Tag Archives: medical electives

Applying Competency-Based Education to Global Health Electives

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.

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.

How it All Began: The Early Days of CFHI

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The Early Days of CFHI Featured at San Francisco Film Festival

This past July the documentary film “The Most Distant Places” was featured amongst others at the Bay Area Global Health Film Festival. This story, directed by Mike Seely, is depicted from the perspective of Ecuadorian doctor Dr. Edgar Rodas, then a medical school Dean in Cuenca, Ecuador. The film chronicled the importance of constructing a mobile surgical clinic and the team involved in bringing mobile care to remote communities in Ecuador.

The film festival was organized to shed light on a critical message in need of a strong voice: access to the most basic surgical care is a human right, not a luxury. Dr. Rodas shared his story and expressed an unwavering commitment to his fellow Ecuadorians. As the film came to an end and the audience allowed the weight of the story to settle, he delicately reminded everyone that every effort produces a result. These efforts would eventually result in CFHI- Child Family Health International as we know it today.

A Chance Meeting

A young Evaleen Jones (right), in Ecuador.

As I sat across the table from Dr. Evaleen Jones, CFHI’s Founder and President, I marveled that even after twenty-one years, she tells the story of CFHI’s beginning with energy and excitement. She reminisced about her time in Ecuador as a third year medical student at Stanford University School of Medicine. At the time, Stanford University did not readily offer International Health opportunities abroad with a student focus. To best serve patients living in densely populated Latino communities within the Bay Area, Evaleen knew that Spanish language and cultural competencies were essential. And so, with only a modest amount of money she embarked on her first adventure abroad.

Once in Ecuador, Evaleen’s efforts to connect with local physicians led her to Dr. Edgar Rodas, the doctor who would be featured in the Distant Places film many years later. She came to know him as a simple man who exuded a deep-seeded commitment to the well-being of his fellow countrymen. As a surgeon he rejected the notion that a person cannot have an operation simply because they don’t have enough money. Regardless of the enormity of such an undertaking, he felt the status quo would not suffice.

As chronicled in the film, Dr. Rodas’ goal was to build a mobile surgical clinic. Evaleen, sensing the strength of his presence and understanding the value of his quest, jumped in headfirst and agreed to return to the States to arrange funding for construction of the mobile clinic. According to Evaleen, “There are some people who you can sense very quickly are special individuals.” Even after only a week of knowing Dr. Rodas, she allowed her instincts to propel her forward.

CFHI Begins

The start of her fourth year in medical school Evaleen hit the ground running. Every conceivable connection was utilized- donations of all kinds– designing and constructing a surgical clinic, shipping the mobile unit. Evaleen’s fearlessness in asking gave her the edge that ultimately convinced others to help. Each someone told her “absolutely not Evaleen, this is impossible,” it motivated her to continue.

It was during this time that CFHI came to life. Approaching potential donors as a recognized NGO lead to greater success. Evaleen had also not lost sight of her original intentions: CFHI was to be a platform to provide medical students (and later students of varying fields interested in health) with learning opportunities abroad, and to increase language and cultural competencies. Dr. Jones states again and again that the world is a classroom and students should pay for the privilege of learning. Uniquely CFHI, she also saw that students could be a sustainable source of support for locally-run health care efforts that don’t breed reliance on Western ‘aid.’ While placed in the global classroom, students are encouraged to open their minds and listen well, and let the world change them. Even with the passing of time, Dr. Rodas and Dr. Evaleen Jones remain faithful to their belief that, “It has always been about the people, not the projects.”

–Lyndsey Brahm

Special thanks to CFHI alumna and volunteer Lyndsey Brahm for her work on this post. Lyndsey will be attending the University of Copenhagen, School of Global Health in 2014.

Have some ideas and interested in blogging for CFHI? Email info(at)cfhi.org for details.

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: Asset-Based Community Engagement

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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-based 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

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.

A Visit with The Father of Palliative Care in India

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

Pallium India

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

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

Who is Dr. Rajagopal

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

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

A Day in the Life– Implementing Palliative Care in India

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

Ms. Hema and Dr. Raj on home visits

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

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

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

Dr. Raj conducting a home visit, Trivandrum Southern India

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

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

CFHI 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.”

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.

CFHI Alum: “It Made Me Want To Be A Doctor A Lot More…”

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“It made me want to be a doctor a lot more, for sure,” she said. “Seeing doctors in action, they were really fantastic role models. It’s hard to get exposure shadowing doctors here (in the Bay Area). I’ve had a few opportunities at Stanford. The more time I got… the more inspired I am to become a doctor.” These are the words of Christina O’Neal, as reported in the Contra Costa Times by Correspondent Doug Mead. Christina, a Stanford University premedical student, spent part of her summer in the Cultural Crossroads in Health Program in Oaxaca, Mexico.

Christina told the Contra Costa Times in the article that her month on the CFHI program in Oaxaca, “was pretty life-changing. Everybody gets pretty much free health care there,” she said. “It’s interesting to see how things are run. There’s a lot of poverty, and the government, in terms of health care, has a lot of problems. But the infrastructure was good. I was impressed with how smooth it ran and how dedicated the doctors were. It was an awesome experience.”

The experience really improved Christina’s Spanish and Medical Spanish skills. “I’d say, before I got there, I was conversational (in Spanish),” she said. “Now, I’m borderline fluent. My comprehension, especially, skyrocketed. I’ve always had a pretty standard ability to speak. Now, I understand everything that’s happening. Even though my vocabulary didn’t grow as much, I can express myself better. Once you understand people better, it helps you to speak more correctly. We went over grammar and medical vocabulary every day (in class).”

We are very glad for Christina that her experience was so impactful and we greatly appreciate her kind words about the CFHI program as she ended her interview with the newspaper saying, “Everything was fantastic. It surpassed all my expectations. It was a phenomenal experience.”

CFHI Students make Local Press in Ecuador

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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

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

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Australia site of Global Health Conference

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

UTAS Site of Global Health Conference Tasmania

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

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

Panel discussion at the Global Health Conference Hobart Tasmania July 2010

Interview with CFHI’s Medical Director –Audio Post

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

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

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

From Untouchable to Breadwinner, From a Human Waste Disposal Problem to Useable Fertilizer: A Sanitation and Public Health Success Story

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Human waste is always a strange topic to talk about but it is clear that sanitation is one of the biggest public health challenges. The idea of a Toilet Museum may bring a laugh but I was introduced to an organization that, while understanding the lighter side of the issue, has taken this subject very seriously. “This is nothing short of amazing work,” reports CFHI India Coordinator, Hema Pandey, as she has made it an important part of CFHI’s Public Health and Community Medicine Program in New Delhi. Students also report that this experience is very enlightening to them. It is all the great work of an organization called Sulabh International, an NGO based here in New Delhi, that has for all practical purposes, solved a problem as old as the human race: how to effectively manage human waste. Moreover, they have done it in one of the poorest and most populated countries in the world. At the heart of it, was the desire to free the Scavengers, a caste of Indian society who, for as long as anyone can remember, were relegated to cleaning the excrement of others and carrying it in buckets on their heads, therefore being considered untouchable.

CFHI Students Visiting Sulabh International in New Delhi

Sulabh is nothing short of a movement, started by Dr. Bindeshwar Pathak. Dr. Pathak’s outstanding accomplishments can be summed up in two areas, a new technology for waste management and a social revolution for more than a million people to whom society gave no hope for self-determination.

The technology is alarmingly simple. Sulabh’s design of a two-pit, pour flush toilet is an appropriate, affordable, environmentally sound, and culturally acceptable technology. Many United Nations groups including WHO and UNDP have recommended this technology for more than 2.6 billion people in the world. Essentially the pits are constructed in such a way that one side can be used and filled over about a three-year period. Once it is filled, you switch to the second pit. Over the next three years, the pit design allows for the natural breakdown of the waste in the first pit so that after the three year period, the pit can be opened revealing a dried substance with no harmful bacteria, that is 100% recyclable as a high qulaity fertilizer. This design is perfect for rural areas but Dr. Pathak has taken it to the next step by designing a process of dealing with large-scale public toilets. In this process, bio gas is generated in significant portions to power lighting, heating, cooking, and electricity.

CFHI Students visiting Sulabh International

Receiving Instruction on 2-Pit Toilet System at Sulabh

Dr. Pathak is credited with changing the mindset of the Indian people about sanitation and the persons who were required to do the sanitation work. He has done this by example. He went to live among Scavengers learning the affects of the life they were considered destined to and thereby designing a social movement to raise them out of poverty and their unacceptable destiny. Sulabh has schools, training centers and successful assistance programs that are training former Scavengers for everything from light industry, to culinary and food service jobs, and all aspects of computer technology.

This is a terrific success story, making great progress for health as well as a wonderful human story, and one that definitely gets the attention of our students.

CFHI Expands Rural Program in Himalayan Region of India

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CFHI’s program in rural areas of Northern India will expand in 2010 and our student programs will support a local doctor’s dream of increasing access to healthcare in this region. Dr. U.S. Paul has been working in the surrounding areas for many years and he knows well the needs of the people in rural villages. We are happy to help him in this new effort to serve thousands more people in the foothills of the Himalayas who have little or no access to healthcare. The effort is being conducted by a local nonprofit, the Indian Global Health and Education Forum. The village of Sirasu will be one of the areas served. The villages are accessible on foot after crossing the great river. This photo shows the crossing point at Gullar on the River Ganges, about 45 minutes drive north of Rishikesh.

Ganges Crossing Point at Gullar

As we made the drive along mountain roads tracing the edge of the gorge, with sheer drop-offs right next to you that are not for the faint of heart, Dr. Paul spoke of his excitement at being able to operate regular health camps for this remote population. The area around Sirasu is one of several village groupings that will be served Sirasu and its grouping have a population of about 1,500 people. Each village has its own identity and Dr. Paul is an expert at providing care that is respectful of the cultural differences that may exist even from village to village.

Crossing to the East side of the river Ganges in a simple rowboat, I looked over and saw Dr. Paul beaming with joy because he knows how important these services are to the people.

Crossing The River Ganges --Mr. Mayank Vats, CFHI Local Coordinator, and Dr. U.S. Paul board a boat to cross to the East side of the Ganges river

Once across the river, it is a 20-30 minute hike up the East side of the gorge to Sirasu. Dr. Paul meets with village leaders to discuss recent developments. An initial camp was held in November during which Dr. Paul saw more than 150 people in one day. The people ask Dr. Paul to schedule the camps as often as possible. With many other villages to cover, Dr. Paul says he will plan to make monthly visits. While they would wish for more, the people are very happy and express their gratitude.

Local School that serves as a site for the health camp

The camps are conducted at the few local schools as these are natural gathering points and are the largest structures around.

Everything is built on relationships. The local formalities of introductions and meetings to discuss the different aspects are a time to build trust and gain the valuable support of village leaders. These meetings over cups of tea are important times to size everyone up and get a feel for each other. It is the oral culture’s way of completing an application form.

Every meeting has to have tea

We look forward to these additions to our program and to developing these new relationships.

After meeting with local leaders of Sirasu to discuss health camps

CFHI South Africa Alum in the News

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David Liskey (in a photo by Jan Sonnenmair), was a 2008 CFHI South Africa participant that came to us through our Oregon partner IE3.

David Liskey photo by Jan Sonnenmair

David was featured recently in the Oregon State University President’s report. Read about his experience and “how race, culture and poverty affect health care in a country with one of the highest HIV infection rate in the world.”

David participated in an 11 week program with CFHI and received credit from his home institution. From his first-hand experience, he wrote a University Honors College senior thesis. David was perceptive and able to see how culture impacts health.

In the president’s report, he reflects, “The different experiences and topics I studied had an effect on how I see the world.”

Report from Kwazulu-Natal: Filling a Need for Forty Years –The Islamic Medical Association of South Africa

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Dr. Ebrahim Khan is a family practitioner with a private practice in the Kwazulu-Natal Province of South Africa and serves as Medical Director of the CFHI program based out of Durban. As with most doctors in South Africa, the demands on his time are great. Dr. Khan’s daily schedule is easily enough for two or three men. His long and distinguished career has earned him the respect and confidence of the local community, and even at this point in his career, his desire to be of service and give back is as vibrant as I have seen in twenty-year-old students, so he is a good match for the many CFHI students from around the world who choose the Durban program. I especially sensed a love for teaching medicine in a way that guides the students to make their own discoveries.

Among the many hats Dr. Khan wears is that of being the Vice President of the Islamic Medical Association of South Africa. In the early 1970’s, a few Muslim Doctors, noting with concern the disparate health services under the Apartheid government of South Africa, embarked upon the establishment of a modest Sunday clinic on the south coast of Natal in Eastern South Africa, where there were virtually no services for the black rural community. This was the birth of what would be called the Islamic Medical Association. With such a deeply personal mission, it did not fade away after the end of Apartheid. Now almost 40 years later, IMA has set up various healthcare and crisis relief centers operating full time in various places in the country where there is dire need for such facilities; social work and counseling are happening for families and children as well. The IMA mission challenges them as healthcare professionals to “establish and project a value system that is a living entity in our own lives, and in the practice of health care solely for the service and the pleasure of the Almighty. ” The health professionals who give their service are truly dedicated to improving primary care for the underserved.

Avril Whate, Vusi Ngcobo, Steve Schmidbauer

One of the many programs that IMA provides here is a small community clinic in Marianhill outside of Durban, a favorite site for CFHI students. One of the services that has been happening for some time now is voluntary counseling and testing (VCT) for HIV. Vusi Ngcobo is the counselor who is responsible for the success of the VCT program here. In an area with such a high prevalence of HIV, it is important that voluntary testing happens so that the virus can be detected as early as possible. For those found to be HIV-negative, they will still receive valuable information about HIV prevention.

The clinic here and the many other projects of IMA are the continuation of a very long tradition of providing healthcare and teaching medical students. I learned that in ancient times, medical education was flourishing in Islamic society as evidenced by written case studies for teaching that date to the seventh century!

International Experiences and Medcial Education

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The May-June issue of International Educator, the magazine of the Association of International Educators (NAFSA), contains an article by Karen Legget entitled: Teaching Medicine Without Borders. Ms Legget traces the movement from “International Health” to “Global Health” and the impact this is having on medical education.

She looks at various programs from medical schools to organizations (including CFHI) and conducts interviews with students and administrators alike. Her article can be found through the NAFSA website.

CFHI Program Spotlight: Sight for All

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One of CFHI’s newest programs, Sight for All- Ophthalmology Rotation is unique in that it is based out of just one organization- a local NGO located in New Delhi, India. CFHI participants rotate through the various departments, learning how programs and treatment are implemented to reduce preventable visual handicaps. Participants are exposed to mobile eye care clinics, ophthalmic procedures in the operating theater, and take part in advanced level classes at the institute.

The Sight for All program recently had its first participant, Melanie Mamon, and she shares a report on her experiences. To learn more about the program’s location, arrival dates, and clinical sites, click here.