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Equipping Healthcare Workers through Global Health Electives

  • October 23, 2016
  • Medical Outreach Exchange, Health Systems Infrastructure Development, Preparation

Majid Sadigh, MD

In his work, Dr. Sadigh travels the globe responding to various calls for humanitarian aid with the focus of providing critical medical care and easing the suffering of others. He is particularly devoted to improving health in resource-limited countries in which inhabitants often experience great hardships and unavoidable health crises.

Global health has been defined as a collaborative transnational research and action for promoting health for all.[1] It strives to improve health and quality of life through medical care while also considering the complex socioeconomic, political, and cultural determinants of health that must be met with interdisciplinary and international cooperation.[2] Its rise has come in response to this new era of globalization, as people and pathogens cross borders more easily than ever. We can now travel from one end of the Earth to the other in only a matter of hours, rendering ailments no longer specific to any one region– Ebola to Africa, Dengue to Brazil, or tuberculosis to India– but increasingly ubiquitous and, accordingly, universally palpable. Due to the ease of travel and migration, healthcare workers must be prepared to treat any condition. What can be done to prepare the new generation of physicians for this new set of challenges, especially in a profession that is already so demanding?

Global health electives might be the perfect solution. They prepare trainees to navigate a wide array of medical conditions in a multiethnic dimension and with limited resources while also fueling their love for medicine. Leaving the encasement of one’s privilege to train in a resource-limited setting is not an easy endeavor. For some, it is the first exposure to the way most of the world lives, where nylon gloves are used in place of catheters, where the number of radiation machines in a nation can be counted on one hand, where patients sleep on the floor in a shortage of beds. Where the direction in which one’s moral compass points is questioned. It requires self awareness, strength, and humility to accept and then overcome challenges to one’s known way of being, thinking, and perceiving the world. Through these challenges, the role of healthcare worker as an advocate for health equity is emboldened.

Upon return, these awakenings incite a widening of the eyes to harsh realities here at home in the United States where many rural Americans have surprisingly limited access to healthcare. Skills acquired during their global health electives are directly transferrable to their practice at home, as trainees are less reliant on diagnostic testing, have broader differential diagnoses and exhibit greater adeptness with the physical exam.[3] These skills result in decreased dependence on expensive tests, and thus increased mobility in resource-limited settings and in treating marginalized populations including refugees, immigrants, and native peoples living on reservations. Furthermore, trainees with global health experiences are more likely to practice medicine in resource-limited settings where healthcare workers are needed most, both domestically and abroad.[4]

But beyond the ability to treat a plethora of conditions in a dearth of resources, healthcare workers must be able to navigate the practice of medicine from the perspective of a multitude of cultures, swapping out lenses at any moment and interacting through that frame. The Institute of Medicine defines optimal primary care as including “an understanding of the cultural, nutritional and belief systems of patients and communities that may assist or hinder effective healthcare delivery.”[5] To be a true patient advocate, one must have the ability to understand what constitutes wellness to each particular patient, and then communicate with the patient in the context of that definition. Such quality of healthcare cannot be delivered without cultural competence. Given the diversity of people in the United States, it is crucial that a healthcare worker not grimace at the sight of a woman with genital mutilation, not misinterpret burn scars on a child’s skin from a traditional healer as parental abuse, or consider that a woman wearing a hijab may prefer to be treated by a female physician. Health is overall well-being: emotional, mental, spiritual, and physical. While the desire for holistic health may be universal, these concepts contain intricacies that are largely shaped by culture. Thus, cultural elitism must be set aside to allow true patient advocacy.

Even the most comprehensive cultural awareness would fall short in practice if lacking the fundamental principle that one’s own cultural values are not necessarily the ones against which all others should be compared. With humility, one can assess anew the cultural dimensions of each patient’s experiences and let go of the false sense of security that stereotyping brings. The training of healthcare workers in both international and resource-limited settings encourages consideration of these very principles– cultural competence, relativism, sensitivity, and humility– as each is challenged in a clinical setting. The goal of these electives is to instigate a journey as an active and reflective healthcare practitioner committed to a lifelong openness to learning, self-reflection and self-critique.

In addition to impacting physicians early in their careers, global health programs can also move physicians more established in their careers. Medicine requires a lifetime of hard work and dedication, and a tremendous supply of empathy. Sometimes even the most devoted physicians lose themselves in the heaps of paperwork and bureaucracy. Global health programs can help reinvigorate physicians dealing with burnout, reminding them of that original call to empathy that brought them to medicine. In the same breath, they can prevent the new generation of physicians-to-be from becoming burnt out in the first place. Senior and retired physicians can also greatly benefit from becoming involved in global health, feeling a much needed revitalization.

Global health electives provide a unique and important opportunity for healthcare workers to become better equipped to manage disparities in health and society, and thus better able to serve as advocates for health equity. After all, what is the role of a healthcare worker if not to advocate for equal care for all? As Thomas Moore writes in Utopia, “freely I share what I have; not unwillingly I accept what is better.” A well-designed global health elective challenges one’s pre-designated beliefs, and encourages cultural competence, relativity, and humility. We must build up the new generation of physicians to become leaders in global health, patient advocacy, and health equity.


 

Sources

[1] Beaglehole and Bonita 2010
[2] Koplan et al. 2009; Kickbusch 2006 ; Fineberg and Hunter 2013 ; Frenk et al. 2010
[3] Drain et al. 2007
[4] Ramsey et al. 2004
[5] https://muse.jhu.edu/article/268076/pdf