Report from the Student National Medical Association 2010 Conference
SNMA Conference 2010 Chicago
It is early Spring in Chicago and this is my first visit to theStudent National Medical Association (SNMA) annual conference. The SNMA is the oldest and largest independent student-run organization focused on the needs and concerns of medical students of color. CFHI has supported this conference in the past and we have been happy to have the help of the SNMA in increasing awareness of CFHI programs to more and more students. We have been looking forward to actually being here this year and as the conference begins, it is clear that the students who have assembled on this balmy weekend in Chicago have a great deal of interest and wonder about Global Health.
From the CFHI Table at the 2010 SNMA Annual Conference in Chicago
It is only the first day of the conference and the stream of students who have come to learn about CFHI programs has been almost nonstop. This medical education conference carries the title Healthy Impact 2010: Educate, Advocate, Empower. The goal is to further the SNMA mission to support the pursuits of current and future underrepresented minority medical students and successfully train clinically excellent, culturally competent, and socially conscious physicians. The organization of the conference and its program are as impressive as the seriousness of the students.
Not even 24 hours on the ground here in Chicago, and already I have met CFHI alumni from CFHI programs in Bolivia, South Africa, and India. I look forward to the coming days and the sharing of ideas and experiences.
One of CFHI’s newest programs is a Dental Program set in Quito, Ecuador.
CFHI Global Health Dental Program
CFHI is happy to partner with the Sonrie Ecuador Clinics to provide an outstanding program for pre-dental and dental students who want to understand how oral health is approached in a different culture and a different healthcare system.
The “Sonrie Ecuador Clinics” provide dental care and promote oral health in Quito and its surrounding neighborhoods. The clinics have been operating for over twelve years and continually strive to better the services offered to their patients give attention to the dental health. In general, the main dental problem seen by Ecuadorian dentists is cavities. Ecuadorians are considered to be concerned about their dental health, although adequate oral hygiene is not, in reality, reported amongst the majority of the population.
This program will provide a rich and diverse experience for pre-dentistry and dentistry students, allowing them to view local oral health practitioners providing close to world class care in a developing country while at the same time improving their cultural competency and broadening their public health knowledge. Ecuadorian dental professionals who work in a country are interesting and thought provoking as they give context to the real challenges of providing the best possible dental care to the different socioeconomic classes of Ecuador.
Empathic Listening Training for Health Professionals
Professionalism as a component of medical education is something we all know is important but can be hard to effectively impart and even harder to measure. Students who want to improve their professional skills report that it can be difficult to find effective ways to do so.
One of the most obvious ways that the professionalism of a doctor or medical professional is seen by his or her patients, is through the communication skills that are used on a daily basis. Effective communication is a two-way street and becomes ever more challenging each day as our societies become more multicultural. Empathy spans culture, gender, race, age, and socioeconomic factors that can become barriers to effective communication. The need to be understood is a universal human trait and with the right tools, the medical professional can use that energy to charge the healing process in a positive way instead of just letting that energy create stress, confusion and possibly frustration.
Over the years, many CFHI students have commented that the time spent immersed in another culture, has increased their awareness of others and also their awareness of self. Being in a foreign culture and a foreign healthcare system makes a person aware, sometimes awkwardly aware of themselves and of their assumptions about how healthcare should be delivered. Many of the things that we might take for granted on a daily basis are suddenly removed. The experience is one that is new, different, challenging, perhaps uncomfortable and, at the same time, an amazing opportunity for learning. Here too empathy can play a role. The practice of self empathy can help transform the experience to be one of learning and not just stress.
The Professional Edition of Choose Your Words by Mel Sears
Melanie Sears has been a Registered Nurse for more than 25 years and a certified trainer in effective communication since 1991. Her book, Choose Your Words: Harnessing the Power of Compassionate Communication to Heal and Connect, is an excellent workbook designed to help health professionals be more effective in their communication with both patients and colleagues. Joining her as co-trainer will be John Kinyon, also a certified trainer in communication skills since 2000. John has worked in a number of international settings and has worked with many groups to address the challenges of cross cultural communication.
CFHI is honored and grateful to have Mel and John offer their expertise to CFHI participants.
It is true that Child Family Health International does not have any programs in Haiti. It is also true that we are part of the world community and, in a situation like this, if there is a way for us to help, we will do all that we can do, as we did in the Asian Tsunami and have done in other events over the years. CFHI has actually worked in the past with our friends at VIDA and a Haitian partner, the Consortium for the Development of Haiti, to send medical supplies to a number of grassroots clinics and hospitals. It was a very successful endeavor. And so when news of the earthquake came, we tried to re-initiate our successful partnership and get disaster relief supplies to Haiti as quickly as possible. We sent out a message to CFHI supporters, who were already contacting us to find ways to help, and they responded generously.
Our great friends at VIDA (Volunteers for Inter-American Development Assistance) were also right on it, and within about 24 hours of the Tuesday quake, they had assembled over one million dollars in urgently needed first aid and disaster medical supplies. Being on the West Coast, we found ourselves at a disadvantage as the access to the airport and other avenues to get supplies in were quickly clogged. It was also only later, by late Friday and Saturday, that the impact of the earthquake on the functionality of the airport and the seaport were really known. Once it was obvious that all avenues to get supplies in would have to go through the military (directly or indirectly) and staging areas in Florida and other close points, we realized that there was no way to get a shipment directly to Haiti.
We found great support from another wonderful NGO,MedShare, which recently opened a warehouse on the West Coast. They were dealing with the same issues, and through their East Coast connections, were able to get shipments into the pipeline for Haiti. We are grateful for all this collaboration and happy to be in such good company. Our role is very small but, as we are seeing, if we all pitch in and do what we can, a big difference can be made.
On a personal note, having spent some time in Haiti in the early ’90s, when I worked for Food For The Poor, I was moved by the earthquake through the memories that I carry. My visits to Haiti gave me an experience that has stayed with me ever since. The overall work of Food For The Poor was refreshingly simple: provide for basic needs, and develop ways for people to pull themselves out of poverty. Expecting to find people beaten down by poverty, I was challenged to reevaluate my assumptions. Sure the poverty was there, and it was among the worst I have seen anywhere in the world, and some of the people were caught in its clutches in a way that made it hard for them to break free. But, as I have seen in other places, that wasn’t the whole story. By and large, I saw, in Haiti, people who did not let poverty define them or their happiness. These are the people that don’t make the news but carry on their lives as best they can. I gained deep respect for people who perhaps had a better sense of the important things in life than I did. It was a lesson I have tried never to forget and one that I am reminded of again as I see images that trigger forgotten memories of sadness and beauty, despair and hope all mixed and juxtaposed in a society so abused by history, and so full of potential. The people of Haiti re-taught me lessons of never making assumptions, of never writing anyone off, and of the richness that comes from allowing another person, another culture, to change the way I think. I carry these lessons to my work today, even as I carry the memories and, too, the hope that the resounding resilience of the Haitian people and their great joy in living will raise them up, once again, from being dealt a terrible blow.
The anniversary of the great Asian Tsunami is December 26th. Do you remember where you were on that day in 2004?
The effects of the huge earthquake, estimated at 9.1 or greater, and resulting tsunami were devastating. Some reports say that about a quarter million people in some eleven countries, lost their lives, almost in an instant. For those who were left, they not only had to deal with the grief and loss but also with the fact that their lives and livelihood would be forever changed. Many made their living off the sea and now the trauma of this event made it hard for them to comfortably return to their work.
CFHI’s loyal donors and alumni were quick to respond. Within 48 hours, we had connected with other international organizations and had a disaster relief container with supplies for 10,000 people, on the ground in one of the worst hit areas in Indonesia. Our donors continued to give. We let people know that CFHI did not have any programs in the areas that were directly impacted and suggested several other organizations to which to donate. Many of our donors still wanted to give to CFHI, they said that they trusted CFHI to find the best way to use the donations. So after helping with the immediate disaster response, we started doing our homework.
With many programs in India, CFHI was asked to help in the areas of Southern India that were greatly impacted. CFHI met with local and WHO health officials by conference calls. There was great concern that widespread disease would be one of the effects of the tsunami so we were asked to wait while health officials conducted surveillance to see where disease would most likely occur, along that portion of the Indian coastline. As it turned out, preventative efforts held disease in check so we began looking for other lasting effects of the tsunami. For young children, the trauma was the most significant lasting effect. In a number of small coastal fishing villages, much was lost including the schools. One of the most important things to help children dealing with trauma, is to reestablish a routine that is safe and comforting to them. With the loss of the schools, there was a big hole in the day of every child. CFHI teamed-up with the service organization Round Table India –that was charged by the Indian Government with rebuilding the lost schools. CFHI’s donors were able to support the rebuilding of two schools that were lost in the tsunami, thus reestablishing this most significant daily routine for many children.
Sewing Class at Kovalam
Some of CFHI’s donors have continued to donate to make sure that efforts to help those so devastated by the tsunami would not fade away. As this fifth anniversary approaches, CFHI is happy to be continuing in this effort. Loyola College in Chennai started an outreach program to provide ongoing assistance to people affected by the tsunami. A successful community college effort has been established and is training people in skills to help them find jobs in many fields including culinary work and food service for the tourist industry, website design, mechanical work on air conditioning and refrigeration systems, etc. In addition, the Kovalam Community College is providing general courses in English, general life skills, health education, and working with the large population of widows created by the tsunami doing women’s empowerment workshops and helping the widows develop their skills.
During my visit to India earlier this month, I met Fr. Xavier Vedam, S.J. the Vice Principal of Loyoal College in Chennal and the Director of the Loyola Outreach program. I was very impressed with these efforts by local students volunteering to help in the villages that continue in their recovery from the devastating events of December 262004. I was struck by the passion of Fr. Vedam and the fact that they are not giving up but continuing to provide services, engaging the community, and helping people in real ways. To see that many people are now in gainful employment and that the self confidence and attitude of people in whole villages have been so positively impacted, is a wonderful accomplishment and we applaud these ongoing efforts that bring development based on the strengths of the local people.
Human waste is always a strange topic to talk about but it is clear that sanitation is one of the biggest public health challenges. The idea of a Toilet Museum may bring a laugh but I was introduced to an organization that, while understanding the lighter side of the issue, has taken this subject very seriously. “This is nothing short of amazing work,” reports CFHI India Coordinator, Hema Pandey, as she has made it an important part of CFHI’s Public Health and Community Medicine Program in New Delhi. Students also report that this experience is very enlightening to them. It is all the great work of an organization called Sulabh International, an NGO based here in New Delhi, that has for all practical purposes, solved a problem as old as the human race: how to effectively manage human waste. Moreover, they have done it in one of the poorest and most populated countries in the world. At the heart of it, was the desire to free the Scavengers, a caste of Indian society who, for as long as anyone can remember, were relegated to cleaning the excrement of others and carrying it in buckets on their heads, therefore being considered untouchable.
CFHI Students Visiting Sulabh International in New Delhi
Sulabh is nothing short of a movement, started by Dr. Bindeshwar Pathak. Dr. Pathak’s outstanding accomplishments can be summed up in two areas, a new technology for waste management and a social revolution for more than a million people to whom society gave no hope for self-determination.
The technology is alarmingly simple. Sulabh’s design of a two-pit, pour flush toilet is an appropriate, affordable, environmentally sound, and culturally acceptable technology. Many United Nations groups including WHO and UNDP have recommended this technology for more than 2.6 billion people in the world. Essentially the pits are constructed in such a way that one side can be used and filled over about a three-year period. Once it is filled, you switch to the second pit. Over the next three years, the pit design allows for the natural breakdown of the waste in the first pit so that after the three year period, the pit can be opened revealing a dried substance with no harmful bacteria, that is 100% recyclable as a high qulaity fertilizer. This design is perfect for rural areas but Dr. Pathak has taken it to the next step by designing a process of dealing with large-scale public toilets. In this process, bio gas is generated in significant portions to power lighting, heating, cooking, and electricity.
Receiving Instruction on 2-Pit Toilet System at Sulabh
Dr. Pathak is credited with changing the mindset of the Indian people about sanitation and the persons who were required to do the sanitation work. He has done this by example. He went to live among Scavengers learning the affects of the life they were considered destined to and thereby designing a social movement to raise them out of poverty and their unacceptable destiny. Sulabh has schools, training centers and successful assistance programs that are training former Scavengers for everything from light industry, to culinary and food service jobs, and all aspects of computer technology.
This is a terrific success story, making great progress for health as well as a wonderful human story, and one that definitely gets the attention of our students.
CFHI’s program in rural areas of Northern India will expand in 2010 and our student programs will support a local doctor’s dream of increasing access to healthcare in this region. Dr. U.S. Paul has been working in the surrounding areas for many years and he knows well the needs of the people in rural villages. We are happy to help him in this new effort to serve thousands more people in the foothills of the Himalayas who have little or no access to healthcare. The effort is being conducted by a local nonprofit, the Indian Global Health and Education Forum. The village of Sirasu will be one of the areas served. The villages are accessible on foot after crossing the great river. This photo shows the crossing point at Gullar on the River Ganges, about 45 minutes drive north of Rishikesh.
Ganges Crossing Point at Gullar
As we made the drive along mountain roads tracing the edge of the gorge, with sheer drop-offs right next to you that are not for the faint of heart, Dr. Paul spoke of his excitement at being able to operate regular health camps for this remote population. The area around Sirasu is one of several village groupings that will be served Sirasu and its grouping have a population of about 1,500 people. Each village has its own identity and Dr. Paul is an expert at providing care that is respectful of the cultural differences that may exist even from village to village.
Crossing to the East side of the river Ganges in a simple rowboat, I looked over and saw Dr. Paul beaming with joy because he knows how important these services are to the people.
Crossing The River Ganges --Mr. Mayank Vats, CFHI Local Coordinator, and Dr. U.S. Paul board a boat to cross to the East side of the Ganges river
Once across the river, it is a 20-30 minute hike up the East side of the gorge to Sirasu. Dr. Paul meets with village leaders to discuss recent developments. An initial camp was held in November during which Dr. Paul saw more than 150 people in one day. The people ask Dr. Paul to schedule the camps as often as possible. With many other villages to cover, Dr. Paul says he will plan to make monthly visits. While they would wish for more, the people are very happy and express their gratitude.
Local School that serves as a site for the health camp
The camps are conducted at the few local schools as these are natural gathering points and are the largest structures around.
Everything is built on relationships. The local formalities of introductions and meetings to discuss the different aspects are a time to build trust and gain the valuable support of village leaders. These meetings over cups of tea are important times to size everyone up and get a feel for each other. It is the oral culture’s way of completing an application form.
Every meeting has to have tea
We look forward to these additions to our program and to developing these new relationships.
After meeting with local leaders of Sirasu to discuss health camps
Ukwanda is a Xhosa word meaning to grow and develop. It is also the name of a rural health project run from the Tygerberg Medical Campus of Stellenbosch University in Cape Town. CFHI, with a generous grant from the Dickler Family Foundation, has helped to fund part of this project to bring more healthcare to Avian Park, an underserved community near Woster in the rural area well north of Cape Town.
Long story short, they are building on the success of a TB clinic, which was the only healthcare in this community. Once people saw their neighbors responding to TB treatment, the numbers of patients willing to come for treatment began to climb. Now they are increasing visits to homes in the community and beginning distribution of antiretroviral medication (ARVs) for the treatment of HIV/AIDS. The hope is to add more regular visits by a doctor and bring primary care to this community.
While it is still a work in progress and well on its way to success, the story behind the story is fascinating. Stellenbosch University was a bastion of Apartheid. Among its graduates are a number of the country’s prime ministers during the Apartheid regime. It still has a majority white student population but the diversity of its student body is increasing. Even for years after the change to majority rule, to think that Stellenbosch University would be successful leading an initiative to build strong relationships with multiracial rural communities would simply not have made any sense. It is wonderful to see the progress that has been made here. The university has hired a diverse team and has supported their efforts to build the relationships necessary for successful collaboration at the grassroots level. Working to earn the support of the local Rotary Club, local politicians, community leaders, and even seeking out the strongest voices block to block, the university has committed its time, talent, and funding to truly engage the community.
I met with Lindsay Meyer, who is coordinating the community engagement on this project for the university, and it is easy to see that her heart and soul are completely committed to its success. By building the support that she has, she managed to find the creative solutions when road block after road block surfaced along the way. She has taken her guidance from the leadership of the university as all the resources of the university have been made available to this project. From agriculture, to education to law and even theater, the various parts of the university have had a hand in this project. The process of acquiring land for the project has been assisted by the legal faculty; the soil was tested and found suitable for a community garden by the agriculture faculty and students; education programs have been set up and educational storytelling through drama has engaged the community even more.
Lindsay sees her work as cutting edge and it truly is. We congratulate Lindsay, her team and Stellenbosch University for doing what it takes to make this project a real part of the community and not just a satellite office of the university.
As the Executive Director of CFHI, it was indeed a high honor for me to represent our organization and I came prepared to explain our work and our efforts in Bolivia, Ecuador, India, Mexico, and South Africa. To my great surprise, I did not have to do any of that. I found the staff at the NGO Section of ECOSOC wonderfully welcoming and accommodating, and also found they had done their homework and already were quite aware of CFHI and our work. They had read the documents we had sent more than a year earlier in the process of being granted consultative status and they also brushed-up by reading our website prior to my arrival.
What with the UN being such a huge organization, I expected everything to be very bureaucratic and fairly impersonal. Sure it is a big place and with the leaders of the world, about to arrive, there was quite a bit of bustle all about, so it was a surprise to find such personalized service and attention. My meetings with the Deputy Chief of the NGO Section and the Program Officer were cordial and productive.
I learned that there are about 3,200 NGOs around the world that have been granted consultative status. Many are more associated with a cause while they see CFHI as a more “practical” organization. The grassroots nature of our work is appealing to them as well as the diversity of our global family along with the close, long term relationships with CFHI partners who are at the front lines of the delivery of healthcare in so many places. To a large extent, we have our finger on the pulse of global health at the grassroots level and so we have much to share, especially the CFHI model of empowering local communities. Of those more than 3,000 organizations, only about 800 are really active. Work is going on to improve the website of the NGO section and the hope is that there will be much more online functionality to allow for sharing and collaboration.
Flags of the CFHI Global Family now including the United Nations
One official told me, “The international community has looked at your organization from top to bottom and the feeling is that it is a good organization and has a model that is important. We actually hope that it can be replicated in areas of health yes, but also in other areas.” So as we add the UN flag to the flags of nations comprising the CFHI Global Family, we do so with great honor and great pride, and with responsibility for the role that we have assumed through this honor.
One of CFHI’s newest programs, Sight for All- Ophthalmology Rotation is unique in that it is based out of just one organization- a local NGO located in New Delhi, India. CFHI participants rotate through the various departments, learning how programs and treatment are implemented to reduce preventable visual handicaps. Participants are exposed to mobile eye care clinics, ophthalmic procedures in the operating theater, and take part in advanced level classes at the institute.
The Sight for All program recently had its first participant, Melanie Mamon, and she shares a report on her experiences. To learn more about the program’s location, arrival dates, and clinical sites, click here.
