March 31, 2017 by
Majid Sadigh, M.D. & Mitra Sadigh
Medical student Mary-Kate LoPiccolo and Dr. Majid Sadigh examine a patient during clinical rotations at Mulago Hospital in the capital city of Kampala, Uganda (Photo: Tyler Sizemore)
For many medical students, training in a resource-limited setting is their 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 a bed shortage might mean patients sleep on the floor. Working in this environment requires self-awareness, strength, and humility to accept and then overcome challenges to one’s way of being, thinking, and perceiving the world.
Global health has been defined as collaborative research and action that promote health for all. The goal of these efforts is to improve health and quality of life through medical care, while also considering the complex socioeconomic, political, and cultural determinants of health. These endeavors are increasingly important, as people and pathogens can 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, meaning that Ebola is no longer confined to Africa, Zika to Brazil, or hyper-resistant tuberculosis (XDR-TB) to South Africa’s KwaZulu-Natal province in South Africa. With the ease of travel and migration, doctors must be prepared to treat any condition. Global health electives that teach trainees to navigate a wide array of medical conditions when working with multiple ethnicities and with limited resources can help prepare the next generation of physicians for the challenges they will face in this era of globalization.
After their experiences abroad, students may be shocked to discover similar harsh realities here in the United States, where many Americans have surprisingly limited access to health care. The skills trainees learn during their global health electives are directly transferable to their practice at home. Physicians with these skills are less likely to depend on expensive tests; they’re able to adapt to using fewer resources and treating marginalized populations and those facing urban, rural, and reservation poverty. In addition, trainees with global health experiences are more likely to practice medicine in resource-limited settings where health care workers are needed most, both domestically and abroad.
Benefits beyond medicine
But beyond the ability to treat a plethora of conditions with a dearth of resources, doctors must be able to navigate medical practice from the perspective of a multitude of cultures, quickly swapping out lenses as needed and interacting through a new lens. According to an Institute of Medicine report, optimal primary care includes “an understanding of the cultural, nutritional, and belief systems of patients and communities that may assist or hinder effective health care delivery.”
For us to be true advocates for our patients, we must be able to understand what wellness means for each patient and then communicate with that patient in the context of that definition. Delivering health care of this quality requires cultural competence. Given the diversity of people in the United States, it is crucial that physicians and other health professionals, for example, know that a child’s burn scars may be from treatment by a traditional healer and are not a sign of parental abuse, or that a woman wearing a hijab may prefer to be treated by a female physician. Health encompasses overall well-being: physical, emotional, mental, and spiritual.
With humility, we can assess the cultural dimensions of each patient’s experiences and let go of the false sense of security that stereotyping brings. The training of health care workers in both international and resource-limited settings encourages us to consider these very principles—cultural competence, relativism, sensitivity, and humility—as each is challenged in a clinical setting. The goal of these electives is to help our students begin a journey as active health care practitioners committed to a lifelong openness to learning, self-reflection, and self-critique.
In addition to influencing physicians early in their careers, global health programs can be transformational for senior and retired physicians by restoring a sense of empathy and purpose that can get lost in paperwork and bureaucracy. These programs can also help reinvigorate physicians dealing with burnout and can prevent the next generation of physicians from becoming burnt out in the first place.
At the Larner College of Medicine at the University of Vermont, we offer a six-week global health elective in five Global Health Program satellite sites—the Dominican Republic, Russia, Uganda, Vietnam, and Zimbabwe—to 12 carefully selected medical students at the beginning of their first year of medical school. When students return, their medical training is enriched via weekly global health meetings and monthly global health evenings featuring nationally renowned speakers. Then, as senior medical students, the students return to the satellite site where they studied during their first year. Our program is carefully designed to be longitudinal and consistent from day one. Trainees begin with exposure and, after a period of growth, learn how to give.
A well-designed global health elective challenges students’ beliefs and provides a unique opportunity for future doctors to become better equipped to manage disparities in health and society and serve as health equity advocates. After all, what is the role of a health care worker if not to advocate for equal care for all? We must build up the new generation of physicians to become leaders in global health, patient advocacy, and health equity.
This commentary was originally published at AAMCNews on March 7, 2017.