Tag Archives: WHO

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 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!

The Rio Political Declaration

1 Reply

Heads of State vow to “achieve social and health equity.” Students respectfully ask for more specifics.

Last week, Heads of State, Ministers, government representatives, and leaders of different sectors met in Rio de Janerio at the WHO World Conference on Social Determinants of Health. (Writing and discussions about social determinants of health can often get lost in very academic and sterile sounding language, so it is important to keep it as close to real life as possible.) What is important about the World Conference on Social Determinants of Health (WCSDH) in Rio is that 125 nations pledged their commitment to work to promote awareness, develop policies, and support programs to transform certain social factors that play a significant role in determining whether or not a person will be healthy. The U. S. Centers for Disease Control uses the following words in an attempt to define ‘Social Determinants of Health’, “…complex, integrated, and overlapping social structures, and economic systems that are responsible for…” As you can see, we are already getting off into language that feels far removed from the daily realities of global health disparities like lack of access to care. Of course, all this has to do more with economics, education, and politics than with the common understanding of health and healthcare. And that is exactly the point. The fact that many high level political decision makers were present in Rio gives us some hope that there is a growing realization that health ministers alone cannot address these issues.

The Rio Declaration referenced a similar conference in 1978 that produced The Declaration of Alma Ata, named for the Russian city –then in the USSR, where health was defined as “…a state of complete physical, mental, and social wellbeing, and not merely the absence of disease of infirmity… .” It went on to declare health as “a fundamental human right.” So we have known for a very long time that the goal of health for a nation and for the world is larger than healthcare, at least as we know it in the United States.

More than thirty years later, it is great to see the Spirit of Alma Ata is still alive. For, as economics, politics, and situational specifics change, it is imperative to remember that fundamental values and rights remain constant. It was right for Alma Ata to call for essential primary healthcare for all the world’s population back in 1978, and it is right for Rio to say today that just because we have not yet achieved the promise of Alma Ata does not mean that we should stop trying.

Progress is being made, but there is much more that can be done. That is why it is good to see the fresh eyes of students also present at the Rio conference. The International Federation of Medical Students (IFMSA) sent a delegation of ten medical students to Rio. Their take on the events of the WCSDH can be found on the IFMSA blog. While the IFMSA students don’t have the experience of some of the professionals who have been working at this for several decades, they do bring a fresh perspective and the ability to think more simply, with less jaded minds. In their critique, Renzo Guinto, the leader of the youth delegation, hits the nail on the head by saying: “The main problem of the Rio Declaration is that it failed to explicitly tell us how the unfair distribution of power, resources and wealth will be addressed, especially by Member States. The WHO Commission on Social Determinants of Health has been adamant about the need to tackle this lingering issue, as health inequities within and between countries are rooted in power relations and resource maldistribution. We understand that changing the current dynamics of power will not happen overnight. However, we believe that this Declaration could have been the watershed moment for leaders to make a strong commitment in making this world a fairer place.”

Students who participate in any of Child Family Health International’s (CFHI) Global Health Immersion Programs are, in fact, immersed into underserved communities around the world. They are mentored by local healthcare workers who face the challenges of few resources and many patients. Students say that they are deeply impacted as they see dramatic health disparities and the realities of the social determinats of health playing out right in front of their eyes. They become some of the most effective advocates for global health equity because they are eye witnesses to the consequences of inequity. And some of them are moved enough to have the experience directly impact their career plans, like Erin Newton who wrote about her experience on the Great Nonprofits Website. “Having never been exposed to the poverty, illness, and disease that I experienced in India, I learned so much about myself and found that I have a true passion for underserved and rural patient care. I learned that much of it can be prevented and I want to help treat these individuals and educate the rural communities as a future physician.”

Along with his challenges, Mr. Guinto also seems to speak for IFMSA in pledging to “…commit ourselves to continue engaging with all sectors involved in the work towards global health equity, spreading awareness of the social dimensions of health to our fellow young people, mobilizing them to take action in their respective communities and countries, doing our part, little by little, but with courage, constancy, and conviction.” We call on all CFHI alumni, whether they be part of IFMSA, AMSA (America), AMSA (Australia), ASDA, NSNA, SNMA, as well as many other groups, or just individual health science students, to read Mr. Guinto article and find the best way to engage in the great effort to achieve heath equity both at home and abroad.

With additional specific yet respectful challenges, Mr. Guinto offers an important contribution to the dialogues around social determinants of health that may require the veterans of this work to take a step back and refocus for a fresh look at what is taken for granted, or thought to be impossible. For it is only that kind of courage that will produce the bold steps needed to truly transform the status quo and bring about the promise of Alma Ata that is still waiting for us all.

World Health Day 2011

World AIDS Day – What We Can Celebrate

The Great Asian Tsunami Five Years Later

1 Reply

The anniversary of the great Asian Tsunami is December 26^th. Do you remember where you were on that day in 2004?

The effects of the huge earthquake, estimated at 9.1 or greater, and resulting tsunami were devastating. Some reports say that about a quarter million people in some eleven countries, lost their lives, almost in an instant. For those who were left, they not only had to deal with the grief and loss but also with the fact that their lives and livelihood would be forever changed. Many made their living off the sea and now the trauma of this event made it hard for them to comfortably return to their work.

CFHI’s loyal donors and alumni were quick to respond. Within 48 hours, we had connected with other international organizations and had a disaster relief container with supplies for 10,000 people, on the ground in one of the worst hit areas in Indonesia. Our donors continued to give. We let people know that CFHI did not have any programs in the areas that were directly impacted and suggested several other organizations to which to donate. Many of our donors still wanted to give to CFHI, they said that they trusted CFHI to find the best way to use the donations. So after helping with the immediate disaster response, we started doing our homework.

With many programs in India, CFHI was asked to help in the areas of Southern India that were greatly impacted. CFHI met with local and WHO health officials by conference calls. There was great concern that widespread disease would be one of the effects of the tsunami so we were asked to wait while health officials conducted surveillance to see where disease would most likely occur, along that portion of the Indian coastline. As it turned out, preventative efforts held disease in check so we began looking for other lasting effects of the tsunami. For young children, the trauma was the most significant lasting effect. In a number of small coastal fishing villages, much was lost including the schools. One of the most important things to help children dealing with trauma, is to reestablish a routine that is safe and comforting to them. With the loss of the schools, there was a big hole in the day of every child. CFHI teamed-up with the service organization Round Table India –that was charged by the Indian Government with rebuilding the lost schools. CFHI’s donors were able to support the rebuilding of two schools that were lost in the tsunami, thus reestablishing this most significant daily routine for many children.

Sewing Class at Kovalam

Some of CFHI’s donors have continued to donate to make sure that efforts to help those so devastated by the tsunami would not fade away. As this fifth anniversary approaches, CFHI is happy to be continuing in this effort. Loyola College in Chennai started an outreach program to provide ongoing assistance to people affected by the tsunami. A successful community college effort has been established and is training people in skills to help them find jobs in many fields including culinary work and food service for the tourist industry, website design, mechanical work on air conditioning and refrigeration systems, etc. In addition, the Kovalam Community College is providing general courses in English, general life skills, health education, and working with the large population of widows created by the tsunami doing women’s empowerment workshops and helping the widows develop their skills.

During my visit to India earlier this month, I met Fr. Xavier Vedam, S.J. the Vice Principal of Loyoal College in Chennal and the Director of the Loyola Outreach program. I was very impressed with these efforts by local students volunteering to help in the villages that continue in their recovery from the devastating events of December 262004. I was struck by the passion of Fr. Vedam and the fact that they are not giving up but continuing to provide services, engaging the community, and helping people in real ways. To see that many people are now in gainful employment and that the self confidence and attitude of people in whole villages have been so positively impacted, is a wonderful accomplishment and we applaud these ongoing efforts that bring development based on the strengths of the local people.

Fr. Vedam and Students at Kovalam

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

1 Reply

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.

Equity Should Play a Role in Measuring Global Health