Global health is “the new pink”
Andrey Ostrovsky writes on the challenges involved in training students and professionals for work in global health.
My girlfriend writes for a fashion magazine. She makes it seem as though there is a new trend every week: pumps are “the new heels,” clutches are “the new shoulder bag,” and pink is “the new red.” While I don’t know what most of those words mean, I do know that medicine, like fashion, has its trends. In medicine, global health is “the new pink.”
With globalization quickly escalating, more and more doctors-in-training are trying to pursue work in global health. “Trying” is the operative word. There appear to be endless options available for medical students and doctors to “go international.” There are week-long volunteer clinics in almost any country of one’s choosing. There are MPH programs in international health. There are certificate courses on “Global Medicine Made Simple.” However, there is nothing simple about global medicine, nor the path to practicing it.
The problem with all of the international health options available to us is that there is not one single program that can propel a medical student directly into a career in global health. The current path is circuitous and the end result is an under-qualified physician in an overburdened system. This is a generalization of course, but it is based on sad truths nevertheless.
To effectively practice medicine internationally, a doctor should be more than a doctor. He should be the health system administrator, public health advocate, policy maker and implementer, the economist, and the voice of the people he is serving. In theory, an effective global health doc would have an MD, MBA, MPH, JD, and a PhD all in one! In practice, people simply don’t have the money to go through 15 years of post-graduate work to help an underserved population. Unfortunately, it takes many, if not most, doctors just that long to achieve a position where they can make a significant impact. Even at that point, the doctor is still deficient in many skills needed to effectively practice international medicine. Ideally, a primary care-based residency program in international health would incorporate all of the previously mentioned skills into one cohesive program that would propel doctors into effective global service.
So where do we go for such a program? A good place to start is with an endeavor put together by the “Calvin Klein” of global health, Dr. Jim Yong Kim (pardon the extended metaphor, but I’m on a roll). His name is widely known in international circles, and he is one of greatest contributors to global health development. Dr. Kim, in collaboration with colleagues from the Harvard School of Public Health, is developing a program designed for newly trained doctors that mirrors an MBA style, case-based learning method to teach international health, on a systems level. Doctors in this program are being trained to address economic, political, and organizational issues, in addition to directly treating patients. Is this program the answer to our training prayers? The answer is uncertain as of now.
What is certain is that almost anyone can administer penicillin, but not everyone can administer a health system. The focus of international health should not only be treating the symptoms, but also treating the causes of the problem. Volunteering at a clinic for a week is all well and good, but once you leave, who will follow-up with the patients that you have just started on a medical intervention or prevent future problems from developing in that patient? The key to effectively working abroad is treating not only the people, but the system as a whole. Health systems strengthening (HSS) should be the goal of our generation of physicians.
The seeds of change must be sowed. Unlike fashion, where the Fall styles are already being sold in early Summer, proper health system infrastructure commonly lags behind the growth of the system. Funding appears to be outpacing proper structuring of health systems. With organizations like the Global Fund dispersing over $5.9 billion and the Gates Foundation dishing out almost $10 billion to global health initiatives, the money is undoubtedly there. What is missing is our training. For those billions of dollars to be utilized properly, doctors must be trained properly.
So far, no single training program has the perfect blend of imparting health system knowledge to fill the missing piece in today’s global health puzzle. In fact, just one program would not suffice in addressing the huge demand for proper training - there are just too many people to be trained. What the global health community needs is a template for such a program and the template should be developed by experts in the field of HSS.
An ideal place to develop and discuss such a template is the Health Systems Action Network (HSAN). HSAN is a network of health systems experts from around the world whose mission is to facilitate “equitable, accountable, and sustainable health systems for improved health outcomes” (hsanet.org). Conceived in 2005 and birthed as a registered non-governmental organization (NGO) in 2006, HSAN is still in its infancy. It is trying to develop into the evidence-based resource backbone of the HSS mammoth. In addition to providing summaries of global initiatives for HSS, global leader views on HSS, and HSS reports, HSAN can be the repository for global health education programs focused on HSS. With input from multiple experts and students, HSAN can research the pros and cons of different programs, thus providing program directors with the tools necessary to improve upon existing or create new educational programs in global health.
HSAN needs proper guidance, much of which is already being provided by the dozens of experts that have joined its body. To reach its potential, HSAN also needs ongoing nourishment. We, the young health professionals, are that nourishment. Since most of our careers are still ahead of us, medical student involvement is crucial in the design and implementation of the programs addressing today’s and tomorrow’s problems. With our involvement, HSAN can lead the effort to create a template for courses in international health that would address both the world’s need for improved healthcare and medical students’ urge to provide that care.
To strengthen health systems, health professionals must be educated effectively and efficiently. The search for the perfect training program continues and there are certainly developments in the works. These developments must include student input. To have your voice heard and to be a stakeholder in your own training in global health, please visit HSANet.org and look for the medical student section. Give your input. Help influence your own training. Health systems strengthening: it’s “the new pink” of global health.
Andrey Ostrovsky, 3rd year medical student at the Boston University School of Medicine, Boston, MA, U.S.A.
andrey@bu.edu