Tag Archives: Cultural Humility

The LGBTQ+ Population in Uganda

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

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

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

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

For more information, please refer to the following sources:

The OSAC LGBTQ Guide to Travel Safety

The State Department’s Website for LGBTI Travelers

The Human Rights Watch

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

CFHI Salutes Medical Director Dr. Raj on World Social Justice Day

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February 20th is World Social Justice Day. We would like to take this day to highlight one of our partners who has been working to achieve social justice. Dr. Rajagopal has been helping to reform the Hospice and Palliative Care laws in India through his organization, Pallium India.Through both personal visits to patients, and by building a strong system of doctors across the nation, Dr. Rajagopal has highly improved the state of Palliative and Hospice Care in India. Access to Morphine and Pain Killers is an enormous problem in India because of previous problems with morphine addictions. India has the highest amount of victims for mouth cancer, and it is estimated that less than 3% of cancer patients get proper pain relief. (1)

Dr. Raj conducting a home visit, Trivandrum Southern India

Fortunately, laws in India have been changed. Now, a policy has been set so that in Kerala, doctors with at least 6 weeks of training, such as Dr. Rajagopal, can prescribe morphine for palliative care. (2) The rule was introduced in June 1998 in Trivandrum, the capital city of the state of Kerala. Since then, the central government has recommended this new rule to all the states in India. The idea of easier access to morphine and other pain relieving drugs was initially recommended by organizations and committees such as WHO Collaborating Center for Policy and Communications in Cancer Care (Wisconsin, USA). The Center is currently attempting to simplify complicated state narcotic regulations to further improve the availability of opioid analgesics.

Through his organization, Pallium India, Dr. Rajagopal strives to provide Palliative and Hospice care to those that need it. Not only does Pallium India provide medical care to patients, but the organization also provides resources such as food and sewing machines to the patient’s family to help them get back on their feet. CFHI has partnered with Dr. Rajagopal to launch the Palliative Care In Southern India Program in Trivandrum, India that centers around Hospice and Palliative care. The CFHI participants involved in the program are given the opportunity to visit the patients and experience first hand how patients are treated and managed. Pallium India and CFHI have worked together to reform India’s Hospice and Palliative Care system.

(1), (2) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573467/

-Special thanks to guest bloggers Alexandria Tso and Nayanika Kapoor for contributing this article.

CFHI vs. Brigades: Defining “Helping” in Healthcare Abroad

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A Doctor Walks Into a Community..

For healthcare professionals or those on that path, it’s tempting to drop into a community abroad and start treating patients. The stark realities of poverty, lack of resources, and unaddressed illness provides an often disturbing (and therefore motivational) contrast to our Western frame of reference. We are often shocked and saddened. As a consequence, we want to help.

An important question arises however, when we are students or even when we are credentialed professionals visiting a faraway community, what’s the best way to help?

Two Approaches to Global Health

An article profiling Child Family Health International – CFHI’s Global Health Education Programs in the current online edition of the Association of American Medical Colleges’ journal Academic Medicine contrasts two interpretations of ‘helping.’ The article contrasts CFHI’s program structure to that of brigades. Brigades are short-term (often lasting one or two weeks) international activities that set-up clinics in parallel to or completely outside of existing health systems. These temporary establishments are meant to see many patients in a short period of time. Commonly, medications, often drug samples, are brought down from the home country of volunteers and dolled out to patients.

The students writing the article draw an important contrast between the two definitions of ‘helping’ represented by CFHI Programs and brigades. Brigades aim to ‘help’ by directly treating patients using Western physicians and students. But they do so often at the expense of follow-up and continuity of care. Brigades define ‘help’ in a very immediate sense. Contrastingly, CFHI defines helping as empowering local communities and using Western funds to develop and elevate the stature of the native health care workforce. CFHI positions local physicians, nurses, and community members as local experts, in a unique role to teach outsiders about their approach and insight. CFHI believes they are the sustainable solutions to global health challenges.

Humility and Knowledge Key

CFHI Student with Local Doctor, India

CFHI’s definition of helping is perhaps more humble, believing we need to first respect and attempt to understand the complexities that underlie global health challenges, rather than trying to address these challenges with immediate auxiliary patient care. This admiration of local health care providers and the goal of first comprehending the complexities of global health disparities is fundamental to shaping the collaborative global health leaders of the future. Before we try to change a reality, we must begin to understand it. This understanding is afforded by CFHI’s Global Health Education Programs.

The Power of IFMSA & The Global Health Placebo Effect

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International Federation of Medical Students’ Associations (IFMSA) is not just another acronym in a field laden with catchy abbreviations- it is a groundbreaking organization that despite its 60+ years of existence is doing something that remains innovative- bringing together medical student colleagues from around the world to work together as peers.

IFMSA Meets in U.S. for the First Time in Decades

Dr. Jessica Evert, CFHI Executive Director & IFMSA Alumna, with other IFMSA Alumni

This year the setting for the IFMSA General Assembly is Baltimore. Medical students from Sudan work alongside colleagues from the US, those from Panama collaborate with Poland, the interactions are endless. As an alumna of IFMSA I got the privilege to join the meeting and reconnect with old friends from my days as IFMSA-USA Vice President. IFMSA’s US affiliate is the American Medical Student Association (AMSA), who is also partnered with CFHI. IFMSA is a great resource for AMSA members, especially those interested in global health. Often the global health dialogue is dominated by Western voices. IFMSA allows 1,000+ medical students from around the world to work face-to-face twice a year. It democratizes global health and allows for crucial relationship development that is necessary for a unified global advocacy voice for health equity and justice. It has the secondary effect of humanizing perceptions of the developing world- rather that breading pity; it engenders mutual respect between colleagues from both resource-rich and resource-limited countries.

CFHI Global Health Approach Shared & Praised at IFMSA

Child Family Health International (CFHI) was in great company during the IFMSA alumni meeting. Attendees praised CFHI for its gold-standard model for global health education. Colleagues from Ghana, Serbia, Philippines, Nigeria, and beyond approached me with gratitude for CFHIs important advocacy voice in the global health education field.

I was equally as impressed by the candid discussion about advocacy provided by Predrag Stojicic from LeadingChange. Predrag distilled buzz words and espoused a platform for grassroots champion recruitment and leadership. A thoughtful organization, The 53^rd Week, took the stage to describe their pragmatic approach to evaluate and maximize short-term medical trips. These trips are characterized by volunteers going to resource-limited communities, usually for 1-2 weeks to deliver medical care and related services. While well intended, the global health community is increasingly leery of short-term volunteer experiences, as their impact has been questioned and downfalls revealed.

The ‘Global Health Placebo Effect’

Lawrence Loh, co-founder of The 53^rd Week, calls the appearance of impact enabled by short-term medical missions the “Global Health Placebo Effect.” Under the strong leadership of Loh and co-founder Henry Lin, The 53^rd Week is creating a platform for the multiple, disjointed teams who visit a community at different times during the year to coordinate their efforts to created continuity, sustainability, and an overarching orchestrated approach targeted towards upstream interventions. Concurrently, they are raising awareness of the risks of short-term medical missions and suggesting alternatives that may lead to more tangible and sustainable ‘help.’

The efforts of these great colleagues and the synergy with CFHI philosophical approach and model of running Global Health Education Programs has been inspirational!

Turning Dark Profits into Enlightened Transformation

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From Skepticism to Hope: Turning Dark Profits into Enlightened Transformation

I’ve been a doctor now for 13 (lucky) years but I recently had the opportunity to reflect on my path towards becoming a physician and my involvement in Continue reading →

CFHI & Northwestern University Students Impact Women’s Health in Mexico

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A Global Team

Global Health Initiative (GHI) at Chicago Lake Shore Medical Associates is a nonprofit organization leading through philanthropic advocacy. Funding from GHI provided medical students at Northwestern’s Feinberg School of Medicine (FSM) the opportunity to engage in a month-long global health experience in Oaxaca, Mexico with a lasting impact. Beginning in 2011, Continue reading →

Empowerment Means Having a Voice

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Voices of empowerment from women in rural Northern India

About an hour outside of the north Indian city of Dehradun, the terrain starts to change as you begin to enter the foothills of the Himalayas. Paved streets give way to winding dirt roads, some seemingly carved into the incline of the mountain like the etches of a screw and only wide enough for one vehicle. Luckily almost no one in this area has a car, so we are usually sharing the road only with the monkeys and the goats. On this particular trip, the monsoons have not yet released India from their grip and our vehicle struggles on the loose dirt and gravel as the torrents of rain pour down. Oddly enough, here, about as far away from an urban setting as you can get, I’m reminded of a car wash because the sheets of rain are hitting the car so hard that you can feel their force on the hood of the vehicle like the power washes you can get back home.

Luckily, as we reach the village of Patti, the torrents subside and we are able to disembark without getting too wet. CFHI has supported the operation of a clinic in this area since the late 1990s –it is the base of the CFHI Rural Himalayan Global Health Immersion Program. In the last seven years, we have trained women elected from the surrounding villages as health promoters. Previous to these efforts, there was no organized healthcare happening in this area. Today is a meeting of the health promoters, some having walked as many as five hours for the event (a fact that always humbles me greatly). An initial three year training effort took women with little or no formal education and taught them the basic skills of health promotion. Many of them come from a long line of traditional birth attendants, so they already had some experience in the area of health. After the initial training, they have been able to monitor women throughout their entire pregnancy. Additionally, they instruct their communities on many topics: sanitation, nutrition, immunizations, hygiene, and family planning, to name a few.

As the rain began to intensify once again, we huddled around two tables pushed together on a porch, under a metal roof, next to a rice field. The sound of the rain caused everyone to move in closer and lean in to hear. My many previous visits over the years have been in more extreme dry heat when we sat spread out in the shade as we

CFHI Health Promoters Meeting in the Village of Patti, Northern India

talked. –Of course I need to stop here and say that since I have no capacity in Hindi, the CFHI India Coordinator, Ms. Hema Pandey, was gracious enough to do the translation, and her easy, relaxed, yet professional manner also contributed greatly to the level of the conversation. Maybe it was this more close huddling, or maybe it was just the product of seven years of meeting them once or twice a year, but for whatever reason, this time the conversation took a more intimate track. Over the years, our meetings have been about stories of the work the Health Promoters are doing, each in her own village. I’ve always been moved by their commitment and dedication as the women are all volunteering in this role and, at times, it can occupy a lot of their time and energy. We always talk about what they need and we try to line up successive training experiences for them. Today, however, I somehow felt like I could ask them more about themselves. Now, all these years into their work, I could see in them their own sense of being experienced –that they are really settling into their roles. It also helped that there was a young 18 year old woman who had joined us for the first time, as she now wants become a Health Promoter. The older women took her under their collective wing as she found it hard to answer any direct questions –not used to being asked her opinion. “Don’t worry, you’ll get used to it,” was the message as all the older women laughed. “We were all once like you,” one of them told her, “not knowing how to speak, not sure what to say … you’ll learn.” It was also touching to see the older women buoyed in spirit by her interest. There was more of a general feeling –not only of pride, but also of purpose, and an almost palatable sense of hope for the future in the smiles of the older women, broader than I have ever seen them before.

I asked the women what they liked most about their work. They answered with the stories of what they have been able to do. “And for you,” I asked, “what do YOU like about it.” There was some discussion amongst the group. They said that they like “feeling empowered.” “What does it mean,” I asked, “to feel empowered?” “It means that now I can speak,” said one, motioning to the new recruit whose personal growth and self confidence the women will now each personally see to. “It means I can teach,” said another. “It means improvement, progress for the whole village,” said another. This spawned a longer conversation of the feeling of satisfaction they have in seeing the results of their work. They see women having healthier pregnancies; they see children growing up stronger and healthier. One of the biggest changes, they report, is that now, even the men of the villages will listen to them in a way that never happened before. The women told me that the men have come to see the women as possessing knowledge and understanding as a Health Promoter that no one else has. What was even more remarkable than the statement itself was the body language, the tone of confidence, and the feeling of accomplishment that came through in these statements, none of which required the skills of a translator to be successfully communicated.

A Visit with The Father of Palliative Care in India

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Dr. Rajagopal Dispenses Needed Medicines and a Healthy Dose of Respect.

Pallium India

After a meeting with CFHI’s Founder, Dr. Evaleen Jones at Stanford University, Dr. Rajagopal (Dr. Raj), the Founder of Pallium India agreed to become one of CFHI’s newest partners in India. CFHI India Coordinator, Ms. Hema Pandey, and I had the privilege of spending three days with him in Trivandrum, Southern India as we work to develop a CFHI Global Health Immersion Program exploring Palliative Care.

As the monsoon season takes its time to come to a close, the beautiful, lush countryside around Trivandrum in Kerala –Southern India is as calming as the presence of Dr. Raj to his patients. We were given the great privilege of being allowed to shadow Dr. Raj during a day of home visits to various patients of Pallium India, the nonprofit he founded.

Who is Dr. Rajagopal

Dr. Raj is responsible for beginning the palliative care movement in India. He tells me that while the goal of palliative care might be the same in India as it is in England, where the modern hospice movement was started, the implementation is different. Dr. Raj feels that to simply pick up and transplant palliative care as it has been developed in the West can inadvertently have consequences that cause more suffering –when the main goal of palliative care is to reduce suffering. Dr, Raj is indeed a unique individual; he is both a visionary and a worker in the trenches. To follow him for a day doing home visits was inspiring. It was also a primer in how to do this kind of patient care.

Dr. Raj pointed out to me the four domains of patient care that were outlined by Cicely Saunders, the founder of the modern hospice movement. The four interlocking domains are Physical, Emotional, Social, and Spiritual. It is certainly a tall order for anyone to provide such comprehensive care, and to do it in low resource settings is even more challenging.

A Day in the Life– Implementing Palliative Care in India

As we drove into some of the poorest communities in Southern India, Dr. Raj and his team, a nurse, a social worker, and a driver went about their routine. Patient files are reviewed as we travel in the van. The size of the patient files is notable. After Dr. Raj read the file a bit, he begins to tell us the context of the family we are about to see. We get a succinct yet

Ms. Hema and Dr. Raj on home visits

thorough description of the family composition and history. The level of detail is impressive and we even had a few questions about the family that Dr. Raj answered from the record. I asked him when he last saw the family and he said that this was his first visit to them. There are three other teams conducting home visits and so the family has been seen by the other teams in the past. It is amazing to see the level of detail that is recorded from the home visit. From these notes, other services from nutrition, to physical therapy, to social work are provided –all driven initially from the teams’ weekly or fortnightly visits.

As we arrive, Dr. Raj gives warm and respectful greetings. He makes use of his reading of the chart right away to let the family know that he is up to speed on the situation even though this is his first time seeing them. Telling and retelling the story can be a help, at times, for a family but to have to do it with every healthcare worker that shows up, can become a burden.

In the home visit, Dr. Raj is totally in his element. Calm, positive, and respectful, he has a way of making the patient and the family feel that he has all the time in the world to spend with them –they have no idea that he has six more home visits to do. His careful touch, his undivided attention, his deep listening, his affirming comments are all the epitome of what a home visit should be. He listens and draws

Dr. Raj conducting a home visit, Trivandrum Southern India

out information to help him tweak the treatment plan based on what has happened since the previous home visit. As he leaves, he has given not only some medicines and ordered some more physical therapy but he has also given the family and the patient dignity, respect, and acknowledgment through his manner, his interactions, and his presence.

And, of course, as we make it back to the van, it’s time for Dr. Raj to write page after page of notes so the follow-up treatments can be done and so the next home visitor can pick up right where he left off.

CFHI Featured in Everyday Ambassador Blog

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Everyday Ambassador Blog

We at Child Family Health International (CFHI) are deeply honored to be featured in the Everyday Ambassador blog post by Kate Otto. Kate’s own accomplishments in global citizenship and smart diplomacy are considerable for anyone, especially for someone at such an early point in her career. She is a great example for students today who are interested in global service.

CFHI is equally proud to be a member of the International Volunteer Programs Association (IVPA), also featured in the blog post.

Many CFHI alumni are already doing their part in the Global Health field. With over 6,000 alumni now, we have a wonderful, growing family of everyday ambassadors who advocate and educate through their everyday activities. Through their first-hand accounts of shadowing local healthcare workers in underserved and low-resourced settings, they can speak with conviction and in compelling stories about the similarities and the differences of healthcare systems, and about important global health issues. Whether they do it in a professional capacity as a lecturer or professor, or in the informal setting of a party or a dinner, they can be equally effective in telling the story and enlightening people about global realities, thereby each doing his or her own part to bring us all closer together as the human family and improve the health of the world community.

You don’t have to be abroad to be making a difference. Visit our Facebook and LinkedIn pages and join in the conversations that are happening with people all around the globe. Follow #GlobalHealth on Twitter and keep yourself current on issues and causes. Share all of this with your own social networks and you will be surprised how much influence you can have as an individual. Our world is, in so many ways, becoming a ‘smaller place’. Be a part of it; participate!

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.”

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.

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.

Global Health Down Under -A students’ Conference- Hobart, Tasmania

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Australia site of Global Health Conference

CFHI is very happy to be at the Global Health Conference in Hobart, Tasmania that is being put on by the Australian Medical Students’ Association (AMSA). The conference running 1-4 July has a full academic program with impressive topics and excellent speakers. The entire conference is organized by and for students and the level of professionalism is truly outstanding. CFHI is very happy to be an NGO sponsor here and we find the interest and engagement of the students to be at a very high level. A CFHI alum from Perth, Samantha Mulholland (2009, Pediatric Health, La Paz), has been present and giving her first-hand descriptions of her CFHI experience.

UTAS Site of Global Health Conference Tasmania

The University of Tasmania in Hobart is the site for the conference as some 500 students gather from across Australia and New Zealand, and even from Asia and Africa.

Indeed students all over the world have a growing interest in Global Health. What is refreshing here is that so many of them are deeply informed on world issues, social determinants of health and many other areas. Panels of leading experts, student questions and discussions have all been engaging and enlightening.

Panel discussion at the Global Health Conference Hobart Tasmania July 2010

Expectations –When Helping is Complicated

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Kim McLennan, an accomplished physical therapist, and long-time CFHI volunteer, is now in Haiti and has been communicating to us some of the complexities of just trying to help. A veteran of many humanitarian missions, Kim knows that to lend a helping hand is not always as easy as it looks on the surface. The crisis in Haiti, and the

Some of the many peopel who have volunteered their time going to Haiti in the aftermath of the 7.1 earthquake

This is a U.S. Navy photo of some of the many vounteers who have gone to Haiti to help after the great earthquake

outpouring of volunteers to give assistance has amplified the Grey Areas of coordinating and managing international aid. The questions of culture, ethics, passion, compassion, and the realities of unexpected complexities are raised in her moving, first-hand account. Dr. Evaleen Jones, CFHI’s Founder and President, asked Kim if we could share her writings through this Blog. Kim gives us her experience alongside her on-the-spot reflections which are informed by her years of cross-cultural work in some very challenging situations.

We are grateful to Kim for her permission to present her observations and thoughts here. Unfinished and raw, they give us an unvarnished view of reality with no easy answers –much as the real situations in Haiti, and elsewhere in the world. You are welcome to click on the “Read More” button to leave a comment.

“Expectations

Here in Haiti, 5 months after the devastation of a 7.1 earthquake, volunteers are coming in droves. I am one of them. By the end of my stay, I will have been here 7 weeks. Most of my fellow volunteers come for one week or two if they’re lucky. Professionally, the greatest number are doctors, nurses, emergency room specialists, pediatric and wound care specialists, prosthetists and physical therapists. The majority have never been to a developing country or to Haiti before they arrive.

They come with the expectation of being welcomed for their concern and service, everyone paying their own expenses and hoping their week of selflessness will do some lasting good. Most leave, probably feeling that their mission was accomplished, even if in some small isolated way. This morning, at the hospital I’m working in, there are 20 American doctors, nurses and other hopeful people wanting to do something useful. They’re surprised when they realize how different the system is here, how charts and notes and procedures that are standard in the US are hardly used here. They are surprised that the Haitian nurses don’t speak English or seem happy to share their small desk or coveted stash of medical supplies. Many come with their own supplies of state of the art medical technology and toys and blankets and shoes. Most of it is very useful and appreciated by the patients. The Haitian staff seems to disappear when the volunteers arrive to see the rare and unusual patient injuries that have occurred here.

There have been many surgeries and interventions that would have never occurred without the volunteers being here. External fixators and wound vacs are found throughout the hospital, and the meticulous care given to the patient’s wounds is without parallel. But this is precisely the problem. The nurses here do not have the training to change the dressings or change the wound vacs and no one is training them. There will be no physical therapy or discharge planning when the NGOs pull out for good. For all their good intentions, the volunteers seem to ‘take over’ when they arrive and then complain that the Haitian staff doesn’t seem interested. Cultural differences aside, who likes it when someone new arrives on the scene, walks in, starts to do your job and then leaves, making you feel less than adequate after witnessing such expertise.

As you know, this is a touchy subject. Everyone who comes here has the best intentions, simply wanting to help. The problem is when they come, they come in groups with their own comfortable systems in place, just in a new setting. Most of the Haitian hospitals are not equipped to house or feed these additional visitors and the plumbing in Haiti already is barely serviceable. They often don’t seem to try to learn a few words of Creole, or go outside the compound to meet the Haitians and share a local meal. It probably feels like a vacation except that the food is scarce and the air-conditioning doesn’t work.

The first time I went overseas to volunteer 12 years ago in South Africa, I stayed for one month and it took me almost three weeks to feel I was accepted a little by the local staff and they still did not seem keen to have me in their midst. I have been looking ever since for better ways to interact and contribute to poor people in need of basic healthcare. I believe the answer is recognizing the potential of the local people….

It truly does no good to ‘do your thing” as a volunteer, no matter how much it is needed if you don’t teach someone else how to do it also. Volunteering in Haiti can contribute to the Haitian infrastructure only if we volunteers think about the consequences of us being here. Are we willing to be patient and work alongside someone whose future may improve from our training? Are we willing to trust that they may know a better way than the way we’ve been taught? We are influencing an entire system by our presence and we should be including them every step of the way…..”

Service World -A Bold New Initiative in International Volunteering and Service

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On June 23, 2010, the Brookings Institute hosted a forum on international volunteering and service and the launch of Service World: Strategies for the Future of International Volunteer Service.

Ambassador Elizabeth Frawley Bagley at Brookings 23 June 2010

Ambassador Bagley at Launch of Service World Effort

CFHI is proud to be one of the organizations endorsing this effort that is a call for increased international cooperation at all levels. We know that as the world effectively grows smaller, the health of the world’s population will depend more and more on our ability to share knowledge, understanding and efforts across boarders and continents. Improved understanding of how culture impacts health and the global sharing of current best practices along with traditional proven interventions will benefit all of our efforts at improved health for all populations. This is the intersection of modern medicine, that builds on science and technology, and the cumulative wisdom of ancient cultures that builds on a deeper knowledge of the earth and the human mind, body, and spirit. CFHI students experience this today in the Amazon jungle and the foothills of Himalayas. To increase the ability of future health professionals to to have these transformational experiences in a manner that is socially responsible to the host communities, can only improve the health of the world community, and our progress as people toward global citizenship.

Ambassador Elizabeth Frawley Bagley, Special Representative for Global Partnerships in the Office of the Secretary of State, gave the keynote, inspiring those present to work collectively toward the goal of increased opportunities for people of all ages and walks of life to volunteer service internationally. 2010 marks the 50th anniversary of the birth of the idea of the Peace Corps. As the celebratory events for this anniversary happen this coming October, our nation will have the opportunity to reflect on this great idea and the great accomplishments that have come from it. Service World recognizes that the positive impacts have come not only from the government sponsored Peace Corps but also from the many private and nonprofit organizations that have taken up this global vision and provided opportunities for so many people from the United States and many other countries.

CFHI’s Founder and President, Dr. Evaleen Jones, has often recounted that the Peace Corps was an inspiration for her as a young medical student at Stanford University,when she began the creation of CFHI . More information on Service World will be posted on the Blog over the coming months.

Interview with CFHI’s Medical Director –Audio Post

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I had the chance to sit down with CFHI’s Medical Director, Dr. Jessica Evert, at our offices in San Francisco, just before she was honored with an award from the Global Heath Education Consortium (GHEC) at their annual conference in Cuernavaca, Mexico. Dr. Evert began her role as CFHI Medical Director in January. Her education career includes studies at Emory University, The Ohio State University College of Medicine, and the University of California at San Francisco, where she continues to serve as a clinical faculty member of the Department of Family and Community Medicine.

We spoke about her introduction to Global Health, how she integrates her work as a physician in the San Francisco Bay Area with her Global Health Activities, and what attracted her to CFHI. She talks about how CFHI’s model is one that changes the dynamic by empowering local communities through actively building on their strengths in ways that lead to sustainable solutions.

Please click on the links to listen to our conversation and you are invited to join the conversation through adding your comments below.

Everyone Pitching in to Help Haiti and Some Old Lessons Re-Learned

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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.