Tag Archives: health workforce

Truth in the Spoof: Medical Voluntourism in The Onion

Truth in the Spoof: An expose of voluntourism in The Onion.

By: Aditi Joshi, MD

Newsflash!  This week’s headlines report a new humanitarian organization ‘Doctors Without Licenses’ will start providing substandard care by putting together a group of “decertified physicians, pre-medical undergraduates, and ‘people just interested in the human body’.” The organization states it will be sending their staff to conflict zones and underserved areas to incorrectly provide medical care.

Image from The Onion satirical article

This news was reported in The Onion, a satirical weekly publication, so it is, of course, facetious. The sad truth is that it refers to a very real phenomenon.

Voluntourism and Medical Voluntourism – Repercussions

Searching ‘voluntourism’ on Google, one finds a number of hits for organizations that set up volunteer opportunities for well-meaning individuals to work in underserved communities. Medical voluntourism refers to doing medical care within these communities; these volunteers can be physicians, nurses, residents, medical students and a growing number of organizations offer hands-on opportunities for pre-medical students, as well. More and more research as well as anecdotal reports state that these short term volunteer trips do more harm than good to the local community.  (If you’re interested in a great contrast between voluntourism and global health—this article is a must read. The volunteers may be providing direct patient care, giving medications, and doing procedures. In cases where the volunteer has no formal training, and would not be allowed to do the same in their home countries, this type of care is unethical whether or not the results are disastrous.  Even for those who are trained and skilled, the lack of knowledge of local infrastructure, drug formularies, culture, language and historical frameworks can actually lead ‘good’ actions to having negative consequences.

Solutions and Social Responsibility

Proposed solutions vary as the scope of the problem is large and not fully realized. However, organizations such as Child Family Health International – CFHI, try to decrease harm by giving students the opportunity to immerse within the culture, focus on broad global health competencies, observe native health care providers who are dedicated to their communities long-term health. This prevents the student from being a short-term ‘band-aid’ health worker or trying to get patient care experience that they are not licensed to undertake. The students are able to understand health concerns in other countries while minimizing possible harmful outcomes.

Voluntourism is most likely here to stay, however the importance of finding ways to reduce harm while giving the local community the help it requires is an ongoing challenge.

 

Thanks to our guest blogger, Aditi Joshi MD, ER Physician and Former President IFMSA-USA for authoring this post.

New MCAT Means Greater Need for Global Health Exposure

The New MCAT – Shaping Future Physicians for the Better

For pre-medical students their life choices are often defined by the MCAT—the often-dreaded U. S. medical school entrance exam that determines whether their professional dreams are dashed or realized.  Rarely do we consider that what we test and emphasize on such exams determines what is prioritized in undergraduate education and consequently Continue reading

Global Health Training Guidebook: 2nd Edition Out

Global Health Training in Graduate Medical Education: A Guidebook

Extra, Extra! Read all about it!  Just published, the second edition of the guidebook is edited by Jack Chase, MD and CFHI’s own Medical Director, Jessica Evert, MD.  The book builds upon the  first edition to provide an expanded, evidence-based perspective on curriculum and capacity-building in the global health workforce.

The guidebook contains relevant material for readers at many career levels, from college and professional students to medical educators and residency and fellowship training program directors.

The 2nd edition is now available in paperback and e-book from Amazon.com, and can be read from the GHEC website.

Congrats, Dr. Evert!

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Read more about CFHI’s Global Health Education Programs that provide global health training to 700 students per year.

 

Empowerment Means Having a Voice

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.

CFHI Logo SmallLuckily, 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

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.

World AIDS Day – What We Can Celebrate

World AIDS Day2010_WHO-EMRO

World AIDS Day2010_WHO-EMRO

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

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

UN_AIDS_Global_Report_2010

UN_AIDS_Global_Report_2010

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

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

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

Open Education Resources for Global Health Education

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 CUGH Conference Presentationthe 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 Students make Local Press in Ecuador

CFHI students made the local press in Ecuador this summer.  La Prensa, a local publication in the town of Puyo in the Pastaza Province of Southern Ecuador, carried a full page story of CFHI Students on the Amazon Indigenous Health Program, one of CFHI’s Global Health Immersion Programs.

CFHI Students Make New in Ecuador Summer 2010

CFHI Students Make New in Ecuador Summer 2010

Puyo, a city of about 25,000 people, with its close proximity to the Amazon Jungle, functions as the base for this program that allows students to see the interplay between the government Ministry of Health and the traditional medicine of indigenous populations living in the jungle much as they have for many hundreds of years.  Dr. Wilfrido Torres, a local physician and the Medical Director of several CFHI programs, reports that international students coming to Puyo and to the Jungle Region, “help the local population see that local doctors and community health workers have important knowledge to share with the world.”  CFHI is honored to have local experts like Dr. Torres who are eager to interact with international students.

This summer, the CFHI students were able to participate in a medical conference that CFHI helped support.  The conference, a multidisciplinary conference on the latest treatments and testing for diabetes and hypertension, was part of a series of conferences to educate health professionals and paraprofessionals on these chronic diseases that are relatively new to the local population.

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

Map of Austraila and Tasmania

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

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.

GH Conference Hobart

Panel discussion at the Global Health Conference Hobart Tasmania July 2010

Interview with CFHI’s Medical Director –Audio Post

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.

Jessica Evert MD

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.

Dr. Jessica Evert 1

Dr. Jessica Evert 2

Dr. Jessica Evert 3

Dr. Jessica Evert 4

South Africa –Local Hospital Takes Courageous Stand Against New Menace

During a program visit to South Africa, I continue to be amazed by the dedication, commitment, and resourcefulness of the healthcare workers.  I find examples everywhere I go –this one, I wasn’t ready for:

With HIV rates among the highest in the world, you’d think there may be no higher priority in South African health services than addressing this disease and working to prevent it.  Meet the new menace, “Tik.”

Dr. Adam has been head of G. F. Jooste Hospital for a little more than a year and in his short tenure, he has witnessed an explosion of drug use in the surrounding community that at times has crippled the functioning of this district hospital.  These are the Cape Flats, just ten minutes from the beautiful city center of Cape Town, and there is a real fight here to stop this menace from spreading.  The drug is crystal meth, and the impact is devastating.  Dr. Adam has had a long and distinguished career as a practicing physician and in more recent years, adding a degree in public health, he has been the doctor/administrator at various facilities in South Africa but he has never seen anything quite like this.  They thought they had a challenge seeing 40 or 50 patients per month in the ER who were out of control, high, and totally unpredictable, but now these patients number more than 180 per month, and this is in addition to all other patients seen in the facility.  The psychiatric effects of tik (which gets its name from the noise made when the crystalline structure is heated) are severe, and Dr. Adam explains that the ER is not a psychiatric ward.  Instead of adding medical equipment, they have been forced to add bullet-proof glass and a metal detector to the entrance area.  Patients can arrive in a wild state, combative, and completely noncompliant.  “The only choice we have is to sedate them until they calm down and we can begin to help them,” Dr. Adam says, noting that recently one female doctor had to be rescued from underneath a male patient who simply jumped on top of her. This 184-bed hospital is already stretched beyond capacity most every day, and sees 4,500 patients in its emergency room every month.  But the evidence suggests things may get even worse.  In today’s  edition of the Cape Times newspaper, a story by Anso Thom reports that “Tik is the most commonly abused recreational drug in Cape Town…,” and that a new study shows one in ten pregnant women are using tik.

“Tik is holding us hostage in this hospital,” proclaims Dr. Adam.  But he is not sitting still.  He has formed strong alliances with neighborhood and community groups to help coordinate a positive response from within the community to reclaim its streets and build a network of neighborhood watch and support.  He opens the hospital auditorium on Saturdays for community meetings and to provide a safe place for children to come for organized activities.  He is most proud of getting approval and funding for an outpatient substance abuse program that will begin very soon.  The relentless cycle of treating patients, releasing them, only to have them return in a worse state in only a few days can finally be stopped.  Armed with a psychiatrist, an addiction recovery expert, and a local public health masters student to document the progress,  Dr. Adam is putting together a team that will take a stand against the menace.  Dr. Adam knows that the only way to really fight this new epidemic is to break the cycle of addiction.  A holistic approach will aim to help strengthen the family unit as well as the patient.  Strengthening the community by strengthening individual families is a plan for wellness in the face of an almost hopeless situation.

“We’ve got to start somewhere,” says Dr. Adam.  Reflecting on the toll it has taken on his hospital, Dr. Adam says it would be tempting to say that the hospital is simply not equipped to treat these patients and send them elsewhere. But there is really nowhere else, and Dr. Adam is not the kind of person who could turn a blind eye to a problem like this.  You can sense the conviction and commitment in his voice as he says, “Our core business is the health of the community.”

CFHI Granted Consultative Status at the United Nations

Just prior to the opening of the United National General Assembly this year, I was fortunate enough to be at the UN to represent the small but powerful global family of Child Family Health International (CFHI).  Recently CFHI was granted Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC).  This is a great honor that speaks to our unique collection of dedicated professionals and students who truly work at the grassroots level to improve the health of the world community.

As the Executive Director of CFHI, it was indeed a high honor for me to represent our organization and I came prepared to explain our work and our efforts in Bolivia, Ecuador, India, Mexico, and South Africa. To my great surprise, I did not have to do any of that.  I found the staff at the NGO Section of ECOSOC  wonderfully welcoming and accommodating, and also found they had done their homework and already were quite aware of CFHI and our work.  They had read the documents we had sent more than a year earlier in the process of being granted consultative status and they also brushed-up by reading our website prior to my arrival.

What with the UN being such a huge organization, I expected everything to be very bureaucratic and fairly impersonal.  Sure it is a big place and with the leaders of the world, about to arrive, there was quite a bit of bustle all about, so it was a surprise to find such personalized service and attention.  My meetings with the Deputy Chief of the NGO Section and the Program Officer were cordial and productive.

I learned that there are about 3,200 NGOs around the world that have been granted consultative status.  Many are more associated with a cause while they see CFHI as a more “practical” organization.  The grassroots nature of our work is appealing to them as well as the diversity of our global family along with the close, long term relationships with CFHI partners who are at the front lines of the delivery of healthcare in so many places.  To a large extent, we have our finger on the pulse of global health at the grassroots level and so we have much to share, especially the CFHI model of empowering local communities.  Of those more than 3,000 organizations, only about 800 are really active.  Work is going on to improve the website of the NGO section and the hope is that there will be much more online functionality to allow for sharing and collaboration.

Flags of the CFHI Global Family now including the United Nations

Flags of the CFHI Global Family now including the United Nations

One official told me, “The international community has looked at your organization from top to bottom and the feeling is that it is a good organization and has a model that is important. We actually hope that it can be replicated in areas of health yes, but also in other areas.” So as we add the UN flag to the flags of nations comprising the CFHI Global Family, we do so with great honor and great pride, and with responsibility for the role that we have assumed through this honor.

Just What Global Health Needs … Geometry!

As Dr. Calvin Wilson began his plenary presentation at the Sixth Annual Family Medicine Global Health Workshop in Denver earlier this month, he said to the audience of physicians, “Now class today we’re going to learn geometry.”  As he began talking about the vertical approach, and the horizontal approach, Dr Wilson was joking but he was also making a point.  As disparities related to health continue to be significant and much more is needed to be accomplished in order to achieve the Millennium Development Goals set by the United Nations, it is clear that a different approach is needed to address global health issues.  Dr. Wilson, an associate professor of family medicine at the University of Colorado School of Medicine, and the director of the Center for Global Health of the Colorado School of Public Health, was attempting to deal with a controversial issue in global health today: the debate between vertical and horizontal funding of health initiatives.  The vertical initiatives are programs that address a single area of focus, such as a disease like HIV/AIDS, or malaria.  The horizontal initiatives are programs that attempt to improve aspects of the health care system in an area or a country.  Dr. Wilson gave a careful and balanced approach to this issue and pointed out pluses and minuses to both sides.  His presentation can be found through the website of the American Academy of Family Physicians.

Dr. Julio Frenk, the Dean of Harvard’s School of Public Health, and former Minister of Health for Mexico used examples from his home country to illustrate the importance of the diagonal approach when he was interviewed in the June issue of Global Pulse. Dr. Frenk sights, how work on HIV/AIDS in Mexico was designed to also enhance the healthcare system. “By starting with AIDS, we were able to build an entire insurance system that was then in place to start covering other diseases.”  Dr. Frenk’s interview with Global Pulse can be found here

It is unfortunate that this debate has gone on for so long and that there is still no clear resolution to it.  Perhaps two next steps are helpful in this process.

  1. Cease the Competition:  It is sad that any debate has developed regarding this issue at all.  Even more counterproductive is that at times there seems to be a competitive nature to the debate from one side or another.  From the grassroots perspective, it is often obvious that these approaches are much more in concert with each other rather than in competition.  Resources are needed for programs that implement specific treatments and for specific prevention methods but these programs are usually only as good as the infrastructure available to make things happen on the ground.  The reality is that vertical strategies will, at some point, need to hit the ground and their implementation will involve: public health education, vaccination, or training to increase the competencies of treating healthcare workers.  To utilize the existing infrastructure, no matter how lacking it might be, is preferable to starting from scratch or to creating parallel infrastructures.  Building on the existing infrastructure allows the lessons of past implementation experiences to inform the future and, if done well, allows for culturally appropriate adaptations to be made for each setting that can improve the effectiveness of any implementation, while reducing the potential for inflicting unintended harm.  In most resource-poor settings, when you bring in relatively small amounts of cash, you can make many things happen.  Unfortunately when you pull out the cash, it often has the effect of inhibiting the local input.
  2. A workable Construct: While there has been a lot of talk about the need for a more balanced approach, there has not been a lot of action.  It is hard to move forward without a method of implementation.  Since we are talking about a very broad spectrum of health initiatives, it is unrealistic, and frankly not very helpful to propose anything that is too specific.  One option has been proposed that appears very promising.  15 by 2015 is an initiative proposed by a partnership of the World Organization of Family Doctors (WONCA), Global Health through Education, Training and Service (GHETS), and the European Forum for Primary Care (EFPC).  In an article published in the British Journal of General Practice in January, 2008, they make their proposal, “We propose that by 2015, 15% of the budgets of vertical disease-oriented programmes be invested in strengthening well-coordinated, integrated local primary healthcare systems and that this percentage would increase over time.  15 By 2015 is a very helpful construct.  It raises the awareness of the need for both vertical and horizontal approaches that complement each other and creates a simple framework that allows customization as needed.  The 15% threshold is not meant to be the highest possible for the horizontal component but it is a conservative number that can surely be an agreed upon minimum.  In this way, new initiatives can build on the existing knowledge and experience, and leave the community with an incrementally improved infrastructure.

In his address to the Global Health Workshop in Denver, Dr. Wilson used some different language.  Instead of consistently using “vertical” and “horizontal,” he used the terms disease focus approach and integrated systems approach. These are terms that seem to fit more logically to the conversation.  Perhaps these terms can be seen to be more obviously collaborative than their geometric versions and help us bridge the gap by taking the shortest distance between these two points that should not be divergent at all.

CFHI Announces New Effort to Address Brain Drain

TrainHealth is an initiative of CFHI that helps to address the health care worker shortage in the developing world.

CFHI provides opportunities for health care workers to expand and refine their knowledge, so that they can better serve their own communities.

Additional training and professional development opportunities are well documented to help fight brain drain and increase job satisfaction.

Trainhealth is a direct response to the grassroots requests CFHI has received from our partner sites.

Through the great help of volunteers, a special website has been set up to champion this effort.  You can visit it at Train Health.org.