GHEC “Transcending Global Health Barriers”
Brianna McKelvie and Kamal Menghrajani report for us on last weekend’s ‘Global Health Education Consortium’ that aimed to educate the next generation of global health leaders. We start with Brianna, who talks about the most parts of the conference that gave her the most to think about.
I attended the Global Health Education Consortium/Western Regional International Health conference in Seattle, WA last weekend. This was the first year that the two organizations were combined for their annual conference and this meant that the conference was larger and included more students than in previous years. The theme of the conference was “Transcending Global Health Barriers”.
I attended many panels and heard many speakers over the course of the weekend, but there were some that stood out. What impressed me especially was the way that technology was used to address some of the issues in global health education. Dr. Bob Bollinger is the Director of the John Hopkins Center for Clinical Global Health Education and he spoke about how he is using video conferencing to present grand rounds to a medical school in India. He is also bringing his medical students to case presentations by a physician at the Indian medical school. He has also helped to develop an online course for nurses and it is being used worldwide by over 2500 nurses/students. He is passionate about the use of technology in global health because it is cost effective and relatively easy to implement. It means that people can stay in their home countries and be learning material developed by professors who live half-way around the world.
I also heard from Dr. Roy Colven, a dermatologist at the University of Washington, who is using the concept of virtual office hours to consult with physicians from around the world. It started with HIV-related dermatological case presentations that he presented to various sites around the world. Physicians who were streaming the lecture could log into live chat and post their questions and opinions to the other attendees while he was giving a lecture about the case. What Dr. Colven noticed however was that the cases that he was presenting were too easily diagnosed by the other physicians. So he decided to use the virtual office hours as a time wherein physicians from around the world could send in their cases, and, instead of a lecture, they could all collaborate over the cases while Dr. Colven facilitated the discussion (as he was the only one with audio). This gives physicians from all corners of the globe an opportunity to discuss complicated cases with many other physicians. It also gives them access to a specialist, who in this case is a dermatologist. Variations on this theme are now being used for a variety of specialties, including radiology and dermatological-pathology.
Finally, I heard from Dr. Walter Curioso who has been working with the University of Washington and various organizations in Peru to train Peruvian students in global public health informatics. The variants in technology are only useful if there are people available who understand how that technology works and are able to develop new technologies. He has helped develop multiple modalities to train Peruvian students in public health informatics, including undergraduate and Master’s programs in Peru and scholarships to bring Peruvian students to the United States in order to learn more about bio-informatics. The most interesting part of his presentation was the fact that they are using the Peruvian model to develop a similar program in Thailand; a “South helping South” initiative as he called it.
I found the use of technology in global health education fascinating and innovative. It occurred to me this weekend that training in the health sector could come to occur entirely over the internet. The use of technology could be used in an infinite number of ways and could be one of the most important tools in closing the gap between resource-poor and resource-rich settings. It can bring primary care physicians practicing in the remote areas of Malawi to a specialist who can help them interpret an image or advise them on an unusual rash seen in a pediatric AIDS patient. It can be used to supplement the education of medical/nursing students in Uganda who lack the textbooks and journals that are available to medical students in North America, but can learn the material from an online source or from a teaching module. The initial start-up costs can be quite expensive, but the uses are limitless and very cost-effective in the end. I know that there are endless possibilities in the way that technology can be used in global health education and I was excited to see its potential being harnessed.
While the use of technology in global health education was not the focus of the conference, it was the most interesting part for me. I heard a lot of people talk about the projects that they were doing, and I heard from people heading impressive organizations with large budgets. However, a lot of these project presentations started to sound the same to me, and they did not seem to be asking enough of the tough questions. As the torrent of interest flows into global health (a “tsunami of interest” as one speaker called it), we now have a situation where people with the best intentions do not know how to harness their energy. We now have a plethora of outreach projects that involve many short-term initiatives from students, taking them all over the world. And while I don’t know how I feel about these initiatives, I know that I heard from representatives from many of these projects who did not seem to be asking the deeper questions. If interest in global health were enough to solve the problem of disparity, then we would be seeing more progress on the Millennium Development Goals. I think that we need to start accepting that good intentions are not enough and we need to be asking more of global health projects.
I did hear some presentations this weekend where people were starting to ask the harder ethical questions. Trying to abolish the disparity in health seen throughout the world is a very tall order, and involves a synergy in everything that contributes to health: education, politics, infrastructure etc. This can be overwhelming as the term “global health” is really a lot more complicated than it sounds. But that does not mean that we should not be trying to enforce quality control and trying to search within ourselves to answer the hard questions. Global health is a very new field compared with other fields and it will take time to find its footing. As I looked over the student research projects this weekend, I was inspired by how much interest there is in this field and how many people were involved in creative and dedicated projects. However, I also saw some flawed methodology in the research. I know that students try their hardest on these projects, but it can be hard to juggle a short-term research project with all of our studies, especially when we have so little experience in research. I think this is one way in which global health will grow. This interest in research is starting to get recognized at the faculty level, and with the experience and funding that the faculty can provide, I think the research will become more robust over time and can hopefully be used to guide global health projects.
I heard many people this weekend talking about the implications of their projects, and discussing what sustainability meant and how it can be implemented. I heard people talk about institutional partnerships, and collaboration and evaluation of outcomes. I really do think that global health has come along way, and with the exponential new interest from this generation I think it will continue to grow in the right direction, as long as we set the bar higher than just good intentions; we need to be demanding results.
And now over to Kamal, who talks about the aspects of the conference that most interested her
Hey, everyone! Kamal Menghrajani here. I’m a second-year medical student at UNC-Chapel Hill and I made the trek across the country for the 18th annual GHEC Conference at the University of Washington. Focused on education in global health, this conference was excellent from a student perspective.
Friday featured the Pre-Conference Assembly in which we heard about work by the NIH / Fogarty International Center to provide student research opportunities in international sites; ideas for creating a Global Health Service Corps, a group that would offer loan repayment to medical professionals in return for service to impoverished communities around the world; and a report from the Institute of Medicine on future directions for public health. The day also featured a career clinic for bright-eyed students, providing an outlook for the public health landscape and tips on how to establish a successful career in the field.
One of my favorite parts of Friday was getting to meet Dr. Javier Sevilla Martir at a lunchtime Topic Table. The theme for discussion was Strengthening Capacity for Global Health and Dr. Sevilla Martir spoke passionately about his work in Central America. A native of Honduras, he had worked there for four years as a general practitioner and realized there was a need for more rural health services. To this end, he started a weekend clinic in an underserved area and kept records of the patients he saw. He began to see trends in the data, especially a need for improved nutrition services for the elderly. He moved to the U.S. and, within months, recruited medical and public health students to return to the area and assess the needs of the elderly population there. They discovered malnutrition, depression, and social issues and built and ambulatory care center to make way for a long-term, sustainable approach to addressing these needs. Over time, this morphed into a four-year elective for medical students at Indiana University, in which they learn medical Spanish, visit the ambulatory care center in Las Lajas, do their Family Medicine third-year clerkship at the National University of Honduras, and have the option of doing an independent project in Honduras during their fourth year. I found Dr. Sevilla Martir’s work to be fascinating – it took into account so many principles critical to sound implementation of public health and global medicine projects, including a connection with and buy-in from the local community; long-term, sustainable thinking; and a four-year program that connected students with the community throughout their training, making for a richer experience on both ends.
With so much going on during the conference, I focused my efforts on Saturday morning on learning about student projects. The first presentation I attended highlighted the necessity of scientific rigor in public health endeavors. A student was discussing the importance of bed nets in reducing the occurrence of malaria, however the exposure measured was presence of a bed net in the house, and the outcome measured was anemia in kids under five. The study seemed to be confounded, as no information was given as to frequency of use or correctness of use of the bed nets, or whether they were even used on the children, etc. As for the outcome, it measured anemia instead of parasitemia – although this is common practice in many places, anemia may have been caused by myriad other sources unrelated to malarial infection. Finally, other confounders, such as level of malaria incidence, were not analyzed.
To me, this highlighted the need for critical appraisal of research methodology, with which medical students are often not acquainted. Having a research mentor with a background in scientific research and who is well-versed in the issues that arise in field work is critical. Additionally, in-country support can assist in making sure the research is culturally and geographically appropriate. Finally, attention should be paid to the objectives of the project, and ways in which the data can be used to inform interventions and take action to meet the needs that are uncovered.
An interesting afternoon session looked at the role of governments in global health interventions. Dr. Steve Gloyd made some interesting points about the theoretical advantages of government healthcare. First, he said that there is a pre-existing network of government clinics and services that is far more extensive than anything found in the NGO or private sectors. This means that national governments are uniquely poised to offer rural services and disseminate country-wide initiatives. Additionally, most NGOs last no more than five years, suggesting the government would be able to provide sustainable, long-term services in a manner unmatched by other providers. His second main point was that this government network lent itself to a standardization of quality of care and an ability to centralize patient services. This would mean, for example, that a mother-to-be could seek prenatal care at one public clinic and know she was getting comprehensive services comparable to other areas of the country, instead of having to make five to seven separate stops at NGO or private clinics that were each specialized or limited in what they could provide. The third point Dr. Gloyd made was that government-run public health has been found, in his experience, to be more cost effective – the budget for an NGO with 15-20 people may be twice that of a 500-worker ministry of health. Finally, he suggested that governments are theoretically accountable to the people – but that the private sector and NGOs are accountable to their funders. This critical difference may lead to the provision of services that don’t make the most sense for that area.
On Sunday I explored the posters and exhibits and learned a little bit about student projects going on at other schools. At UNC, we are in our second year of partnering with the University of Nicaragua to build public health services for a historically poor and underserved part of the country. Our program is comprised of a multidisciplinary team of doctors and students from both schools that’s working to discover the needs in this rural area and begin implementing sustainable solutions to meet them. Hearing from students about their field work in Ecuador, Honduras, and other Latin American countries inspired us to pool resources with experts and fellow students at UNC who could better inform our work.
All in all, the conference was a wonderful learning experience. Exchanging ideas with and hearing inspiring stories from so many professionals and students stoked my passion for global health. Exploring the many the presentations and discussions at the conference helped me gain a broadened perspective on the field that I can now apply in my own work, and I hope you have gained something from reading about my experience there.