Tag Archives: Local Experts

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.

AAB logo

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.

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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 1st 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

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?

IMG_8705My 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? 

IMG_9148I 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.

Making Sure Global Health Education Doesn’t Perpetuate Disparities

“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 Ecuador Global Health

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!

CFHI Commended in Chronicle for Higher Education Article

 

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 India Student on ProgramCFHI 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 vs. Brigades: Defining “Helping” in Healthcare Abroad

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 aamcacademicmed

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 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.

CFHI: Asset-Based Community Engagement

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

What Makes CFHI Different?

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

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

CFHI Student with Dr. Paul, Rural Urban Himalayan Rotation

Not Just Talking the Talk, But Walking the Walk

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

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

A Global Team

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

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

Oxford Handbook on Neuroethics

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.

A Visit with The Father of Palliative Care in India

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

Pallium India

Pallium India

 

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

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

Who is Dr.  Rajagopal

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

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

A Day in the Life– Implementing Palliative Care in India

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

Ms. Hema and Dr. Raj on home visits Pallium India

Ms. Hema and Dr. Raj on home visits

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

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

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

Dr. Raj conducting a home visit, Trivandrum Southern India

Dr. Raj conducting a home visit, Trivandrum Southern India

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

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

 

CFHI Partners Develop Competency-Based Medical Education

What is Competency Based Education?

CFHI India StudentCompetency-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

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.”

The Roots Have Taken Hold –A Follow-up on a Success Story in the Making in South Africa

Ukwanda Logo

Ukwanda Logo

In October of 2009, fresh from a visit to South Africa, I wrote an entry to this Blog called The Roots in Grassroots –Ukwanda Rural Health Program.  I was so impressed with the intentional efforts of the University of Stellenbosch to successfully bring primary health care to Avian Park, an underserved community in the rural areas well north of Cape Town.  CFHI’s work has always intentionally been at the community level so this was the first time that we were helping to fund a project of a university.  On paper, it looked like a serious effort to truly do the relationship building and ground work necessary to successfully establish the first primary healthcare facility for this poor but growing community.  Our contacts on the ground were also very enthusiastic about this initiative and so CFHI chose to help support it.

What I saw in 2009 was an idea beginning to take form.  What had looked so possible on paper, was proving to be a significant challenge to implement.

Avain Park Old Clinic

Avain Park Old Clinic

I saw a very run down set of metal freight containers being used as a makeshift TB clinic.  I saw some initial linkages with the community but everything was still new and tenuous.  CFHI’s commitment was funding that would be used to renovate the freight containers to make them fully functional.  The project was already well beyond its targeted schedule and I could see during my visit that the freight containers were not in good enough condition to be renovated but would need to be replaced.  Stellenbosch was able to get some additional funding as well as some in-kind help to make the new containers possible.  Concerns about acquiring the land where the new clinic would be, the full support of the local political and community leaders, and other logistical details were still not resolved.  Success felt illusive.  Yet, in the face of the many challenges, the Ukwanda team from Stellenbosch chose to dig in deeper, engaging the community, dealing with their concerns and creatively finding the resources to deal with many unforeseen issues that arose.

Freight container being prepared at Cape Town Water Front

Freight container being prepared at Cape Town Water Front

At a stage like this, I am, quite frankly, used to seeing a big university either pull back its funding and  sunset the project, or do an end run around the community and find a maneuver that would give them the legal security they need to move forward even if it does not lead to community support.  Instead of using the university’s paid legal teams to get it out of a jam, the University of Stellenbosch chose to involve its School of Law and get faculty and students from this arm of the university to research creative solutions.

This week, I paid another visit to Avian Park and I met with Prof. Hoffie Conradie, also a medical doctor whose blood, sweat, and tears have flowed into this clinic for years now.  What I saw this time was the brand new set of freight containers fully set up, painted, and functioning at about 80% of the planned use.

Avian Park New Clinic 2011

Avian Park New Clinic 2011

In addition to the original TB clinic, there is now an ARV clinic and a team of home-based care workers based out of the clinic.  Weekly physician clinic hours by Dr. Conradie are well attended and welcomed by the community.  Still to come will be family planning and other health education initiatives.  While a water line has made it to the clinic, electricity is still lacking but this is in the works and seen only as a minor inconvenience.  The clinic was bustling with activity and clearly has become a focal point of the community.

Even more impressive was that I just happened to arrive as a team from the University Of Stellenbosch School Of Sociology was just concluding an intensive study of Avian Park.  A social anthropology professor and his students had made many visits and conducted house to house interviews.  The students made use of volunteers from the community, mostly young people who assisted the students in navigating the unpaved maze of roads and any unfamiliar customs or local norms.  The result is a significant body of primary research data that will now be analyzed and synthesized to produce a profile of the community that will not only help the Medical School in its work in the community but also all the other arms of the university; agriculture, theology, social work, as they also look to begin projects in Avian Park.

Meeting later with Project Coordinator, Lindsay Meyer, in Cape Town, she attributed the tremendous cross pollination of efforts from Stellenbosch at Avian Park to the leadership of the university.   The Rector of the University of Stellenbosch has motivated and guided his faculty across all schools to develop strategic plans that have goals that are connected to the Millennium Development Goals of the United Nations.  All schools and departments are also required to have initiatives that are benefiting the community in some way.  With this kind of guidance, a university that often has so many disparate activities can instead become like an orchestra, each producing their own sound but from the same sheet of music.

Prof Hoffie Conradie addresses sociology & medical studnets and community members at Avain Park clinic

Prof Hoffie Conradie addresses sociology & medical studnets and community members at Avain Park clinic

And so it was in Avian Park. The sociology students and the medical students were each doing their own endeavors but in a way that appeared to the community and to this outsider as a coordinated effort that will build on each other.  Universities can easily become a place of many silos of information growing ever higher and rarely moving horizontally in a way that combines data for richer analysis and in a way that can most effectively benefit communities.  How refreshing it is to see what can happen when the full resources of a university are coordinated and focused to help a community.

Our hats are off to the University of Stellenbosch and its Ukwanda Rural Health Project and the Avian Park Rural Clinic for their dedication and commitment to community-based work done well!

Global Health TV Looks at CFHI Program In India

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.

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

Expectations –When Helping is Complicated

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

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

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

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

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

Expectations

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

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

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

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

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

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

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-South Collaboration -Second Report From Cuernavaca

This is my second report from the Global Health Conference happening in Cuernavaca, Mexico.  The conference is the joint effort of the Global Health Education Consortium (GHEC), based in San Francisco, California,  and the Instituto Nacional de Salud Publica (INSP), here in Curenavaca.  I spoke with Lisa DeMaria, Investigadora en Ciencias Medicas of INSP and she told me about a perhaps lesser known part of the Global Health field. “There is a sophisticated network in Latin America of middle income countries with similar health issues that are working closely together to address common challenges.” “The face of Global Health is changing,” she told me as we discussed that there is much more happening today in Global Health than just the very wealthy countries attempting to help the very poor countries.

The conference this weekend is a good manifestation of this with at least 22 countries represented.  It is also the First Latin American Caribbean Conference on Global Health and so the extensive regional network of health professionals is strongly represented.  INSP and GHEC have championed the effort to establish this first of a kind conference without knowing for sure if there would be a second conference but the momentum that has been created here seems to be sufficient to ensure continuation with countries like Brazil, Chile, and others stepping up to carry on the tradition.

South-South Collaboration

The 19th Annual GHEC Conference and the 1st Latin American and Caribbean Conference on Global Helath

GHEC - INSP Conference 2010 Cuerenavaca, Mexico

GHEC - INSP Conference 2010 Cuerenavaca, Mexico

Of course, the planning for a conference like this  happens more than a year in advance so as we are gathered comfortably here in Curenavaca, Mexico, having important discussions and sharing of ideas, it is important to look back and see all that has happened along the way on the journey to Cuernavaca.  Not long after the decision to have the conference, came the outbreak of H1N1 in 2009 and many questioned the wisdom of continuing with the conference plan especially with the fear that a repeat flu outbreak could happen in early 2010.

More fundamentally, the intention of this conference –different, I think, from other South-South conferences– is to have the South participants truly take the lead.  “The idea from the beginning was that the North participants are the guests and are primarily coming to learn” said Karen Lam, the Global Health Education Consortium (GHEC) Program Manager.  With its almost 20 year history and strong following,  GHEC has been able to bring the numbers that frankly support the undertaking of a major conference like this and make it financially feasible.  The back story is all the effort to truly make it a success.  GHEC has partnered with the Instutio Nacional de Salud Publica (INSP) here in Cuernavaca.  INSP is the conference venue and has been a great host for this event.  Both INSP and GHEC are to be highly commended for all the hard work to bring this event to a reality and in such a successful way!

“The vast majority of the presentations  are by and from the perspective of the South participants,” Lam pointed out.   Sessions are covering everything from Ethics and Equity Issues, to Global Health Diplomacy, to Public Policy, and Social Determinants of Health.

It is encouraging to see so many Mexican, Caribbean, and South American students able to be a part of this conference and to see the work of the collaborations of  their fellow students and teachers so prominently featured.  So far the sharing and exchange of ideas is stimulating and leaves one hopeful for all the collaborations that will now have their beginnings here in Cuernavaca.

A Dental Program for International Students

One of CFHI’s newest programs is a Dental Program set in Quito, Ecuador.

CFHI Global Health Dental Program

CFHI Global Health Dental Program

CFHI is happy to partner with the Sonrie Ecuador Clinics to provide an outstanding program for pre-dental and dental students who want to understand how oral health is approached in a different culture and a different healthcare system.

The “Sonrie Ecuador Clinics” provide dental care and promote oral health in Quito and its surrounding neighborhoods.  The clinics have been operating for over twelve years and continually strive to better the services offered to their patients give attention to the dental health.  In general, the main dental problem seen by Ecuadorian dentists is cavities.  Ecuadorians are considered to be concerned about their dental health, although adequate oral hygiene is not, in reality, reported amongst the majority of the population.

This program will provide a rich and diverse experience for pre-dentistry and dentistry students, allowing them  to  view  local oral  health   practitioners  providing  close to  world class care in a developing country while at the same time improving their cultural competency and broadening their public health knowledge.  Ecuadorian dental professionals who work  in a country are interesting and thought provoking as they give context to the real challenges of  providing the best possible dental care to the different socioeconomic classes of Ecuador.