[Cecelia Baskett]

I agree with Mark, the second article was great. I enjoyed learning how to teach and the article helped me understand the pitfalls of my own education. I always blamed myself for not being the perfect student. It never occurred to me that my learning style and natural gifts were not appreciated or utilized. I would have loved hearing the senior residents and attending walk through the medical problem solving more. I felt that I was told what to do and left to figure it out fro myself. I remember asking for resources to teach me how to medical problem solve. No one had suggestions. I want my money back, lol.

[Cecelia Baskett]

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?

Faculty development is essential in providing quality care. Barriers to providing this program maybe lack of in-person training, lack of physician specialist, and lack of education resources. Although technology has changed the art of communication on the planet, in-person training still has several benefits. For example, learning to perform a good physical exam takes practice with timely feedback. There is also valuable in learning medicine alongside a specialist. They have so much insight to offer and challenges the learner to consider different complications and to improve. Lastly, low resource settings are low resource. The learner is at a major disadvantage without the availability of tests and imaging. Can the teacher help the learner when they practice at a level 3 Trauma center?

Inconvenient Truths About Effective Clinical Teaching. Lancet 2007

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?

Practicing in a low resource area is a challenge in its own right. I think the “thinking out loud” approach will help leaners overcome this challenge. When thinking of differential diagnoses and plans to investigate the possibilities, listening to a seasoned physician think through the obstacles to benefit the patient is priceless. It would improve the critical thinking of the learner.

I have had many concerns of the delivery of my medical education. So when I started practicing and teaching a NP, I was apprehensive. But one day, I sat down with the NP and worked through a DDX. Unknowingly I thought “out loud” reasoning back and forth about the evidence for and against each diagnosis. I also worked out the financial and time sensitive obstacles verbally. The NP told me that no one had ever taught her how to think through her DDX, only to order tests and wait for results.

[Cecelia Baskett]

I agree with Yaritza that health workers need to be supported by the healthcare system. One way to accomplish this would be for the Ministry of health to acknowledge the workers by campaign of focusing on the healthcare goals of the nation or WHO. Put them on the same team and promote the work of the health worker publicly. Also creating a health worker conference with guest speakers, door prizes, etc. Health workers are frontline. We should honor them.

[Cecelia Baskett]

Question #1:

According to the article, access to trained healthcare providers was the main disparity for developing nations. Finding and training motivated healthcare providers is one solution to improve UHC. Targeting high schools and colleges for potential workers would be beneficial. However, there needs to be some reward or compensation for those who are well trained and serving the very poor. Educated people from poor neighborhoods often do not return to serve their own community. Although there are shortages of well-trained healthcare professionals in Nigeria. There are hundreds of educated Nigerians living the American dream.

Question #2
While serving Rwanda on mission trips, I met with and taught many community health workers. They sacrificed their time and traveled long distances on foot to attend training. One worker, Francis, was the leading health worker and managed the group. He helped me train workers during the course of three mission trips. On my last trip to Rwanda, I learned that he stopped working as a health worker to pursue other employment to support his family. Health workers need and deserve compensation. They know the heartbeat of the community and are invaluable part of primary care in the poorest communities. The nation’s healthcare system should make promote and support the workers, giving them training, more responsibilities, and cell phones/paid plans for communication.

[Cecelia Baskett]

I agree with Wendy that crossing cultural barriers begins with awareness. Education is only part of the problem. My prayer is that recent racial conflicts within the US, will stir many into awareness. Doing nothing is not neutral, it’s part of the problem. Everyone has blind-spots and bias. Once awareness and willingness happen, then one can take steps to change the environment around them. This assumes that healthcare provider pursued medicine for patient-centered reasons.

[Cecelia Baskett]

Question # 1
I have thought about this topic in my own practice. Becoming culturally competent first begins with an awareness of one’s own potential blind spots and the willingness to go beyond what is expected to equalize health care access. In my opinion, learning to properly use interpreters, engaging others outside the workplace, and having health information/demographic questionaries available in different languages would decrease the barriers. The first and the third recommendations are mentioned in the article, but the second is not. There is value in spending time with others of a different culture. In my experience, engaging with the people I serve opens my eyes and heart to appreciate others, dispel stereotypes, and understand how best to serve them. Health care includes the word care.

Question #2
Complex humanitarian emergencies often cause hunger/thirst and illness on a mass scale. To mitigate these consequences would save thousands of lives. In my opinion, primary vaccinations already mentioned in the article, and clean water preparation would be very beneficial. Vaccinations are already a priority in many countries and a mandate should be considered. Since people die of thirst before starvation and drinking unclean water causes many diseases of poverty, clean water is a priority. Clean water plans are disaster management plans that would secure two days-worth of clean water in the event of an emergency. This water plan would be reviewed an acted upon yearly or seasonally. In addition, donations from other countries need to be monetary, so goods do not spoil or become waste.

[Cecelia Baskett]

I agree with Wendy that unregulated capitalism is a major obstacle in global health. Making money despite the consequences to the community is unethical. Nevertheless, no one makes another purchase fast food and the sweat shop workers may not have other opportunities for employment. I do not understand the effects of the unfair systems as a whole and it is easy to point the finger at an obvious contributor. But there are 4 fingers pointing back at us. What if we stop “buying in” to all the comforts our western citizenship affords? Be the change is overused, but it is true.

[Cecelia Baskett]

Question #1
The causes of food insecurity and starvation are multifactorial. Therefore, there is not a simple answer to the Sustainable Developmental Goals concerning nutrition. However, I think the most important actions to take involve feeding people now and in the future. While supply has improved, other factors have not. Droughts and civil war/militia conflicts incite most of the food problems in Africa. The most important actions to improve global nutrition is to stop the wars and have disaster management plans for vulnerable people groups. Stopping war is crucial and this responsibility falls on the current governments of the individual countries. Leaders must work together, prevent small groups from taking up arms and fighting. No war equals no displaced peoples. Secondly, natural disasters repeat in predictable locations. Leaders in the country need disaster and contingency plans in the event of emergencies. They also need to assess the risk and help the population become more resilient.

Question #2

With the improvement of infectious disease related deaths, the author mentioned the rise of NCD detection. The diseases of poverty are still a humungous problem; however, NCD’s have been on everyone’s radar in the developed nations. In my opinion, the greatest obstacles to progress in global health are war and processed foods. War and conflict create displaced people groups and rips apart infrastructure for all human services. Until war is overcome, people will suffer and die of diseases like malaria, pneumonia and malnutrition. Afghanistan and Syria are examples. Despite resources, war in Syria has decreased life expectancy. I also named processed foods as another obstacle. These monster creations are the largest contributor to obesity. Some nations had no obesity until western restaurants moved into their neighborhoods. It wide acceptance, convenience, and inexpensive cost make processed food almost impossible to avoid.

[Cecelia Baskett]

I agree with Marissa that the valuing women in society will increase the amount of women who seek healthcare. Male dominated societies not only impair women politically but also physically. Efforts to elevate the value of women in the home, community, and nation will help shift the traditional focus. Liberating women will help them see their own value and the need for wellness.

[Cecelia Baskett]

Question #1 WASH and nutrition promotion do complement one another.The article points out that integrated efforts may be cost-effective and beneficial for families who tend to see health, growth, and development as independent issues.
Promotion of both at the same time will help mothers understand the importance of each for the baby’s health and development. WASH and nutrition promotion are synergistic. Missing one intervention, will lead to illness that will affect the other. For example, it is easy to link between sickness due to improper hand washing and decreased nutrition. But, how will lack of nutrition lead to improper handwashing. Decreased nutrition causes weakness and mental impairment. The connectedness is not intuitive. Starving people maybe more concerned about food insecurity than hand-washing before and after every meal. This overly simplified but practical example strengthens the argument for combined interventions.

Question #2 Expanding healthcare during pregnancy for lifelong benefit is a good idea to help transition the healthcare model from a sick care to well care.Mindset change through education will increase awareness, bringing attention to health of women throughout life. This especially important in male dominated societies. It would also expand the scope of care for women by identifying most common female diseases and developing a strategy of education, screening, treatment.

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