Tag Archives: CUGH

Getting One Step Closer to a Unified Global Health Curriculum


The term “Global Health” can be an all encompassing, and sometimes, vague term.  Individuals from the fields of public health, medicine, and more have all defined this term in different ways.  That is why when the Consortium of Universities for Global health convened in 2008, one of the items that members called for was to define the field of global health and standardize required curricula and competencies for the emerging discipline.

We are excited to announce that, as of this week, we are one step closer in providing that definition as the Global Health Competencies Sub-committee of CUGH released a new toolkit that brings together resources from a wide array of subjects and authors in the field of global health.  All this under the leadership of CFHI and our Executive Director, Dr. Jessica Evert.  Thank you for this great effort across dozens of institutions and fields!

Referred to as the CUGH Global Health Competencies toolkit, the resource is designed to help Global Health faculty build curricula and competencies that may stretch beyond their immediate area of expertise.  As the field of Global Health grows in its maturity as an academic field, we here at CFHI are proud to be at the vanguard.

 

International Experiences: Witnessing the Merger of Public Health & Medicine

 

“Global Health is Public Health”

Nothing makes for fodder amongst academics and medial professionals like definitions.  In the case of global health there are more than a few.  One definition was put forth for the Executive Board of the Consortium of Universities for Global Health (CUGH) by Jeffrey Koplan, MD, MPH, a physician, author and academic.  Another definition, offering a challenge to the often idealized concept, was proposed by a physician from the Global South as “a concept fabricated by developed countries to explain what is regular practice in developing nations.”  During this, the 19th annual National Public Health Week, let’s consider the definition of global health that appeared in The Lancet, “Global Health is Public Health.”

Students in Ecuador Attending a Reproductive Health Information Fair

Students in Ecuador Attending a Reproductive Health Information Fair

Abroad, physicians and other practitioners in resource-restricted settings act simultaneously as caregivers for both individual patients and populations as a whole.  The marriage of public health, clinical medicine, and health systems is cost-effective, pragmatic, and successful.  Slowly the US is catching on, as primary care physicians start to look at their patients, not only individually, but also as panels with certain disease profiles that can be monitored for population-based perspectives.  Similarly, experts have called on medical schools to be accountable to their communities in the Social Accountability of Medical Education movement, suggesting schools success cannot be measured without considering impacts on their own community’s health status.

Discovering Public Health in International Experiences

As head of Child Family Health International(CFHI), students interested in CFHI’s Global Health Education Programs often approach me and ask “What programs are focused on public health?” or conversely, “I want a program solely focused on clinical medicine, not public health.”  What they soon learn upon beginning their CFHI experience, however, is the important reality that in many low and middle-income countries the lines between public health and biomedicine are very much blurred.   This is largely out of necessity demanded by sparse or finite resources, as well as evidence-based and systems approaches to health.

International experiences focused on global health such as CFHI’s have so many proven benefits—studies have shown increased cultural competency, better understanding of caring for people with limited supplies, and a nurturing of lifetime dedication to underserved care.  Importantly, they also increase board scores in public health.  So, rather than asking “how can I find an international experience focused on public health?” consider the question, “how can I find the public health in my international experience?”

How have you found the public health in your international experiences?  Let us know in the comments below.

Student Essays Reflect Realities and Impact of Global Health

Student Essay Contest Winners with CFHI Executive Director Jessica Evert, MD (far left)

Student Essay Contest Winners with CFHI Executive Director Jessica Evert, MD (far left)

At CUGH’s Annual Meeting last week in Washington, DC educators and students from over 60 countries met to discuss the global health landscape.  Perhaps one of the most powerful and emotional sessions was one that captured power of reflection in global Continue reading

CFHI: Asset-Based Community Engagement

Child Family Health International (CFHI) at 20 years old continues to be the gold-standard in forward thinking and innovative frameworks in global health education.  CFHI provides community-basedsmall-logo2_png education alongside local professionals via clinical and public health experiences for students and those interested in learning more about medicine and health-related fields, with more than 20 programs in 6 countries.  Programs cover a variety of topics from maternal health to palliative care.

What Makes CFHI Different?

After all these years CFHI remains unique, continuing to challenge paradigms in global health and advocating for local communities. CFHI partners with communities that are considered low-resource and underserved by global financial standards.  Rather than focusing on what is lacking, however, CFHI helps to identify community strengths, ingenuity, and passion.  In close collaboration with local teams, CFHI creates programs and funds community health projects identified and carried out by local teams. This practice is based on the asset-based community development approach, formalized at Northwestern University.  The CFHI approach positions local health practitioners and patients as the ‘local experts’—presenting global health realities through authentic experiences that help shape and transform young people who are interested in global health, equity, and global citizenship.

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

Not Just Talking the Talk, But Walking the Walk

Importantly, CFHI is a staunch proponent of compensation for local community contributions and practicing financial justice.  Uniquely CFHI, 50% or more of student program fees go directly to the communities they will be visiting, benefiting the local economy at large and specifically undeserved health systems.  CFHI is an active affiliate of Consortium of Universities for Global Health, United Nations ECOSOC and has authored literature about global health educational curriculum development at undergraduate and graduate levels.   CFHI encourages students to “Let the World Change You” in preparation for being a part of socially responsible, sustainable change they wish to see in the world.

Making Global Health Knowledge a Requirement for MD Students

A Post From CFHI’s Medical Director:

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

CFHI Medical Director Blogs on Day 2 of CUGH Conference

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

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.”  Tom Hall GHEC Executive Director Speaks with Student at CUGH10They 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.

A Definition of Global Health

Defining global health has been a challenge. This has been especially true in recent years with the increased interest in science, philanthropy, and politics related to global health. In the June 6, 2009 issue of The Lancet, a multidisciplinary and international panel brought together by the Consortium of Universities for Global Health (CUGH), and led by Jeffrey P. Koplan, MD, has taken a bold step in offering the world a definition.

The article entitled Towards a Common Definition of Global Health, represents an important step in bringing together the work, “and priorities for action between physicians, researchers, funders, the media, and the general public.” A thoughtful process is outlined considering the origins of global health in the areas of public health and international health.

The attempt is to be broad rather than limiting, and emphasizes multidisciplinary approaches and mutuality, as well as equity and collaboration.

We applaud CUGH for this effort and recommend this article to all CFHI students.  We greatly appreciate that an effort has been made across continents and cultures to find common ground for the advancement of the study and the work of Global Health.

In recent years, at conference after conference, speakers have noted that there is no real agreement on just what is involved in Global Health. This long-awaited work is welcome, especially in its tone –it is not forceful or proprietary but open, inviting, and humble. We hope that it serves as a good starting point for people from all aspects of Global Health to find a workable construct that will be helpful to collaboration in our work and research.

Please go the The Lancet website and find the article.