corps on March 1, 1961. As a member organization of the Building Bridges Coalition and the International Volunteer Programs Association, CFHI joins with other member organizations in issuing the following letter inviting you to sign the Service World Declaration. You can see previous postings on this Blog about service world here.

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Dear Friends;

On March 1, 1961, President John F. Kennedy announced the creation of the United States Peace Corps. This Tuesday, March 1, 2011 is the 50^th Anniversary of that historic occasion. We at Child Family Health International are asking you to honor that event by signing the ServiceWorld International Volunteer Service Declaration. It is a simple pledge to encourage expansion of such efforts and that you stand ready to be of service. We and our colleagues in other organizations hope to have 100,000 Americans or more make such a commitment.

The Peace Corps was the first national organization in the world dedicated to international volunteer service. In the past 50 years, the Peace Corps has engaged millions of people from all cultures and nationalities in the search for common ground, and has inspired countless organizations of every type, foreign and domestic, all over the world. We at CFHI are a part of this legacy and whether you have served or are thinking of doing so, you are as well.

You can make a difference today. All you need to do is to join us in signing the International Volunteer Service Declaration. For more information about ServiceWorld and to sign this Declaration on this important date, please visit the Service World Website.

President Kennedy and the first Peace Corps Director Sargent Shriver envisioned 100,000 Americans serving abroad every year. Imagine the impact this would have had on the world if such an effort had been realized 50 years ago and replicated by other nations. ServiceWorld is ambitious, as it seeks to make this vision come true today.

While the current budget crisis makes this moment a challenging time to promote new initiatives, please remember that it is often during such occasions that old paradigms are changed, when necessity and creativity generate needed innovation, and when a “quantum leap” forward is truly possible. Now is such a time for citizen diplomacy and international volunteer service. Help us all become part of those new solutions. After you sign the Declaration, please forward this request to your friends and ask them to join you in this effort, as well.

Sincerely,

Child Family Health International

The Roots Have Taken Hold –A Follow-up on a Success Story in the Making in South Africa

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Ukwanda Logo

In October of 2009, fresh from a visit to South Africa, I wrote an entry to this Blog called The Roots in Grassroots –Ukwanda Rural Health Program. I was so impressed with the intentional efforts of the University of Stellenbosch to successfully bring primary health care to Avian Park, an underserved community in the rural areas well north of Cape Town. CFHI’s work has always intentionally been at the community level so this was the first time that we were helping to fund a project of a university. On paper, it looked like a serious effort to truly do the relationship building and ground work necessary to successfully establish the first primary healthcare facility for this poor but growing community. Our contacts on the ground were also very enthusiastic about this initiative and so CFHI chose to help support it.

What I saw in 2009 was an idea beginning to take form. What had looked so possible on paper, was proving to be a significant challenge to implement.

Avain Park Old Clinic

I saw a very run down set of metal freight containers being used as a makeshift TB clinic. I saw some initial linkages with the community but everything was still new and tenuous. CFHI’s commitment was funding that would be used to renovate the freight containers to make them fully functional. The project was already well beyond its targeted schedule and I could see during my visit that the freight containers were not in good enough condition to be renovated but would need to be replaced. Stellenbosch was able to get some additional funding as well as some in-kind help to make the new containers possible. Concerns about acquiring the land where the new clinic would be, the full support of the local political and community leaders, and other logistical details were still not resolved. Success felt illusive. Yet, in the face of the many challenges, the Ukwanda team from Stellenbosch chose to dig in deeper, engaging the community, dealing with their concerns and creatively finding the resources to deal with many unforeseen issues that arose.

Freight container being prepared at Cape Town Water Front

At a stage like this, I am, quite frankly, used to seeing a big university either pull back its funding and sunset the project, or do an end run around the community and find a maneuver that would give them the legal security they need to move forward even if it does not lead to community support. Instead of using the university’s paid legal teams to get it out of a jam, the University of Stellenbosch chose to involve its School of Law and get faculty and students from this arm of the university to research creative solutions.

This week, I paid another visit to Avian Park and I met with Prof. Hoffie Conradie, also a medical doctor whose blood, sweat, and tears have flowed into this clinic for years now. What I saw this time was the brand new set of freight containers fully set up, painted, and functioning at about 80% of the planned use.

Avian Park New Clinic 2011

In addition to the original TB clinic, there is now an ARV clinic and a team of home-based care workers based out of the clinic. Weekly physician clinic hours by Dr. Conradie are well attended and welcomed by the community. Still to come will be family planning and other health education initiatives. While a water line has made it to the clinic, electricity is still lacking but this is in the works and seen only as a minor inconvenience. The clinic was bustling with activity and clearly has become a focal point of the community.

Even more impressive was that I just happened to arrive as a team from the University Of Stellenbosch School Of Sociology was just concluding an intensive study of Avian Park. A social anthropology professor and his students had made many visits and conducted house to house interviews. The students made use of volunteers from the community, mostly young people who assisted the students in navigating the unpaved maze of roads and any unfamiliar customs or local norms. The result is a significant body of primary research data that will now be analyzed and synthesized to produce a profile of the community that will not only help the Medical School in its work in the community but also all the other arms of the university; agriculture, theology, social work, as they also look to begin projects in Avian Park.

Meeting later with Project Coordinator, Lindsay Meyer, in Cape Town, she attributed the tremendous cross pollination of efforts from Stellenbosch at Avian Park to the leadership of the university. The Rector of the University of Stellenbosch has motivated and guided his faculty across all schools to develop strategic plans that have goals that are connected to the Millennium Development Goals of the United Nations. All schools and departments are also required to have initiatives that are benefiting the community in some way. With this kind of guidance, a university that often has so many disparate activities can instead become like an orchestra, each producing their own sound but from the same sheet of music.

Prof Hoffie Conradie addresses sociology & medical studnets and community members at Avain Park clinic

And so it was in Avian Park. The sociology students and the medical students were each doing their own endeavors but in a way that appeared to the community and to this outsider as a coordinated effort that will build on each other. Universities can easily become a place of many silos of information growing ever higher and rarely moving horizontally in a way that combines data for richer analysis and in a way that can most effectively benefit communities. How refreshing it is to see what can happen when the full resources of a university are coordinated and focused to help a community.

Our hats are off to the University of Stellenbosch and its Ukwanda Rural Health Project and the Avian Park Rural Clinic for their dedication and commitment to community-based work done well!

Familiarity That Melts Away Mistrust -Michelle Obama

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First Lady Howard University Jan 2011

As part of the official visit of President Hu to Washington, First Lady, Michelle Obama spoke to a captivated audience at Howard University saying that when you go abroad, “you are shaping the image of America projected to the rest of the world.” While Mrs. Obama was trying to promote a campaign to increase the number of students going to China, many of her comments are applicable to any cross cultural learning experience:

“…studying abroad isn’t just an important part of a well-rounded educational experience. It’s also becoming increasingly important for success in the modern global economy. Getting ahead in today’s workplaces isn’t just about the skills you bring from the classroom. It’s also about the experience you have with the world beyond our borders — with people, and languages, and cultures that are very different from our own.”

Last Spring, her husband, President Barack Obama, spoke to students at the University of Michigan saying: “As our world grows smaller, more connected. You will live and work with more people who don’t look like you, or think like you, or come from where you come from.” And almost in a response to these words by her husband, Mrs. Obama went on to say:

“That’s why it is so important for more of our young people to live and study in each other’s countries. That’s how, student by student, we develop that habit of cooperation, by immersing yourself in someone else’s culture, by sharing your stories and letting them share theirs, by taking the time to get past the stereotypes and misperceptions that too often divide us.

That’s how you build that familiarity that melts away mistrust. That’s how you begin to see yourselves in one another and realize how much we all share, no matter where we live. ”

CFHI programs have always focused on immersion into a culture, into a different helathcare system. Rather than staging impressive extraordinary displays for students, CHFI’s Global Health Immersion Programs give students a real slice of life, giving the participant and authentic experience of what it is like to be a health professional in that country. Some days may be very low key, other days in a hospital may be overwhelming. Regardless of the program, the bonds that students have made with professionals, with host families and with each other are very strong and lasting.

World AIDS Day – What We Can Celebrate

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World AIDS Day2010_WHO-EMRO

World AIDS Day gives us a chance as a world community to stop and get some perspective on this epidemic that has been with us now for three decades. In the past this day served as a day for us to remember with dignity those we lost to this horrible disease and as a day for carrying out advocacy to improve and better coordinate our efforts at combating this killer. Today is still a day for us to collectively morn the incomprehensible human toll. Today is still a day to increase awareness and mobilize efforts that transcend the hurdles of politics, prejudice, and lack of knowledge. Indeed “Health, HIV, and human rights are inextricably linked,” as the Director General of the World Health Organization reminds us in her statement today.

On this World AIDS Day in 2010, I am struck by the great amount of information we now have. So today is also a day for us to look back and see from whence we have come in this effort. There is great loss, and yes, there needs to be more committed to this effort but the work has gone on for more than 25 years now and there are milestones and accomplishments we must not forget. The numbers are still staggering, over 33 million cases worldwide, and with over two and one half million newly infected, etc, etc. And on the face of it, this can be enough to keep someone feeling discouraged. But there is hope. There are things to celebrate.

UN_AIDS_Global_Report_2010

If we look deeper into the Global Report from UNAIDS, we find that although the greatest burden of disease is still in Sub-Saharan Africa, this is also one of the greatest success stories as the rate if infection has dropped considerably. The report concludes, “In 22 countries in sub-Saharan Africa, the HIV incidence rate declined by more than 25% between 2001 and 2009.”

The Global Report contains a great deal of information that is well presented, and with little effort, one can gain a great deal of perspective not only on the huge effort that we are still deeply engaged in, but also some real sense of what has been accomplished -like the “Significant progress in the virtual elimination of HIV to babies.” Make one of your “things to do” this World AIDS Day a visit to the UNAIDS Report on the Global AIDS Epidemic 2010. It contains an AIDS info Database, Epidemiology Slides, a Global Scorecard, and more. One thing we have clearly done as a global community is arm ourselves with a wealth of information as we combat this continuing threat. Spend 20 or 30 minutes today educating yourself about one of the world’s greatest crises.

Finally there is one more thing that must be celebrated today and that is the the tremendous and heroic efforts of healthcare workers on the front lines of this epidemic. One of the great privileges for me as part of CFHI, is the opportunity I get to visit doctors, nursers, and other healthcare workers in the field. Finding local health professionals who are dedicated to their own underserved communities and trying to support them in their work is at the heart of what we do. We see them in hospital wards that are overflowing, we see them on strenuous trips to rural areas to test, educate, and treat -thus making healthcare accessible to more of the population. We see them in hospitals where the staff room has become a small ward or infection control area thus leaving them spending long hours with no place to go for a break. We see them in clinics working tirelessly as as line of patients stretches out the door and down the street, more than a city block. We see them morn the loss not only of patients but of so many of their colleagues, and yet they continue. We see them in these situations every day, and we see them more dedicated and more earnest in their efforts each day. These are the real heroes in this global fight and we salute you on this World AIDS Day and we pledge our continued efforts to help support and champion your work.

Global Health TV Looks at CFHI Program In India

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Global Health TV, based in London, recently visited one of CFHI’s Community Health Projects in India. The Catch Them Young Program is a health education program directed at youth ages 12-19 in a rural area outside the city of Pune. This is one example of a typical CFHI Community Health Project that originates at the local level and therefore has local ownership. CFHI has been happy to provide some of the funding to advance this project and to support the great dedication that local health professionals and community workers have to their own underserved communities.

The 5 minute short film can be seen on the Global Health TV website. We have posted it to the CFHI YouTube Channel as well. It also shows one of CFHI’s Global Health Immersion Programs in India. CFHI seeks to identify local community health professionals who are dedicated to local underserved communities.

GHTV Feature of CFHI Community Health Project Computer View

GHTV Feature of CFHI Community Health Project in India

These unsung heroes are local experts and CFHI works with them to develop the 4-12 week Global Health Immersion Programs that international students of the health professions attend. The programs are empowering to the local community as the community sees their own health professionals instructing and mentoring international students. The film had its debut at the Canadian Conference on Global Health in Ottawa, November 1-3, 2010.

Report From Ottawa –The Canadian Global Health Conference

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Global Health: a Humanitarian Crisis? With this urgent theme, the Canadian Society for International Health (CSIH) is holding its annual conference here in Ottawa. Recognizing the progress and successes in the arena of Global Health, one of the messages of this conference is to not forget the crisis of the billions of people around the world living on less than $2.00 per day. With this reality, much of the focus here has been on issues of equity.

While the sessions and sharing of ideas have been strong and fruitful, I have found a remarkable effort almost behind the scenes here to include and involve students in this professional conference. I have had the opportunity this year to speak with students in Australia, the UK, the US, and now here in Canada and in all places the interest in Global Health is continuing to grow. Everywhere I go, I find students looking for career paths and guidance in the field of Global Health. Here in Ottawa, I have seen a level of inclusion, mentoring, and respect for students that I have never seen before. Students from across Canada are here with financial and moral support from their schools and students themselves are engaged with the academic world as well as the professional world. Students are taken seriously here and they are responding and rising to that expectation. It is a lesson for Global Health educators around the world to heed.

The leadership of CSIH, as well as the national academic leaders are setting the example by intentionally engaging in efforts to cultivate, nurture and mentor the Global Health professionals of the future not just in the classroom, and not just though international trips but in their own offices and their daily work. Because they are truly engaging and listening to the students, educators are also able to take the appropriate next steps to advance Global Health education and not just marvel at the surge in student interest. Great work has been done on a set of Global Health Core Competencies that can serve as a much needed foundation for faculty and students alike.

CFHI Alum Reflects on Her Experience in South Africa

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Stella Chiu who spent part of her summer on one of CFHI’s Global Health Immersion Programs in South Africa contributed to a blog on the IE3 Global Internships website. Her blog post Coming Home with New Perspectives is an honest sharing of her thoughts as she is still in the re-entry process. Stella says, “I haven’t had any major problems re-integrating. However, the only difficulties I’ve encountered are through the new perspectives that I’ve gained.”

Stella reports that after being completely immersed in the South African culture and healthcare system, and especially with the warm welcome of her South African host family, she now finds herself, at times, ‘homesick’ for South Africa. Stella recommends to others who go abroad to build in time to reflect after coming home, to “sit down and think” so that you can become aware of how your perspective has changed “both personally and professionally” by what you have experienced. She says of her friends, “Sometimes it is hard for others to understand my outlook on certain things because they have not experienced what I have experienced.”

As part of her own reflection, Stella shares, “I am grateful for the opportunity CHFI-South Africa has given me in developing my clinical skills and finding my niche. I did rotations in surgery, pediatrics, ophthalmology, and in internal medicine and found an unexpected love for surgery. I grew to understand South Africa’s health care system, as well as its deficiencies, setting the groundwork for when I can return someday to work. I have built lifelong relationships with students in the program, and the families that I stayed with. I know that I will always have a home in South Africa.”

We wish Stella well as she continues her re-entry and we know that her host family and those who worked with her in South Africa were grateful for her presence and will never forget her.

A Spark Was Struck Again in Ann Arbor -Celebrating 50 Years of Peace Corps and Launch of ServiceWorld

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As people gathered from different parts of our country and our world last week at the University of Michigan to commemorate the fiftieth anniversary of the spark that started the Peace Corps, at least some of us experienced a new spark.

It is a rich and storied history of how presidential candidate John F. Kennedy , weary from the long day and the long campaign, reached the University of Michigan campus at about 2:00 AM on October 14, 1960. Despite nothing being scheduled to mark his arrival, Kennedy was amazed to find a growing crowd of thousands of students who had gathered to show their support. Moved by this spontaneous crowd, Kennedy went to the front steps of the student union to address them extemporaneously. The young senator was in a very tight race against then Vice President Richard Nixon, and with only three weeks until the election, no plan had been made for speaking to the students perhaps because the vast majority of them were under 21, the voting age in 1960. But there they were. In a cold drizzle, there they were in the wee hours of the morning; there they were. . The press had gone to bed; none of these kids could influence the election. It should have been a throw away moment -a simple expression of kindness and cordiality, but it was not.

We were so fortunate last week that many of those who stood in that drizzle fifty years ago came back. They remember it as a special moment, a moment when they felt a challenge, an invitation, a call …a spark! The history is now recorded, thanks in large part to the University of Michigan, and a wonderful recounting of it is now available in a documentary called A Passing of the Torch. Do yourself a favor and find a way to see it. (It will air on public television in the coming months.)

It was cold and wet in the wee hours this past Thursday, much as it reportedly was at that moment fifty years earlier. While this was anything but a spontaneous gathering, it was a purposeful gathering. There was a sense of anticipation which felt strange because we were merely commemorating a historical event. I’m not sure what we were expecting to see …a ghost… I don’t know, but we were drawn there for something. Thomas Hayden, the editor of the student newspaper in 1960, and now 70 years old, said later at a speaking event on Thursday night that he had not planned on attending the 2 AM commemoration because he had an early meeting that morning. As the night approached, however, he said he could not help but go, even if only to see if one can really relive a moment of their life –he said he was not disappointed. He also asked rhetorically and jokingly, “Where is that damn torch any way? Can someone find me that torch?”

As I sat listening to Tom Hayden in a hall filled to overflowing, I realized that was it –the torch. That is what we were looking for last week. Whatever the torch is, it has inspired many over the years, and I think we saw it many times last week in Ann Arbor. And as I listened to Tom Hayden that night, I realized that his words, his memories, his passion for service and fairness, dedication to participatory government and global understanding, -these are the torch. They are the torch that Kennedy took up and ran with, inviting all to join him. They are the torch that was passed to that crowd of students fifty years ago by an impromptu speech. A torch taken up by Al and Judy Guskin (part of the audience for Kennedy’s speech who responded by starting a student movement that led to the Peace Corps –again, wonderful history that you will love) and by every Peace Corps volunteer who has walked in their steps since. A torch taken up by many of us who have volunteered internationally through a myriad of other organizations.

I think that is what we were drawn to see last week in the early hours of October 14^th –the torch. And see it we did, in the nostalgic eyes of hundreds of returned Peace Corps Volunteers, in the wide eyes of U of M Students eager to make a difference, in the stories of fifty years ago that felt like they could happen again. And indeed they were happening. We were given a renewed challenge and invitation. We were invited to join a new initiative called Service World (www.ourserviceworld.org) with the aim of achieving JFK’s goal of having 100,000 U. S. citizens doing international service annually. Just as a petition was drawn up by Al and Judy Guskin in 1960, signed by over a thousand U of M students, and led to the establishment of the Peace Corps, Service World has a declaration that is now being circulated globally. Fifty years later, international service has become a global ideal. Thanks in large part to the model and the success of the Peace Corps.

It only makes sense in today’s world that a call to globalize Kennedy’s great challenge would arise. Those of us who were in Ann Arbor this time felt a quiver deep inside us that was something other than just a reaction to the damp and cold around us. Was it a spark? Was there a torch that was being offered to be taken up? I know that no torch can be seen in any of the photos or video that everyone recorded, but I also know that it will be seen in all the renewed efforts for international service, and in the hearts of all those who go to the Service World website to virtually sign the scroll in support of the ideals that have spanned many years and lives and are still alive inside us today. Anyone can participate. Here is the text of the Service World Delcaration:

We envision a world in which volunteer service is a common strategy by people of all nations in meeting pressing challenges in education, health, the environment, agriculture, and more. We seek to foster an international culture of service and a heightened sense of compassion across borders that will bring volunteers of different countries, cultures, races, ethnicities and religious beliefs together for common purpose. We encourage individuals and organizations to engage in volunteer service in order to increase prosperity, strengthen economies, implement more informed foreign policies in all nations, and lay a foundation on which governments and civil society can build a more peaceful, healthy and secure world.

We stand ready to serve and support Service World’s bold agenda to expand volunteer opportunities for individuals internationally — at every age and among all socio-economic groups — to learn about global problems and help find more effective ways to solve them.

If these words resonate deep inside you, then please add your name to the scroll and pledge your support for a renewed call to international service that can transform all who are touched by it. If you know others who share this vision, invite them to add their name. Every supporter we can get will help us convince policy makers that international service is important, needs to be nurtured, and will pay dividends for us all.

CFHI Joins in Support of Service World

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CFHI is very excited to support the launch of OurServiceWorld.org and the ServiceWorld International Service Declaration. Those of us involved in Global Health are deeply committed to international service. The ServiceWorld Initiative is an effort to commemorate the 50th anniversary of the Peace Corps by realizing President Kennedy’s original vision of sending 100,000 volunteers to serve abroad each year. Please join us in supporting the future of international service by signing the ServiceWorld International Service Declaration and endorsing ServiceWorld.

As a proud member of the Building Bridges Coalition and the International Volunteer Programs Association, CFHI is happy to join a groundswell of international organizations in support of this effort. Please join with us.

Open Education Resources for Global Health Education

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Here is a follow-up By Dr. Jessica Evert, CFHI Medical Director, from the CUGH Conference, see earlier posts from Sept 20th and Sept 21st.

I am excited about the open access movement, in publishing, medical education, and in global health. The prospect of Open Educational Resources (OER) in addressing workforce issues and the education drought in many low resource countries is quite promising. Tufts and University of Michigan presented there work in this area at the recent CUGH meeting in Seattle, Washington. Erica Frank, who recently moved from Emory to UBC, also presented on her Health Sciences Online project which provides over 50,000 educational resources in over 40 languages (it is powered by Google Translator), that are not only free, but ad-free. Perhaps the most inspiring presentation was by Richard Adanu, from University of Ghana, who presented on OERAfrica. His step-by-step instruction for a cesarean section can be found at this link. He commented on a unique issue at teaching hospitals in Ghana, and many places in Africa. Unlike in the US where there are one or two students in each surgical procedure trying to learn, in Ghana there may be ten or even more. Thus, it is almost impossible for the students to see the procedure. These videos help immensely so students can actually see the procedure. One of my concerns about exporting US medical school curriculum to Africa or other places is that it might not be applicable. I asked Dr. Adanu about this issue. He said that while there may be certain things that are different (the brand of medication available, or specific cultural acceptance of interventions), generally these online resources are viewed before class by students, and then serve as the focal point of a conversation in the classroom setting, where instructors can discuss the local variations and context. Interestingly, Tufts is using their open source software called TUSK to allow medical schools abroad to customize curriculum and utilize smart phone technology to tele-consult and have other collaborative discussions. One faculty member in the audiences commented that in ten years this may put teaching faculty out of business. A panelist replied that it will require that teaches become facilitators of discussions and critical thinking, rather than merely deliverers of information. Half joking, but maybe actually not, moderator David Stern commented, “in the future we may get promoted based on the number of hits we get.” This is a real possibility- any maybe hits from sub-Saharan Africa and low resource countries should carry extra weight in the promotional review. Have you utilized Open Educational Resources (OER)? Feel free to share your experience.

CFHI Convenes UN Forum on MDG 3 Empowerment of Women

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Earlier this month on September 15, 2010, CFHI convened a Forum on the Empowerment of Women, at the United Nations in New York. The purpose of the event was to increase awareness of the United Nations Millennium Development Goal #3, to Promote Gender Equality and Empower Women.

Ambassador Anwarul K. Chowdhury, former Under-Secretary General and High Representative for the Least Developed Countries, moderated a panel of women representing a cross section of leadership roles. As world leaders met this past week to discuss the MDGs, this Forum, held a week in advance, provided an opportunity for the voices of women from everyday life t be heard. Co-sponsoring NGOs included the NGO Committee on Spirituality, Values and Global Concerns, The International Center for Good Business, The Institute of International Social Development, and The Spiritual United Nations. Panelists included M. Christine MacMillan, Commissioner, Director of the International Social Justice Commission of the Salvation Army, Monika Mitchell, Executive Director, Good Business International, Hema Pandey, India Coordinator, Child Family Health International, and Jessica Evert, MD, Medical Director, Child Family Health International.

The Title of the Forum was Successes and Challenges of Women in Leadership Roles in Traditionally Male-Dominated Environments. As women are increasingly taking on leadership roles, it becomes important for them to share their experience. The panelists spoke with examples from their own lives and the audience was invited to share their comments and life experience as well.

We were especially happy to welcome our India Coordinator, Ms. Hema Pandey who was visiting from New Delhi. Hema is responsible for coordinating six CFHI Global Health Immersion Programs taking place in Mumbai, Pune, Delhi, Dehradun, and Rishikesh, as well as multiple ongoing community health projects. In the course of this work, she manages a group of five local CFHI Medical Directors, all of whom are men. Ms. Pandey spoke of using a cooperative style of working that invites the participation of those she works with thus creating a joint feeling of ownership. This being her first trip outside of India, Ms Pandey said she was surprised to find that women in the United States also felt that they were still struggling to achieve gender equality.

As the Forum drew to a close, there was a common expression of the panelists and the audience that this Forum should become and annual event until 2015, the target year for the Millennium Development Goals.

CFHI Medical Director Blogs on Day 2 of CUGH Conference

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This is the second of two guest blogs by Jessica Evert, MD, CFHI Medical Director, blogging from the CUGH Annual Meeting in Seattle. Be sure to leave a comment.

Ann Dower of University of Washington’s I-TECH Center said today “we must practice the art of partnership” in order to be successful in global health. Additionally, I was struck when Kevin De Cock MD, Director of the Center for Global Health at CDC, candidly reflected on his early career immersion experience in Nairobi, Kenya, saying, “I wish I was more humble.” I think this humility and the ability to form meaningful partnerships go hand-in-hand.

This idea of ‘partnership’ has come up countless times at the CUGH meeting over the last 2 days. Many seasoned global health experts have lamented over the lack of partnerships and failures of global health attempts due to this shortcoming. How can we learn from this history? How can we build training and educational programs that prioritize partnership? It seems that many times our process (the process of US based individuals, universities, and organizations) of global engagement is not necessarily the best approach to foster partnership or humility. We often have our own ideas of how to solve problems based on our views and our skills, rather than based on the voice of communities abroad. In academia, there is the nagging issue of faculty, and sometimes students, having to demonstrate personal accomplishments and quick outcomes which often trump the empowerment of communities to own the accomplishments and guide the outcomes. To find the answer to these important questions we need to look at how we frame introductory global health experiences for health science trainees (pre-health, medical, nursing, public health, allied health, dental, and other students) and how our academic institutions approach global engagement. The first experience abroad (a stepping stone experience) or first visit to a region or country is pivotal to frame how future global engagement occurs. If individuals go abroad and set-up a tent clinic outside the local healthcare infrastructure, an appreciation for local capacity, systems, and workforce is not realized. If students go to a hospital with faculty from their US institution who displace local physicians and assumes US clinical expertise translates immediately into similar expertise in an international setting, the student sees the glorification of US faculty, rather than the appreciation of unique practices, language, and expertise of local, native practitioners. It is time we recognize that the skills necessary for partnership need to be fostered from early levels of engagement and need to be modeled by our US teaching institutions and mentors.

How do we teach health science students and trainees about partnerships? What skills does partnership require? To delve into these questions, we must define partnership. The Partnering Initiative, an NGO that specializes in partnership training, defines partnership as follows: “a cross-sector collaboration in which organisations work together in a transparent, equitable and mutually beneficial way towards a sustainable development goal and where those defined as partners agree to commit resources and share the risks as well as the benefits associated with the partnership.” This is no simple task. They also define the partnering principles as follows- equity, transparency, mutual benefit. If partnership is fundamental to the success of global health activities, then we must judge global health activities in part based on these fundamental principles. The need for trust, mutual respect, and communication are presupposed in the process of building partnerships.

We can teach the principles and precursors to partnership through thoughtful global health immersion programs. I am proud to be a part of CFHI. I think CFHI is setting a standard for both academic and NGO based immersion programs. I liken CFHI immersion programs to participant-observation techniques I utilized during my thesis work. In anthropology the mechanism of understanding a culture, community, and executing research is participant-observation. Participant observation involves gaining an understanding of another social group or community, by inserting yourself into that community in a way that is agreeable to the community, while observing the practices and learning about the culture, social structure, systems, and other behaviors. CFHI immersion experiences provide an opportunity for participant-observation. I would argue that such participant-observation, done in the context of long-term CFHI partnerships, lay the groundwork and start fostering skills necessary to form meaningful partnerships with individuals and organizations abroad. The local health care providers are the experts who teach CFHI participants what their communities are facing. We have received feedback from partners that patients consider their local providers more capable because they are teaching western health science students (rather than Western physicians or students providing the expertise in patient care at the international setting). This dynamic is very important and very powerful. The first step in the cycle of partnership, as defined by The Partnering Institute, is “scoping.” In essence we are teaching our students and trainees how to scope, which includes listening, observing, and appreciating a local reality before trying to change it.

If partnerships are key to the success of global health programs and interventions, it is time we look at what it takes to impart the skills necessary to foster partnerships. These skills include observation, humility, and restraint so we can give voice to the local community and engage in truly mutually beneficial ways. By providing stepping stone global health immersion programs that prioritize the “scoping” necessary to form partnerships, we can engender a new generation of globally-active professionals who understand from early in their exposure and interaction with global communities the fundamentals of partnership and humility that Dr. De Cook and others wish they knew from the start. It reminds me of a quote by Nietzche, “When one has finished building one’s house, one suddenly realizes that in the process one has learned something that one really needed to know in the worst way – before one began.” We can provide these lessons before students build their proverbial global health houses through conscientious global health immersion.

Observations From CUGH’s Annual Meeting

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What follows is a Guest Blog by Jessica Evert, MD, CFHI Medical Director, who is attending the CUGH Annual Meeting in Seattle. Previous entries with Jessica are here and here

The opening plenary of CUGH’s Second Annual Meeting (Consortium of Universities in Global Health) was marked by discussion of the great successes and challenges in global health. A live feed from TEDxChange, a non-profit dedicated to the exploring ideas and giving space to innovative thinkers, opened the morning with inspirational data presented by Hans Rosling and commentary by Melinda Gates. The conclusion by Rosling was that there is no “developing” and “developed” world; he cited the fact that countries with some of the best indicators of child survival and birthrate are still considered “developing.” He also gave a very positive report on the progress toward MDGs, specifically reduction of poverty. He emphasized that we cannot consider Africa to be homogeneous, whereas, places such as the Congo have been stagnant on indicators such as child mortality, countries like Kenya have made great strides. Interestingly, Rosling overlaid a graph of the progress by Sweden over the last 200 years, which demonstrated their slow progress in the area of child mortality (400/1000 in 1800) in the first 100 of those years. This was powerful to give a long-term view of the progress that has only been started in the context of the last 10 years of the MDG campaign.

Melinda Gates utilized the model of Coca-Cola in their ability to penetrate far-reaching communities in the world (over 1.5 billion cokes are consumed a day) and promote their product in a positive light (a current marketing slogan being “Open Happiness”). One of the components of this success is the appreciation of and capitalization on local entrepreneurs. I liken this to the importance of local health professionals in global health goals and programs. Gates pointed out that our health improvement or preservation messages are often in a negative light- ‘avoid disease,’ ‘combat germs,’ ‘control infection.’ Rather, she purports, that if we utilize positive messages that draw on popular culture methods (hip hop, fashion, celebrations) it will be more effective. She encourages us to “look at what people want” and market health interventions to those aspirations.

Subsequently a panel of speakers made comments about global health and the role of universities. A common theme is the role of “collaboration” and “developing relationships.” They universally endorsed the importance of international experiences for trainees. During the Q & A session I brought to the attention of the audience and panel that US medical schools, almost universally, do not require global health education for medical students. In addition, global health is not a topic on the medical school boards. In my opinion, a catalyst for the adoption of global health topics as part of the required medical school curriculum in the US is the inclusion of global health topics in the medical school board exams. We can draw on the experience of preventive medicine/public health, which were recent categorical additions to the medical school boards. This proposition begs a question, which is not an easy one, and was put to me by King Holmes after the session, “what do we add?” Yes, global health is a broad field, and yes, narrowing that down to curriculum that is digestible by US medical schools is a challenge. However, there are multiple organizations and individuals who are grappling with these questions- including the Global Health Education Consortium (GHEC). To let the broad scope of ‘global health’ be our barrier or excuse for not integrating it into US medical school education is to succumb to the most basic cop-out that deters many from working toward the most basic, yet overwhelming, challenges to health at home and abroad- including equity, access, compliance, and the like.

I encourage the global health education community, and the larger global health university movement, which is embodied by CUGH, to look in their own backyards, medical/nursing/allied health schools and wider university programs to embrace global health curriculum in a real way. In many US medical schools, students are begging for global health education, exposure, and experiences. To adopt required global health topics into the medical school curriculums is a basic step which these universities have control over. A manageable curriculum could include: basic lessons on the global burden of disease (including infectious disease, mental health, maternal/child mortality, and chronic disease), overview of global health initiatives (such as MDGs, PEPFAR, Global Fund), and discussions of inequities (as evidenced by the 10/90 gap, health disparities). The next question is who teaches these issues- at many of the larger, well-funded universities, experts may be internal and easily accessible. However, there is a challenge at many, even large, medical schools, who lack faculty with expertise in global health. This is where the role of non-profits and global health educational organizations is essential. Schools can utilize resources such as the global health education modules created by Global Health Education Consortium which bring experts to the classroom through PowerPoint presentations with evaluation. Also, many communities have non-profits or church-based organizations who are active globally. Engaging in global health activities does not necessarily correlate with the ability to teach basic global health education, however, we must start somewhere.Unlike cardiology, endocrinology, and other themes taught in medical school, global health is not a cookie-cutter experience or topic. However, if CUGH and organizations, such as the AAMC, require US medical schools to teach basic global health lessons to all medical students, and elevate the importance of these topics, medical schools will be given a tangible requirement that they can respond to with curriculum and faculty development.

Finally, I was struck by the university leaders’ agreement that ‘relationship building’ and ‘collaboration’ are necessary for any global health endeavor to be successful. Our medical schools have great challenges in building these relationships because of unreliable funding streams, focus on outcomes and accomplishments (often at the expense of an appreciation of process and community involvement), and staff/faculty turnover. There is also an inflexibility that is prominent in medical schools and institutions where state department advisories can lead to the complete withdrawal from a country, leaving partners to consider us ‘fair weather friends,’ and there is a tendency for wanting partnerships to fit into a programmatic mold. I hope the university community will see the benefit of partnerships with non-profit organizations, such as CFHI, who have the flexibility, continuity of staff/mission, and reliable funding streams to help facilitate international experiences for trainees in a fashion that is ethically, fiscally, and culturally sound.

CUGH is making their debut in many ways over the coming couple of days. I hope that their ability to leverage universities in the US will lead to increased global health exposure of our health science trainees, so that we are truly training the globally minded professionals that the future requires. In addition, I hope that momentum at the university level recognizes the role of non-governmental (and often not primarily academic) organizations who are setting standards in community engagement and training future health care providers in a way that elevates international communities as the ‘experts’ of their own environment that they are.

CFHI Alum: “It Made Me Want To Be A Doctor A Lot More…”

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“It made me want to be a doctor a lot more, for sure,” she said. “Seeing doctors in action, they were really fantastic role models. It’s hard to get exposure shadowing doctors here (in the Bay Area). I’ve had a few opportunities at Stanford. The more time I got… the more inspired I am to become a doctor.” These are the words of Christina O’Neal, as reported in the Contra Costa Times by Correspondent Doug Mead. Christina, a Stanford University premedical student, spent part of her summer in the Cultural Crossroads in Health Program in Oaxaca, Mexico.

Christina told the Contra Costa Times in the article that her month on the CFHI program in Oaxaca, “was pretty life-changing. Everybody gets pretty much free health care there,” she said. “It’s interesting to see how things are run. There’s a lot of poverty, and the government, in terms of health care, has a lot of problems. But the infrastructure was good. I was impressed with how smooth it ran and how dedicated the doctors were. It was an awesome experience.”

The experience really improved Christina’s Spanish and Medical Spanish skills. “I’d say, before I got there, I was conversational (in Spanish),” she said. “Now, I’m borderline fluent. My comprehension, especially, skyrocketed. I’ve always had a pretty standard ability to speak. Now, I understand everything that’s happening. Even though my vocabulary didn’t grow as much, I can express myself better. Once you understand people better, it helps you to speak more correctly. We went over grammar and medical vocabulary every day (in class).”

We are very glad for Christina that her experience was so impactful and we greatly appreciate her kind words about the CFHI program as she ended her interview with the newspaper saying, “Everything was fantastic. It surpassed all my expectations. It was a phenomenal experience.”

CFHI Board Member Appointed by White House to Bi-National Board

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The Chair of the Board of Directors of Child Family Health International (CFHI), Mr. Gunjan Sinha, was appointed this summer to the US Endowment Board on Science and Technology during the US-India joint commission meeting of the White House Office of Science and Technology.

The Volunteer Board of Directors of CFHI functions far from the limelight but plays an essential role in the success of CFHI. We congratulate Gunjan on this accomplishment! Gunjan’s expertise as an entrepreneur has been indispensable to CFHI over the years, and we are sure he will be viewed the same way in his new role.

The Governments of the United States and India held the meeting of the Joint Commission on Science and Technology cooperation in Washington, D.C. on June 24-25 at the Smithsonian Institution’s National Museum of Natural History. CFHI’s Board Chair, Gunjan Sinha joined the meeting as part of the U.S. delegation lead by Dr. John Holdren, Assistant to the President Barak Obama for Science and Technology and Director of the White House Office of Science and Technology Policy. The Indian delegation was lead by Sri Prithviraj Chavan, Minister of State for Science and Technology and Earth Sciences. As part of the overall focus on science and technology policy, Mr. Sinha was appointed on the US Endowment Board, set forth between US and India to foster Science and Technology cooperation between the two largest democracies in the world.

The meeting follows the June 3rd discussion between US Secretary of State Hilary Clinton and India’s External Affairs Minister Shri Krishna that focused on the importance of facilitating cooperation in strategic and high technology sectors as a key instrument to achieve the full potential of the strategic partnership between the two largest democracies in the world.

Mr. Sinha is also Chairman of MetricStream, a market leader in Enterprise-wide Governance, Risk, Compliance (GRC) and Quality Solutions for global corporations, based in Palo Alto, California.

The delegates at the commission include senior officials from various US federal agencies and departments including the Office of the Chief Technical Officer, Office of International and Tribal Affairs, US Environmental Protection Agency (EPA), US National Institutes of Health (NIH), US Department of Energy (DoE), National Science Foundation and Bureau of Oceans, Environment and Science.

The joint commission between the two countries and the US-India Endowment Board will look to inspire public good and economic prosperity in US and India, through science and technology cooperation, greater public-private partnerships, promoting innovations and entrepreneurship and creating appropriate policy environment for greater bilateral co-operation. Areas of focus of the Endowment Board will include such significant areas like Food Security, Climate Change, Energy Policy and Healthcare among others.

In line with the mission of the White House Office of Science and Technology Policy, the commission’s aims to ensure that Federal investments make the greatest possible contribution to economic prosperity, public health, environmental quality and national security, and to foster professional and scientific relationships with government officials, academics and industry representatives for providing policy-relevant advice, analysis and judgment for the President on major policies, plans and programs of the Federal government

An Accessible Resource and Network for Premedical Students

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Premed Network

Special Post for Premeds

At last, an accessible resource and network for premedical students. Do yourself a favor and join Premed Network. This website, the brainchild of Omar Baig, is a breath of fresh air. Just in time for the start of school, Premed Network has updated features and is home to a host of resources that every premed student should know about.

Premed Network Website Image

As I travel to conferences and meetings with campus groups, I find that like medical and nursing and public health students, premeds have a number of issues that are pertinent to their point in their academic career. Their questions and decisions are important and shared across campuses and across the country. There is nothing pretentious here, students can be themselves and are allowed to have all the normal questions that everyone has. For young people taking a real serious look at medicine as a career, and for those who are deeply engaged in preparing themselves for medical school, this is a great network to join. CFHI has joined Premed Network and we are happy to provide any support or advice to premeds interested in Global Health.

CFHI Convenes Forum on the Empowerment of Women

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CFHI is proud to convene a Forum on the Empowerment of Women to be held at the United Nations Church Center on September 15, 2010, in conjunction with the opening of the 65^th Session of the United Nations General Assembly.

The Forum, entitled Successes and Challenges of Women in Leadership Roles in Traditionally Male-Dominated Environments, is an effort to shed light on the global effort to achieve Millennium Development Goal Number Three.

In government and NGO organizations worldwide, women are increasingly taking on leadership roles. What are women finding as they assume these roles? From the grassroots level to the executive level, women are succeeding in roles heretofore held only by men. Are there common experiences across these different levels? Are there common challenges? What cultural issues need to be considered? What strategies are most successful?

Join the audience along with a distinguished panel including CFHI Medical Director, Jessica Evert, MD, and direct from New Delhi, CFHI India Coordinator, Hema Pandey, as these topics and others are discussed in this lively forum. Gain insights and share your own story. Join us September 15^th at 1:00 PM at 777 UN Plaza (44th Street between 1st and 2nd Avenues) 8^th floor, Boss Room. The forum is free and open to the general public but we do ask that you RSVP. Please click here to see more information here and the email address to RSVP.