When Things Wrong Global Healthgoand the Staying and
When Things Wrong: Global Healthgoand the Staying and Getting out of Trouble Millennium Development Goals Cynthia Haq MD Daniel Van Durme, MD Director, Center for Global Health University of Wisconsin-Madison Chair, Dept of Family Med & Rural Health & Director, Ctr for Global Health Joshua Counihan, M 4 Florida State University College of Med American Academy of Family Physicians 7 th Family Medicine Global Health Workshop Coral Gables, Florida, September, 2010
UW-Madison Center for Global Health Medicine and Public Health Nursing Pharmacy Veterinary Medicine International Studies
Global Health and University Engagement n n n Agricultural & Life Sciences Area Studies Arts & Sciences Business Center for Global Health Division of International Studies Education Engineering Law School Nelson Institute of Environmental Studies And more!
Education for Health for UW Students, Staff, Faculty … and Communities
FSU College of Medicine n 1 st Medical School of 21 st Century • Graduates – 27 in 2005 120 in 2011 • Care for rural, minority, elderly and underserved • Dean and many in key leadership are Family Physicians • Family Medicine and Rural Health is one of just 5 depts. n FSUCOM - Center on Global Health • Founded in 2009 • Research training, simulation education and exchange with Kazakhstan • Hosting Fulbright scholar from Uzbekistan • Coordinate numerous service learning experiences for medical students
Global Health in Medical Schools and AHCs n n n n Global health curriculum Cross cultural communication skills Interdisciplinary team practice Community health efforts-commitment to underserved patients, the poor, uninsured and disadvantaged Global health electives and field courses Global health certificate or tracks MPH-global health emphasis Nationally – 31% of medical students participate in global health experience WHILE IN medical school (2010 data - AAMC)
UW-Madison Center for Global Health Principles Equity n Reciprocity n Sustainability n Interdisciplinarity n Quality and safety n Public health n
“Trouble” in many flavors n Real and perceived threats to safety • Varying degrees of risk tolerance n Cultural breakdowns • May jeopardize current and future work n Unrealistic expectations and “bad” experiences • May lead to bad PR and others will not want to participate in the future
Group Travel n n n “Semper Gumby” – always be flexible Group first – self second Student leader + physician leader Consider applications/essays Limit size to manageable # for quality experience Solo Experiences n n n Bilateral sign-off on learning objectives Confirm contact information overseas Consider approvals in context of other experiences, performance and behaviors
Staying out of Trouble. Preparation n n n Selection of faculty and students Building relationships – assessing and selecting sites Planning agenda with local hosts Preparation of students and faculty Insurance: medical and evacuation Medical preparation-travel health Registration; emergency contact and US embassy
Legal release n Legal release • Voluntary consent, hold harmless, assumption of risk, waiver of liability, etc. • Including but not limited to: Accidents n Illness, injury n Political unrest n Violence, terrorism n Weather n Government restrictions and regulations n
Key information n State Department www. travel. state. gov • Safety Issues – http: //travel. state. gov/travel/tips/safet y/safety_1180. html • Emergencies and Crises http: //travel. state. gov/travel /tips/emergencies/emergen cies_1212. html • Travel warnings • http: //travel. state. gov/travel/cis_p a_tw/tw/tw_1764. html
CDC Travelers’ Health n Not just vaccinations • Tips on staying healthy while abroad • Injuries and Safety • Obtaining Health Care While Abroad • Travel Health Kits • Etc. http: //www. cdc. gov/travel/
Medical – Evacuation Insurance n Several firms • www. insuremytrip. com Compares options • www. hthworldwide. com • www. travelguard. com n n FSU requires all students to carry coverage with specific amounts (e. g. , evacuation, medical, hospital, etc. ) Some will also cover trip cancellation, lost luggage, etc.
Carry info everywhere n Single page • All critical info • Keep copies at all times n Each luggage, wallet, purse, hat, shoe
Embassy Registration n Mandatory at FSU (was recommended) • Free service that allows embassy to better assist you in case of emergency including home emergencies • May indicate frequent destination - easier • May subscribe to receive Travel Warnings • https: //travelregistration. state. gov/ibrs/ui/
Emergency Contacts n Designated people (not just one) with all your travel and contact info • Family and school/residency/sponsor n n Advise on expected frequency of contact Folks at home are worried about you
Staying out of Trouble in the Field n n n n Scheduling with flexibility Food and water Transportation; vehicle and driver Personal items Lodging Night life Donations and gifts
What to do when things go wrong n n n n ”Don’t expect what you expect!” Illnesses Accidents Culture shock Conflicts Natural disasters Emergencies at home
Case Study – War n n You have moved with your husband 4 children to Pakistan as part of a Fulbright program to develop family medicine in Pakistan. You are contacted by the US Embassy requesting that you pack your bags and gather your husband children to take the next flight out of the country…. .
Case Study-Illness n n You are leading a field course with 14 students in Uganda. Sharon, a first year medical student becomes ill with a severe headache, body aches, high fever and delirium…. .
Case Study – Lost Passports n n As you prepare to depart with a group of students from Ecuador, one student realizes their passport is lost. . . As you prepare to depart with a group of students on their way TO Nicaragua, one student cannot find their passport, . . .
Case Study-Accident n n One of your senior faculty is leading a one month filed course with 12 medical students in Malawi. You receive a call notifying you that the van carrying the faculty and students back to the airport was struck by a train. The driver was killed and several people are critically injured.
Case Study-Culture Shock n You are leading a field course and note that one of the students seems withdrawn, sad and aloof. She is reluctant to join group activities and often complains about local conditions. Her behavior is considered rude by local hosts.
Case Study – Conflict n You are leading a group of 16 students, two of whom are openly gay males, in a country where homosexuality is considered a criminal offense, punishable by imprisonment.
Case Study. Gifts and Donations n n US students have raised over $5000 to contribute to an orphanage in the host country where they will study. Local hosts learn about the funds and bring many additional requests for financial and material donations. The van students and you are traveling in is surrounded by beggars at every stop in the city.
Case Study-Ethical Dilemma n n Second year medical students in a remote field site are expected to deliver medical services to critically ill patients. Human health professional resources are limited; your students are eager to contribute, but you are concerned they may not be adequately prepared….
Case Study. Health Challenge n n You and your students are engaged in field work in a remote site where the local HIV prevalence is 10%. One of the students assisting in the hospital sustains a needle stick injury…. .
Case Study. Request to Study Abroad n n Two first year medical students approach you with plans to study in Kashmir. They need your approval and guidance. They hope to assist earthquake victims, they hope to work with what appears to be a well-organized not-for-profit organization that conducts programs in the region……
Case Study - Request to work abroad – Part 2 n n Your institution has a policy against allowing students/residents to travel to sites on the US State Dept. Travel Warnings list. A senior medical student of Haitian descent (fluent in Creole) wants to spend a month in a clinic to help after the earthquake. . .
Case Study n Your examples…. .
Family Medicine-Global Engagement
Opportunities to learn and to serve
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