Tag Archives: Global Health Education

CFHI Unveils Inaugural Alumni Advisory Board

Over the past 23 years, Child Family Health International (CFHI) has transformed over 8,000 participants’ lives through our Global Health Education Programs in 7 countries. CFHI Global Health Scholars experience competency-based education and asset-based community development, while contributing to the transformational ways that CFHI’s partners address health and healing.

As experts in this approach, CFHI welcomes our alumni to contribute to our global health efforts in a new and influential way. CFHI is now accepting applications for its inaugural Alumni Advisory Board (AAB). Through the AAB, CFHI alumni will help shape our organization’s advocacy, education and development efforts, as well as the impact that CFHI Global Health Scholars have long after they return from their international programs.

The Alumni Advisory Board provides a structure to facilitate alumni interaction with CFHI, including soliciting alumni opinions and input, mobilizing alumni on CFHI’s behalf, encouraging intra-alumnus mentoring, and providing alumni an opportunity to stay involved in global health and CFHI in a formal/professional development fashion.

The AAB is 12 members with diverse professional background at varying stages of their career. The board will increase collaboration between CFHI alumni, staff and international partners—all committed to advancing CFHI’s mission and building the next generation of global health leaders.

AAB members will engage and benefit from the experience in various ways. For CFHI alumni in the early stages of their career, the board will provide an opportunity to build leadership skills, network with like-minded students and professionals, and further build their global health experience. AAB members who are further along in their careers can lend their expertise, mentor other CFHI alumni, or serve in a senior leadership role on the board. The AAB will enable our alumni to build on the cross-cultural relationships that were created during their CFHI experience and apply that knowledge to their personal and professional endeavors.

CFHI is seeking a diverse pool of applicants for the Alumni Advisory Board of a variety of professional fields, education levels, and backgrounds. In addition, CFHI welcomes all skills including graphic design, social media, event planning, etc. AAB members will be a voice for their CFHI host community, therefore applicants will be chosen from CFHI’s 7 country sites—Argentina, Ecuador, Bolivia, India, Mexico, South Africa and Uganda.

Applications for CFHI’s inaugural Alumni Advisory Board are due by April 1^st and can be filled out here. A committee consisting of CFHI Staff and Board of Directors will select AAB members for the 2015-2017 term by June 2015.

For more information, please contact alumni@cfhi.org.

Alumni Spotlight: Q&A with Alana D’Onofrio

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Alana D’Onofrio participated in CFHI’s program Exploring HIV & Maternal/Child Health in Kabale, Uganda in September 2014. She is an aspiring physician assistant and recent graduate of Northern Arizona University, where she majored in Biomedical Sciences.

Q. How did you hear about CFHI? What attracted you to the Uganda program?

I heard about CFHI through the study abroad program at Northern Arizona University. CFHI was highly recommended to me. It had always been a passion of mine to volunteer in Africa and experience the culture there—that is what attracted me to the Uganda program.

Q. What were your goals going in to the program? How did CFHI help you in achieving those?

My goals going into the program were really to gain knowledge—whether that be medical or healthcare knowledge, or knowledge of a different culture and how people live, eat, dance, work, etc. in a country completely foreign to me. CFHI helped me accomplish these goals. Their partner organization in Kabale has some very special staff members who were willing to teach me so much. They allowed me to ask any question, explained everything about the people of Uganda and their culture, and made me feel very comfortable.

Q. How did the program impact you?

The program impacted me greatly. It solidified my goals of wanting to go into a healthcare career because I learned how much I love working with patients. I also feel more worldly. I now know so much about a country in Africa where very few Americans travel to. I know about the people, the food, the music, and the languages of Uganda. I saw how amazing the people that live there are, how simply they live, and how much they enjoy life no matter how hard it is. The people there inspired me to live my life like them and to never take anything you have for granted.

Q. What were the highlights of your experience?

I have so many highlights of my time in Uganda. One highlight would be heading down to the clinic everyday, excited to see the staff and looking forward to what I was going to learn or see that day. The relationships that I established with the staff are another highlight. We had amazing conversations and always had so much fun. Other highlights include traveling to villages for outreaches to treat people who could not make it to the main clinic in Kabale, hiking the Muhavura Volcano in Kisoro, and going on a safari in Queen Elizabeth National Park.

Q. How has the program changed your perception of health?

I now understand the diversity of health. Health in Uganda is very different than health in America, yet there are many similarities. There are diseases unique to East Africa that I was able to see and study. There are also differences in the way people are treated and diagnosed for these conditions. The diagnostic tests in Uganda are much more limited, therefore many cases are not solved. Certain conditions and diseases that are treated easily in America are not easily treated in Uganda and are sometimes fatal because people do not have the money to pay for healthcare services or because they wait until that last minute to get checked out.

Q. Who was the most inspiring person you met on the program?

The most inspiring person I met was Allen. He is a medical officer who works under Dr. Anguyo at the KIHEFO clinic and he is the preceptor who I shadowed. He has such a passion to help and treat others. The clinic is very understaffed and Allen wants to go back to school to become more qualified in certain areas such as radiology, so that he can help the clinic even more. While he treated patients, he was so patient and always took the time to explain things to me. Overall, he was a great teacher and such a passionate healthcare worker.

Q. How has your worldview changed?

I knew so little of Uganda and even the continent of Africa before my trip. Africa is not at all like what is portrayed of it on the news. Obviously there are parts with war, disease, and extreme poverty, but there are also amazing things about Africa that I was able to see. I no longer associate one country of Africa with the whole continent. Each country is unique.

Special thanks to Alana D’Onofrio for allowing us to interview her for this post.

Applying Competency-Based Education to Global Health Electives

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For those who have participated in a service-learning trip abroad, you understand how life changing it can be. Visiting and learning from a community and culture different from your own can affect you in deep and meaningful ways. But programs and experiences vary widely. Some may claim opportunities for personal and professional growth, yet transparency and best practices are not always the reality on the ground. Also undermining quality, few programs provide true long-term benefits to the host community. One way that medical service-learning trips, or global health electives, can ensure quality is by applying a competency-based framework.

What is competency-based education?

Competency-based education (CBE) is not new, but the concept is receiving renewed attention in many fields, including global health and medical education. One distinguishing feature of CBE is that it begins with the end in mind. This means that the first priority when creating a competency-based curriculum is identifying the desired characteristics and qualities of a competent graduate. Once these characteristics are defined, they are broken down into building blocks, called competencies, which students master as they move through the curriculum. Unlike traditional education, competencies do not have to be course-specific or based on a specific number of course hours; instead, they integrate everything that the student is learning at a given time and build upon each other throughout their schooling. The amount of time required to master the knowledge, skills, and attitudes necessary to achieve each competency may vary, but competence must be demonstrated before students are able to progress in the curriculum.

The beauty of CBE is that it is fluid and flexible, promoting critical application of the course material with a focus on what students should be able to do, as opposed to a singular emphasis on knowledge. The ability of CBE to produce graduates who are competent professionals has made the approach increasingly popular among various health fields. In fact, The Association of Schools and Programs of Public Health (ASPPH), the Accreditation Council for Graduate Medical Education (ACGME), and the Canadian Medical Education Directives for Specialists (CanMEDS) have all developed core competencies for their programs.

Competency-based education in global health:

CFHI Students with Local Physician

Over the past decade interest in global health has surged. Many health professions have integrated global health into their curriculum by applying a competency-based framework. The ASPPH created a Global Health Competency Model that builds on their established core competencies and the Joint US/Canadian Committee on Global Health Core Competencies established a set of six competencies for medical graduates. Even as competencies for global health education become more prevalent, little attention is being paid to global health electives (GHEs). This is puzzling considering GHEs are the primary way students gain experience in global health and in 2013, 30.2% of graduating medical students participated in a GHE.

It is easy to understand why GHEs are increasing in popularity. GHEs provide benefits to students, improving cultural competence, strengthen clinical skills, and increased appreciation for prevention and providing care to the underserved. However, opportunities for growth are not always guaranteed as they are based entirely on program quality. Unfortunately, little effort has gone into determining the structure and educational objectives for GHEs. One way to ensure GHEs meet the needs of students and host communities is to apply a competency-based framework built around the health needs of the host community. Even though most GHEs take place in low and middle-income countries (LMICs), current global health competencies are primarily developed by professionals from high-income countries and little research has explored the effects of GHEs on local communities. In order to develop positive, reciprocal relationships with host communities, colleagues in LMICs need to be engaged in conversation to identify local health priorities and relevant competencies to address them. Students thinking about participating in a GHE can promote responsible global health education by choosing a program or organization, such as Child Family Health International, that has strong international partnerships and is dedicated to protecting the interests of host communities.

Bottom Line

Global health electives that promote cross-cultural partnerships and emphasize competencies addressing the health needs of the local community can provide incredible opportunities for personal and professional growth, while simultaneously offering benefits to the host community.

Special thanks to CFHI Intern, Emily December Latham, for authoring this blog.

Making Sure Global Health Education Doesn’t Perpetuate Disparities

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“Global health education is at a crossroad. The landmark Commission on Education of Health Professionals for the 21st Century highlighted the substantial disparities in health education worldwide and proposed reforms to enable all health professionals to “participate in patient and population-centered health systems as members of locally responsive and globally connected teams”.

This quote was taken from the Lancet article entitled ‘Equitable access for global health internships: insights and strategies at WHO headquarters.’ The Lancet Global Health article highlights the need for broadly accessible global health internships— ones that allow for exposure to community-engaged programs by students from a variety of socioeconomic and professional school backgrounds. The barriers to access to global health educational opportunities are real and require the global health education community to embrace novel approaches, alliances, and funding mechanisms.

CFHI global health interns with local physician in Ecuador.

Child Family Health International– CFHI a leader in global health education programs for over 20 years, is mindful of these barriers. As a nonprofit running global health internships that advocate for ethics and social responsibility, we recognize there are significant costs associated with global health internships and provide fair compensation to local communities and professional mentors that shape the intern experience through their time, energy and expertise. This follows best practice guidelines set out by the Working Group on Ethics Guidelines for Global Health Training (WEIGHT). However, program fees needed to provide resources for host communities and to support and educate interns can be a barrier to equitable access to reach beyond students from resource-rich backgrounds.

Like the WHO, CFHI utilizes scholarships in an effort to seek out candidates that may have greater financial need, limited opportunity to travel abroad, and those whose are under-represented in our programs. Scholarships and funding initiatives such as these are key to making real strides in south-to-south participation in global health internships and reducing their exclusivity as the domain of the wealthy. In addition, CFHI provides a crowdfunding platform to make it easier for students to raise funds through friends, family, mentors, and wider social media networks. Crowdfunding is growing, and is a powerful tool that should be considered by WHO and other global health internship providers.

“For sustainable improvements in internship access and improved global health education, academic and professional institutions need to partner with the public sector and foundations, donors, and governments to channel resources to achieve this aim. However, the scale of this task necessitates the involvement of multiple stakeholders. Who else will step up and contribute to a growing movement towards equitable access for training, educational, and networking opportunities in global health? And who should lead this transition and monitor its success?”

The article is ‘right on’ with its call to arms. If global health education programs and internships to not focus on equity, access and diversity, we risk perpetuating the same power imbalances and disparities that the global health community strives to eliminate. Child Family Health International commends WHO and the Lancet article authors for highlighting this issue and remedying it with action and advocacy.

How can we ensure that more students have access to global health and other professional and international internships? Comment on the Lancet blog or tell CFHI what you think below!

Internationalizing Medical Education: Shaping Healthcare Providers for Global Health

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Internationalized Medical Education: How do we develop competency-based education and realize its full potential? UN-recognized NGO Child Family Health International (CFHI) has been running global health education programs for over 20 years. We have seen a lot along the way since our beginnings in a small garage in the San Francisco Bay Area.

Global Health and Study Abroad See Upward Trends

CFHI Uganda Program Photo Woman

Fast forward to 2014. Global health has become a buzzword, conjuring up images of Bill and Melinda Gates projects and Partners in Health initiatives. Once a field that rallied for press, global health is receiving increasing limelight. Take a look on the Kaiser Family Foundation webinar on U.S. spending towards global health initiatives or the entire Center for Global Development event devoted to discussing Best Buys in Global Health. Global health teaching in undergrad and medical curricula is also increasing and the 2013 Open Doors Report on International Educational Exchange, states study abroad by U.S. based students is steadily increasing and is at an all time high. The Association of American Medical Colleges data demonstrates that 35% of US medical students participate in international experiences. Spurred by increased participation, global health education is evolving from a phenomenon of one-off volunteer experiences to a field of educational theory and practice, shaping the world’s next generation of healthcare providers with skills demanded by an increasingly inter-connected world.

Looking at Competencies in Medical Education & How Students Engage

A study in the journal Academic Medicine shows the structure of global health programs, the degree to which they are imbedded in local health care systems, and having a capacity-building agenda, affects what students learn. In an era where competency-based education is dominating pedagogy in medical education, we must leverage the richness of global health experiences to meet accreditation standards and competency-based outcomes. Like studies have shown and CFHI’s 7,000 alumni can attest, global health exposure and international experiences make for better practitioners and global citizens. CFHI’s approach leverages asset-based engagement and encourages students to “Let the World Change YOU.”

As we strive to meet demand and look at the nuances of programming, we must continue to examine students’ international experiences. This month thousands of international educators will gather at the NAFSA conference and discuss these topics at the Colloquium on Internationalizing Education for the Health Professions. Here and on our own we must consider key questions—what competencies does a globalized health practitioner need? What competencies are nurtured during global health programs? How do we wed international global health and what is taking place in our own back yards? Just as important, not all global health experiences are created equal. As educators and leaders in the field, we must advocate for socially responsible and ethically sound approaches to placing students in health settings abroad.

CFHI Commended in Chronicle for Higher Education Article

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From the Chronicle of Higher Education:

“Over the past decade, the number of American students in health fields going abroad has nearly tripled, with many opting for programs that take them out of the classroom and into clinics and hospitals. But as participation has increased, so, too, have educators’ concerns.

Far too often, experts say, students are providing patient care—conducting examinations, suturing wounds, even delivering babies—for which they have little or no training. Indeed, as competition intensifies for medical-school slots, some students may actually be going overseas for hands-on experience they could not get in the United States, in hopes of giving their applications a competitive edge.”

The article is entitled “Some Global Health Programs Let Students Do Too Much, Too Soon,” and here at Child Family Health International (CFHI) we couldn’t agree more!

CFHI programs are highlighted in the Chronicle article, including quotes and reflections from CFHI’s Executive Director encouraging students to think about ethical implications of their experiences, and shaping student expectations for what is ok to do abroad.

As the field of global health continues to grow, so too are programs and options available to health students of all fields, often promising opportunities to “help” and engage in hands-on experience beyond their training, skill level, or licensure. From the beginning CFHI has used an asset-based approach for engaging with communities abroad, and encouraging students to “Let the world change YOU.” In this way we position participants of Global Health Education Programs to learn, reflect, and realize that many times the most powerful impact they have in their role abroad is to form connections and relationships with local expert physicians and patients that will serve them in their future careers, as well as learn about the multitude of health determinants and complex global realities that underlie global health challenges. We’d like to extend a big thank you to the Chronicle of Higher Education for helping us spread the word and advocate for social responsibility in health and medical education.

What do you think should be students’ role in health settings abroad? How can students balance enthusiasm for learning while respecting ethical boundaries in clinical settings? Let us know your thoughts in the comments section below.

CFHI Announces New Program in East Africa

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CFHI’s Newest Programs in East Africa: Be Part of “An Activated Community” in Southwest Uganda

It is exciting when CFHI finds a partner so well aligned with its values of addressing broad determinants of health, engaging communities to help themselves, and strengthening local capacity for health care and community activation. The Kigezi Healthcare Foundation (KIHEFO), a non-profit organization operating in Kabale, Uganda, is fighting disease, poverty, and ignorance by creating “An Activated Community.” In partnership with KIHEFO, CFHI’s new Uganda programs HIV & Maternal/Child Health and Nutrition, Food Security & Sustainable Agriculture offer students from all academic backgrounds a firsthand learning experience addressing health, poverty, and education.

Uganda is a country in Sub-Saharan East Africa facing many serious health problems and challenges, including high rates of maternal mortality (only 30% of women give birth in a health facility), HIV and child malnutrition. There is a shortage of medical professionals working in Uganda, along with equipment and medications. With the majority of the population living in rural villages and earning around less than $2 a day while subsistence farming, access to healthcare services is a severe challenge.

KIHEFO’s mission is to fight disease, poverty and ignorance in an integrated, sustainable manner. This means not only delivering healthcare, but helping communities deliver themselves out of poverty and reducing the problems causing sickness and disease. The team is large, “an activated community” made up of staff, former-patients and supporters worldwide mobilizing their communities for improved health and economic well-being.

CFHI Student’s Role in Uganda

Through CFHI, students from all academic backgrounds and levels have the opportunity to work closely to learn first-hand about child and maternal health, HIV, malnutrition prevention and rehabilitation, food security, sustainable agriculture, empowerment of women’s groups, micro-credit savings and community mobilization.

Students observe and learn from healthcare professionals working at the General Clinic, at the HIV/AIDS Clinic learn from counselors and former HIV positive patients about testing and counseling HIV+ patients, and participate in a monthly HIV outreach.

At the Nutrition & Rehabilitation Centre, students learn from social workers and nurses about preventing and rehabilitating malnourished children, and participate in nutrition assessments to measure patient’s growth and progress. Additionally, students learn about sustainable agriculture practices, including permaculture, and the importance of crop diversification and growing food closer to home.

KIHEFO believes there is no single cause of disease, much like there is no single solution. Mirroring the CFHI approach they believe initiatives must be integrated, community-based and sustainable. Join CFHI’s Uganda Programs to learn from the people behind the “community activated” model for improving health and livelihoods.

Learn more.

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.

Student Essays Reflect Realities and Impact of Global Health

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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’s Model for Global Health Electives Included in Oxford University Press Publication

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Oxford Handbook on Neuroethics

“Global Health Ethics is once again in the forefront of discussion with the recently published Oxford Handbook of Neuroethics chapter emphasizing the relevance of biomedical, clinical and public health ethics within the global medical and academic community. Child Family Health International’s (CFHI) Evaleen Jones M.D., Jessica Evert M.D., Scott Loeliger M.D., and Steven Schmidbauer co-authored the chapter on the importance of establishing and sustaining an ethical framework for educational global health programs.

With growing interest in Global Health Electives among the medical and academic community, there are genuine concerns regarding equity, justice, and sustainability within underserved communities. CFHI’s chapter discusses global citizenship via a socially responsible framework to create positive global health educational experiences for students and host communities, connecting students with local health professionals and through direct investments in local community based projects. ”

So reads the beginning of the Press Release for CFHI issued today. Needless to say, we are all very proud and very happy to have this recognition especially from such a noted publisher as Oxford University Press. The portion that CFHI contributed to this chapter on Global Health Ethics is an attempt to describe our model of working in underserved communities by identifying local experts and building on the inherent strengths of the communities. We have seen over and over again low-resource settings where amazing things are being accomplished every day in patient care due to extremely dedicated local professionals. We see their deep commitment to serving the people and we join together with the local health professionals to design Global Heath Education Programs that are open to international students and trainees. You can read our submission here but I want to take this opportunity to thank all our international partners who have chosen to work with us to develop this model and make it successful for the last 20 years. No partnership is one-sided and we are deeply indebted to all the local doctors and nurses, hospital and clinic staff, local coordinators, host families, language teachers, drivers and many others who make our international programs function so well, even in some very challenging circumstances. Our hats are off to all members of the CFHI global family –you all share in this recognition!

Read the full CFHI Press Relase and Chapter.

CFHI Partners Develop Competency-Based Medical Education

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What is Competency Based Education?

Competency-based education (known as CBE) has been all the rage in medical education for nearly a decade. Competency in this realm has been described as the “habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community being served” Continue reading →

New US Census Data Shows Diversity of US Population Increasing

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

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

Source: US Census Bureau -Director's Blog

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

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

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

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

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

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

Making Global Health Knowledge a Requirement for MD Students

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A Post From CFHI’s Medical Director:

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

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

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

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

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

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

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

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

Global Health TV Looks at CFHI Program In India

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

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

GHTV Feature of CFHI Community Health Project Computer View

GHTV Feature of CFHI Community Health Project in India

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

Report From Ottawa –The Canadian Global Health Conference

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

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

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

CFHI Alum Reflects on Her Experience in South Africa

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

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

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

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

Open Education Resources for Global Health Education

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

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

CFHI Medical Director Blogs on Day 2 of CUGH Conference

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

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

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

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

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

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

Observations From CUGH’s Annual Meeting

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

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

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

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

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

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

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