[Autumn Graves]

Taylor Manes, I absolutely agree that active learning is critical in an educational environment. It is important that we engage in educational material on a personal level so the knowledge we are seeking is better incorporated into our lives. For example, simple reading will only get us so far, but drawing, daily practice, teaching a small group, or applying a new lesson into our everyday lives will take our education so much further that will last us a lifetime.

[Autumn Graves]

Question #1: Dr. Burdick describes qualities of effective programming and global collaboration. What barriers exist to expansion of faculty development programming in LMIC (low and middle income) settings?
In my opinion the availability of funding governs the expansion of faculty education, knowledge, and connections. Especially in Low and middle income settings, funding might be more difficult to achieve due to lack of connections, marketing, and access to specific research resources. Although long term goals for education are important, more hands-on clinical patient care might be more prioritized over working within an academic setting as the needs of a community determines the work available for a professional.

Question #2: Which habit of exemplary clinical teaching is translatable to education in LMIC (low and middle income) settings? Can you provide an example of effective implementation from your own experience?
I feel like the greatest way to display exemplary teaching is to be open to new ideas while also balancing traditional knowledge. Many a times I have encountered physicians or other health professionals that immediately close off a patient’s concerns simply because they are not “textbook” – however, I have also encountered physicians who thoughtfully inquire and listen to their patient’s needs even though their diagnosis might not be a simple path or if the clinic where they work does not have access to certain labs or imaging modalities. I think being open to new treatments, ideas, and differential diagnoses is important to be both a successful teacher and learner.

[Autumn Graves]

Alice, I agree with you in regards for the need for border health here along Mexico and the U.S. – these particular groups of people are some of the most marginalized in our country, and it is so important that we as Hippocratic-oath-swearing health professionals implement and advocate for protocols to provide care to these individuals who are so often overlooked by our society. I also agree that vaccination programs are critical as we are embarking into a 21st century era where there is either misinformation or inaccessibility to such immunizations, and it is important that we provide both education and resources to promote this preventative health measure.

[Autumn Graves]

Question 1: What additional elements would be necessary for universal health coverage to be effective?
Within the article it concludes that “reaching the goal of UHC requires not just more money, but better money” and I could not agree more. Many people focus on the accessibility of healthcare, which is indeed a good thing, but in many lower and middle income countries there are patterns at play that display a much more complicated system that has performed healthcare poorly. We have discussed how curative care is more appealing to professionals than primary care systems, and I feel like a great way to make UHC more effective is to provide incentive programs that encourage international public health workers to not only do their job, but to do their job well. Education for example is taught very differently in every region, but perhaps incentivizing higher pay raises for workers who enroll in continuing education programs is a great way to motivate those to enhance their knowledge base and skill set. Also incentivizing workers by paying them for minutes engaged with their patients is more important and a better idea than them receiving profit from unnecessary lab tests, exams, treatments, and prescriptions. It shocks me how little time is spent with patients each day in the countries listed in the article, and it is imperative that we set accountability and financially motivating programs for healthcare workers to work for their patients in a patient-centered way.

Question 2:What is the most appropriate role for community health workers in your particular community of interest?
Currently Central America especially Nicaragua are being impacted by the devastation of Hurricane Iota. Nicaragua and many other surrounding regions have had consistent battles with infectious diseases like gastroenteritis and other digestive tract related diseases. I feel like in this current moment community health workers are critical right now in terms of providing both disaster preparedness education/guidance if a landslide or hurricane impacts a community, as well as promoting cleanliness when using water sources, food, and daily working activities like farming. For example, a week before a predicted hurricane hits, community health workers can provide guidance for others on where to relocate for temporary housing relief and distribute items like nonperishable food items, water bottles, flashlights, soap for cleanliness, water purification tablets for drinking, and more to the neighboring families who need preventative measures to keep their people safe.

[Autumn Graves]

Casey I too agree with how mainstream media highlights disasters in a “reactive” way instead of taking the “proactive” measures necessary to promote a healthy environment for the long haul. I feel like if there was more funding devoted to displaying the need for disaster prevention over response then more prevention measures could be better implemented.

[Autumn Graves]

Question 1: What prevention interventions could best help reduce consequences of complex humanitarian emergencies?
Vaccinations in my opinion are great for preventing a multitude of infectious disease – education on how vaccines are safe and how they work is critical for a community to widely accept this prevention measure in order to significantly diminish the likelihood of viral disease spread. Education on hygienic measures and practices of water and food cleanliness also equally create an impact to decrease pathogenic spread. However, vaccinations need to be administered in a way that is widely accessible for all in order to prevent an epidemiological emergency.

Question 2: Why, in your opinion, is disaster prevention minimized in comparison with disaster response?
When an emergent disaster such as a major hurricane impacts a region, the news and social media do not hesitate to highlight the devastation. This promotes a high demand for emergent relief and organizations and nonprofits race to the scene to help and provide supplies and care. Unfortunately disaster prevention is not as “thrilling” per-se in comparison, and more efforts need to be made in order to create sustainable measures to promote long-term care for communities before a disaster occurs in the first place.

[Autumn Graves]

Nicole, I love that you said to “make connections that you can bring back to the U.S” after returning from a short-term trip. I remember feeling some imposter syndrome after leaving my service-learning project in Costa Rica to fight against sex-trafficking. I was volunteering with a local nonprofit called “Face of Justice”, but because I did not come to Costa Rica with supplies, medical skills, or language fluency, I felt as if I made very little impact during my three months living there even though I learned so much. However, I remember when returning back to the states that people back home had little to no knowledge about the extensiveness of how bad sex-trafficking is in the world. I remember one woman in my hometown to told me, “We are so blessed that sex-trafficking does not happen in the United States even though it happens back *there* where you went”. That really stuck with me and upset me, so following that encounter I decided to start a blog for a few months to educate my friends, family, and Costa Rican friends whom I met from my trip about the realities of sex-trafficking, how to spot it in everyday situations, and how to support victims who feel helpless or ashamed. I felt like that made an impact no matter how small within my own community following my trip return.

[Autumn Graves]

Question 1: What actions can healthcare providers take to decrease cross-cultural barriers?
I think learning a foreign language is overlooked, yet it can vastly impact many patients’ lives whom we will encounter. I remember seeing both positive and negative aspects in physicians when shadowing years ago. I remember one physician who allowed the patient’s granddaughter to be the translator, and I noticed the patient felt left out from her own care because the physician told a joke and only the translating granddaughter understood and failed to translate in Arabic back to the patient, so the patient thought the physician was laughing at her. Had the physician used better nonverbal communication skills or sought a professional Arabic translator, this unfortunate encounter could have been prevented. I also recall a wonderful encounter with a physician who calmed a Spanish-speaking patient by telling him he did not need to undergo surgery and it provided him much relief, for had he needed surgery he might have lost his job following recovery as he was a migrant farmworker who worked long days. This physician told me before his medical training he decided to live in Spain for a year in order to not only learn the language, but also understand their religious and cultural beliefs and behaviors. Thus, I feel like healthcare providers should take the time to research and delve into learning about any new patient they encounter if they are of a culture that they are not familiar with. If one is unable to speak the same language the patient is speaking, I think being aware of one’s own nonverbal cues are imperative or the patient might have a negative experience when receiving care.
Question 2: Describe how short-term healthcare trips came become more effective.
Many short-term healthcare trips can unfortunately show signs of “voluntourism” – a gray area of servitude that outwardly is a kind gesture but actually is an unsustainable and even damaging endeavor even though that is not the intention of the health professional. What we can do better is to ensure that if a health professional is on a short-term trip, we can help educate and train workers who live in the region to be equipped for professional work. An example could be to teach young women to become midwives or doulas for their community – this allows for consistent care to be performed even after a visiting professional leaves, while also providing those in the community sustainable good paying jobs. Another important thing we can do is bring or raise funds for equipment, supplies, or inventories of pharmaceuticals that can last long term for a community. Lastly, I think it is critical that a visiting professional becomes familiar with not only the culture and language of the country, but that they also look into working with community leaders in building better policies that promote healthcare extension for uninsured individuals and people.

[Autumn Graves]

Taylor, I find it interesting that you brought up that poor communication between a governing body and its people is a huge determinant of global health as it is so true yet so overlooked. I think many times us future health professionals forget to see the bigger picture in that providing medical treatments alone will not resolve poor health outcomes in the global community. Instead, we should also be mindful to consider how we can promote policies or advocate for resolutions in a region to encourage politicians to be educated on what their people need most, while also educating communities on what their governing body can do for them.

[Autumn Graves]

Question 1: What actions are most important to improve global nutrition?
Many people either might not be educated on the matter of nutrition, and even if they do, they might have poor accessibility to said nutrition. For example, food deserts exist in urbanized areas where access to nourishing, wholesome ingredients to produce healthy meals is not widely available. I feel like minimizing the barriers to gain accessibility to good food is critical for health and wellness. If the economic infrastructure or businesses in certain regions cannot provide better access, then educating and empowering families to grow and cultivate their own food is a wonderful sustainable practice that lasts long term – small independent farm plots and individual livestock ownership is something that not only can feed one family, but can also be shared to others, which creates a lasting impact to nourish a community.

Question 2: In your opinion, what are today’s greatest obstacles to progress in global health?
I think the greatest obstacle to progress in global health is extreme poverty – poverty creates a social barrier that is both isolating and enforces a loss of human privileges such as access to transportation, technology and communication, or ability to attain healthy meals. This isolation due to poverty can spiral into difficulty finding a job, struggling with substance abuse and alcoholism, increases stress levels and leaves one with poor mental health, and predisposes many to acquiring infectious diseases. Poverty all around results in a poor quality of life, and providing routes of escape from extreme poverty such as enrollment in school, rehab services, and infection prevention services are critical in reducing this debilitating lifestyle.

[Autumn Graves]

Emma, I agree with you that skilled healthcare workers are not always available and thus it is crucial that educational programs for those such as midwives and community members are accessible and affordable. Building up educational programs is one of those endeavors that makes a sustainable, lasting change in communities – simple education on how to resuscitate a newborn, infant or child could help so many families around the world and prevent the newborn mortality rate we still unfortunately see today.

[Autumn Graves]

Question 1: What actions should be taken, in your view, to increase availability of basic newborn resuscitation in low-resource communities?
I think that educational programs are critical to increase newborn resuscitation rates in these types of poorer socioeconomic regions – it is important that people understand that the first few hours and days of a newborn’s life is a critical period where the baby learns to get a pattern of breathing and difficulties or breathing inabilities can arise. Education leads to preparation, which can lead to prevention of infant mortality due to breathing issues following their birth. I believe this is even more especially important for midwives who do home-births to seek more education on resuscitation preparedness as not being in the clinic setting can pose a greater threat to the baby.

Question 2: What is the mechanism, in your opinion, through which WASH and promotion of nutrition complement one another?
Hygiene and sanitation are critical for all of us in everyday life, but in certain regions there might be a certain tropical disease that infiltrates and affects a community more significantly than another. This can pose a great threat to how one cleans and prepares meals – it is so imperative that we educate those in these communities proper cleansing and cooking meals, and boiling or purifying water to prevent gastrointestinal infections like cholera for example. Secondly, a solid, good nutritional foundation promotes thriving immunity – thus nutritional endeavors and WASH programs are critical in helping younger growing patients to grow strong.

[Autumn Graves]

Nicole, I think you are absolutely right about how saddening genital mutilation still exists due to lack of education and resources on this matter. It is so crucial that we not only educate young women but also empower them to be confident in their bodies and being equipped to seek help themselves whenever they need healthcare assistance. It is so difficult meeting the needs of communities where a cultural norm like FGM is detrimentally affecting these young female patients yet they also accept is as the normal thing to do – thus it is up to health professionals and government officials to not only ban genital mutilation but also to tend to the women at an educational level, while also providing lifelong and consistent care to the women who have already sadly have had to succumb to such procedures.

[Autumn Graves]

Question 1: What do you believe are the most direct impacts of conflict upon the health of pregnant women?
Becoming pregnant is life-changing both physically and emotionally on the mother. Not only is her body experiencing many changes, but also family infrastructure changes, the mother-to-be slowly grows to learn about her newfound responsibility as she prepares for her child, and others in her workplace and environment might interact with her differently as well. I think the biggest conflict to the health of pregnant women is continuity of care, especially in mental health. Becoming a mother can be overwhelming to the point that it prevents women from seeking care – difficulty finding time between work, seeking funds for care, getting transportation, and more can put any awaiting mother in a state of fear and worry to the point that they will be unprepared for their delivery. I feel like it is imperative that building that initial rapport with a new expecting maternal patient as well as providing services that meet them where it is more convenient for them to reach health professionals is key. For example, having a community health worker on-site within a village community that is trained to not only screen and exam patients, but also provide mental health aid and counseling for women is a person who is much more reachable to an expectant mother than a person working in a city hospital that requires lengthly transportation and costs.
Question 2: In your opinion, how should maternal healthcare be best expanded to protect women throughout their lives?
Education is a powerful tool, and unfortunately many women today are refused equal access to education and learning experiences in comparison to their male counterparts. Maternal healthcare could very certainly be expanded into lifelong care for women throughout the entirety of their lives through better education to equip and empower communities that women should be treated and cared for as an equal priority – why should a woman receive attention only when there is a baby involved? This issue can be problematic and complex as there are many cultures today where women are believed to be lesser-than. Thus, it is up to healthcare professionals to ensure that they provide education to woman of all ages, including non-childbearing ages, about their health and the resources that can be provided to these women. Annual visits that check on not only women’s physical health but also screen for history of domestic violence and abuse are critical and can aid women in seeking the care they need and deserve.

[Autumn Graves]

Alice, I found your perspective in regards to considering the mental health of HIV patients very interesting – it is so very true that mental health gets overlooked when there are so many other priorities to prevent spread and continually provide treatment for a patient. Patients can experience side effects with ART, experience frustrations in their sexual and social lives, may experience judgment in the workplace or if they want to start a family, and feel overwhelmed having to undergo lifelong treatment to suppress their disease progression. I think counseling, lifelong continuity of care, therapeutic patient group sessions, and more should be normalized to those specifically suffering with HIV as this can help them prioritize their mental health. I strongly believe that if mental health goes unchecked, patients will have a negative approach to their care and treatment, and this can unfortunately exacerbate spread and mortality.

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