Reflections in Global Health
Reflections in Global Health
This theme presents a venue for sharing testimonials, critiques, philosophical musings, poems, or even works of art about life-changing experiences gained while engaged in global health work.
Thousands of health profession students, residents and faculty participate in global health activities around the world, many through established organizations and universities with rigorous safety and security protocols. But many students, staff and faculty do not have the backing of major organizations for their security planning. Global health work may expose individuals to various risks, including petty robbery, sexual violence, car jacking, political violence, terrorism, and conflict-related violence. As we continue to promote learners’ global health engagement, we should promote a serious dialogue on this topic, exchange ideas and best-practices, conduct joint research, and learn from each other and from organizations with a proven track-record of ensuring the safety and security of their staff. This presentation will review some common barriers to safety/security planning, discuss what prospective travelers should consider in choosing safety-conscious programs, and propose a road map to design safety processes and protocols.
This breakout session hopes to create a space for respectful discussion surrounding the role of faith-based organizations (FBOs) in global health. We prompt the question: How can faith be incorporated into global health appropriately? Faith-based organizations have brought about a lot of positive social change, such as founding schools, hospitals, and organizations to serve the most vulnerable. However, there are often concerns that religious ideology may hinder the delivery of some healthcare services, and as result may play a divisive role. In today’s cultural climate, it is often taboo to talk about religion, but because faith-based organizations are influential players in global health initiatives, the conversation should not be overlooked. This breakout session, which will use participants’ experiences with faith and global health, aims to facilitate dialogue about the role of faith in the field of global health.
The terminal was alive with light and color, while everything surrounding was dark, with the occasional flash of lightning in the distance. I wanted to do something cliche like kiss the tarmac. I was in Namibia - as close to home as I'd been in almost three years. Having grown up in Angola, Africa with a Canadian-American mother and Angolan father, I was ready to begin my elective back in Angola as a third-year resident, confident that my background would allow me to be even more effective. On the flight the next day, everything looked and sounded familiar but slightly altered – like trying to look through glasses with the wrong prescription. I had begun a journey which I had dreamed about throughout my medical education: being able to return “home.” However, I immediately felt out of context. What did being home and trying to contribute actually mean?
Pellagra is a deficiency of niacin or its amino acid precursor, tryptophan, that presents with the classic four Ds: dermatitis, diarrhea, dementia, and eventually death, if left untreated. The incidence of pellagra is quite rare presently, due to increased awareness and strategies such as vitamin fortification. However, the deficiency is still present in cultures that rely on maize as their primary source of sustenance. We report a recent outbreak in a catchment area in Kasese, Malawi, of 691 cases of pellagra that were successfully treated with niacin supplementation. We present this short report to highlight the importance of educating providers of at-risk populations about this diagnosis, and to consider solutions for these populations to prevent further deficiencies.
Most global travelers have experienced culture shock when going to their host country. A similar culture shock can occur when the traveler comes back home. This reverse culture shock can be unexpected and potentially more isolating. Often there is a community of expatriates overseas ready to help the newcomer adjust. Coming back, however, can lead to feelings of isolation, loss, and even disloyalty to the home country. Family dynamics can make reentry more difficult; each family member often has a different time line, and a different attitude toward the transition. Each member of the panel will share their story and the story of their family. Each member of the audience will also have the opportunity to share their story by breaking into small groups of eight to ten. The audience members will hear from other returnees’ successes and failures in their readjustment process.
Ethics Considerations for Global Health: Do Multiple Interests Necessarily Create Conflicts of Interest?
Health care professionals participate in global health efforts for multiple reasons. Many do so from a humanitarian commitment to serve, and others as an expression of deeply held religious faith. Some participate to advance their academic/research interests (including the opportunity to publish). Most also enjoy encountering new places and new cultures. Such multiple interests can lead to conflicts of interest. If so, how should they be navigated? Do they need to be publicly declared (in a manner similar to the “Conflict of Interest Form” the speakers were required to complete for this presentation)? How might the core obligations of medical ethics guide us in these considerations? When we work in the arena of global health, we are inviting our patients, our partnering organizations, our colleagues, our trainees, and our host countries and cultures to trust certain things about us. Are we transparent enough with our motivations to allow their trust to be well-placed and secure? What risks do we take – for ourselves and ourU.S.institutions – by asking these questions?
Family Medicine 360 (FM360) is a global exchange program with educational intent that was designed for young and future family doctors. This program is supported by WONCA, and works thanks to the collaboration of the seven WONCA Young Doctors’ Movements. In North America, Polaris is responsible for the exchange in the U.S., Canada and the Caribbean. The U.S.and Canada are the sites that received the greatest number of requests; to date, no requests for exchanges to the Caribbean have been made. The greatest number of requests has originated from Europe and South America. The exchange allows for collaboration, as well as shared best practices. In 2015-2016, FM360 Polaris received 54 inquires; however, not all inquiries were fulfilled, in part due to the small but increasing number of available hosts. By being part of this program, the young doctors have an opportunity to learn about the host country and share their own experiences.
Disasters and epidemic disease continue to mark this new century: Haiti's earthquake, Pakistan's flood, measles’ blight, and Zimbabwe’s cholera. The heartening response from many is to donate personal time, talent, and treasures to provide rescue and assistance to those in distress. But even well-intentioned efforts have their limitations. We must move beyond the rescue mentality and pursue those interventions that actually build more resilient communities. These interventions often include economic development, improvements in basic literacy, and proven effective health interventions. We must also invest into equipping local healthcare personnel to provide for their own.
Not only does the Global Health (GH) experience present an opportunity for resident development, but including a component of written reflection can provide tangible evidence of development in areas that can be difficult to assess, specifically Accreditation Council for Graduate Medical Education (ACGME) milestones. We analyzed and integrated quantitative (frequency) data with qualitative content from the written reflections of 12 of our Family Medicine (FM) residents who participated in GH experiences. Written reflections touched on each of the 22 FM milestones. The most commonly identified milestones fell within the competency areas of Systems-Based Practice, Professionalism, and Practice-Based Learning and Improvement. Our qualitative approach allowed us to gain an appreciation of the unique experiences that demonstrated growth across the various milestones. We conclude that any program that offers GH experiences should incorporate some form of written reflection to maximize resident growth and offer evaluative faculty a window into that development.
The interest in global medicine amongst medical students and residents in the United States continues to increase, and so have the training opportunities. Many opportunities exist for a family medicine resident interested in a career in global health, including formal, non-ACGME (Accreditation Council of Graduate Medical Education)-accredited fellowships. Recently, consensus-based competencies for family medicine global health fellowships were published as a guide for standardizing expectations from fellowship programs. The objective of this project is to share an applicant perspective on the post-residency training opportunities as the next step to a career in global health. The three components of global medicine that a future trainee should consider incorporating into the training – clinical medicine, health policy/public health, and research/academics – are discussed. Also included as a part of this project is a comprehensive list of various training programs, with details pertinent to an applicant.
Global health diplomacy may be defined as a political change activity that meets the dual goals of improving global health, and improving and maintaining international relations abroad, particularly in conflict areas and resource-poor environments. It occupies the interface between international health assistance and international political relations. It may also be defined as a political change process that meets the dual goals of improving global health, and helping repair failures in diplomacy, particularly in conflict areas and resource-poor countries. There are four key objectives of global health diplomacy: 1. Support achievement of international and national goals for the acceleration of control, and the elimination of diseases. 2. Develop sustainable, coordinated public health capacity among partner organizations and governments globally. 3. Prevent maternal morbidity and mortality globally. 4. Improve response to natural and manmade disasters, including complex humanitarian emergencies, globally. Global Public Health Diplomacy (GPHD) crosses over disciplines to include elements of human rights and social justice, foreign policy, national security, development economics, cultural and social determinants of health, and bioethics.
Experiences living and learning globally often deeply affect learners and physicians, and despite important opportunities for presenting about experiences and group debriefing, many of us are left with complex emotions and processing about who and what we encountered and how that may have changed us. This experiential workshop on narrative writing will offer practical exercises for incorporating the reading of literature and narrative writing (poems, short stories, songs) into our global health work. This practice of “history giving” instead of “history taking” is intended to preserve and honor what we learn from others’ lives (while maintaining appropriate confidentiality), be a creative outlet for connecting with others, and develop resilience to prevent burnout and cynicism.
Why should doctors care about human rights? What are major human rights crises in the world today, and how can doctors get involved? Whether they work abroad or in the U.S., students, residents, and doctors will encounter individuals whose health and well-being are deeply affected by human rights violations such as torture, female genital mutilation, violence, human trafficking, sub-standard prison conditions, child labor, and illegal working conditions. Health professionals have a unique role to play not only in caring for these individuals, but in responding to human rights violations and mobilizing others to try to stop these violations. Doctors have a special responsibility to speak out in support of global health issues, based on their ethics and broader advocacy for their patients.
In many societies worldwide, menstruation is a taboo. Many women do not have access to hygiene products, and during menstruation, they are shunned, miss school and work, and are at increased risk of urinary tract infections. A pilot study completed in 2017 surveyed 933 female factory workers in Bangladesh after they were provided hygiene products for two months. With access to hygiene products, the number of days missed from work each month due to menstruation decreased from 3 to 0.5 days. Incidence of UTI also decreased. Future aspects of the project will include development of an education program for youth of both genders on menstruation, and development of an online market to provide easy access to hygiene products. Increasing awareness of the natural process of menstruation and access to hygiene products will decrease the economic and health burden on women caused by current societal views of menstruation.
In 2016, the world witnessed the global refugee crisis unfold. Imagery of young Syrian children, suffering unfathomable despair, remain vivid. Nearly forty percent of refugees traveling to Europe via the Mediterranean sea are children. While 90 million children under the age of seven spend their entire lives in conflict zones, more than 230 million children around the world live in areas affected by armed conflict. Ongoing conflict retards individual, social and psychological development, which in turn destabilizes society. These conditions put children at increased risk for cardiac disease, diabetes, and drug abuse. While much focus addresses physical needs like hunger, somatic illness, and housing, less attention is paid to the psychological well being of these children. These vulnerabilities contribute to economic suppression, educational disparity, and opportunity for radicalization. I traveled to Israel and Palestine to examine how mental and behavioral health specialists manage psychological trauma for children in conflict.
Short-term medical trips (STMTs) are a popular form of medical volunteerism for both residents in training and physicians in practice. STMTs afford structured opportunities to provide care for underserved populations while enabling travel to other countries. In the last few years, academic scrutiny of STMTs has highlighted the possible and often-unnoticed negative consequences of these trips. Several sources of adverse outcomes arise from a lack of continuity follow-up care, the damaging effect to local physicians’ practices, a pressure to perform interventions without appropriate training, the risks of ineffective care with limited resources, and an ignorance of culture and language leading to errors. Our interactive workshop will draw upon the global health expertise of the audience and presenters to explore solutions to these problems. Further, the workshop will seek to identify reasons family physicians engage in STMT work, collectively weigh risks and benefits, and explore other resulting ethical dilemmas encountered.
Struggling in your work abroad? You’re not alone!: Recognizing the challenges of maintaining personal wellness in the setting of global health work
Global health work can be intellectually challenging, personally meaningful and practically helpful. But it can also be incredibly difficulty. As foreigners immersed in low resource and underserved communities, we witness the tragedies of social and economic inequality in the patients we care for. In focusing much of our energy on the needs of the people we serve, we often forget to care for ourselves. In this session we will reflect on the importance of self-care while doing global health work. The presenters will discuss common themes of wellness as they pertain to the global health worker, including: loneliness, cultural exclusion, family challenges, physical illness, acuity of disease, exposure to violence, financial stressors, and the pressure to feel that one’s work is valuable and impactful. Through active audience participation, the presenters will facilitate a conversation with the group to develop and share practical approaches to maintaining personal wellness in our work.
Medical service abroad offers critical care to underserved populations. There is a long tradition of volunteer medical providers engaging in short-term international service in order to "give back" to communities in need. As the global health field evolves, a more critical lens has been applied to short-term medical service, prompting questions of whether this is the most effective mechanism for addressing global inequities in access to care. Timmy Global Health is an Indianapolis-based nonprofit organization that began as an avenue for medical service abroad. Over the past 20 years it has evolved to include long-term partnerships, public health and prevention activities, education and advocacy objectives, and a move towards community-owned solutions to health care access challenges. Throughout these changes, it has retained a priority focus on cross-cultural connectedness, mutual respect, and ethical engagement. This presentation will highlight challenges and opportunities in evolving amidst a shifting global health volunteerism landscape.
This seminar will review some of the opportunities, challenges and best practices surrounding the provision of medical care in a cross-cultural, developing-world context, as encountered during the presenter's time practicing full-spectrum family medicine at a rural Nepali hospital for two years (2013-15). Specifically, this talk will outline the current state of medical care in Nepal, attitudes and barriers to health infrastructure development, and common disease trends. Brief mention will be made of the Bhutanese-Nepali political situation that has led a number of Nepali-speaking refugees to emigrate to America, where they frequently seek attention for health concerns from community family physicians. The talk will address aspects of a skill set needed to engage successfully in global health, with time allotted at the end for participant questions and discussion.
Telling stories is a powerful way to educate, advocate for a cause, and build compassion and empathy. Global health is an epicenter for narrative. Global health students, residents, and physicians frequently encounter challenging clinical cases, ethical conundrums, and divisive conflicts. With much opportunity to intervene, global health actors, may lack the basic skills to capture and share vital narratives. The goal of this workshop is to teach and empower global health physicians in listening to patient stories, develop a thoughtful narrative, and learn the basics of story telling. After the introduction, the session breaks out into groups. Groups collaborate and discuss their previous global health experiences. They choose a story worth-telling from their previous experiences. They identify themes and motivation. They select character or narrative based plot. They outline three act structure and build a dramatic arc. The groups will then share their narrative with the group.
Over 1,000 non-governmental organizations (NGOs) currently provide Western medical care in Guatemala, a country consisting of a large indigenous population practicing Mayan traditional medicine. Through conducting a literature review of articles addressing the relationship between Western and Traditional medicine in Guatemala, we found very limited reports. We then performed focus interviews with a traditional healer and community leaders in the Izabal Department exploring their views on the types of medicine. Western medicine was viewed as a complement to traditional practices; it was thought to be an alternative if primary methods—such as the various plants from the native forest—failed or for specific ailments. Our results emphasize the need to develop further projects to explore the evolving relationship of Western and traditional medicine in Guatemala, to better understand the crossroads patients face in pursuing healthcare. This will also enhance the quality of care provided by NGOs to the Guatemalan people.