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Dara,
You are on point with Article 2. It was thought provoking and engaging. And I wonder, how many clinical teachers have had the chance to read it. I particularly appreciate your statement that “a student needs to hear that a provider doesn’t know what the problem/answer is.” Clearly, this would call for a good measure of humility from a clinical teacher, and I also wonder how many clinical teachers are willing to put on humility before their students. Again, thought provoking!
Gareth,
Perhaps, the UN can expand its Sustainable Goal 4 of Quality Education to include the training and development of professionals such as healthcare providers worldwide and particularly in low-resource communities where the needs are greatest. Currently, this goal only targets education for children. However, the children will grow up and be faced with the same pitfalls that the adults are currently facing if this issue is not addressed. Interestingly, the expansion of Goal 4 in a manner that involves the continuous training of healthcare providers in LMICs will help in achieving Goal 3, which is Good Health and Well-Being.
Question 2
The “Keep it Simple” habit of exemplary clinical teaching is translatable to education in LMIC (low and middle income) settings. The author recommends simplicity because it helps clinicians ensure their understanding of the complexity of their practice well enough to express it simply to both patients and clinical learners. And it helps teachers address a specific scenario by conveying general principles relevant to all situations similar to it. The “Keep it Simple” habit, according to the author, also allows effective clinical teachers recognize and translate complex clinical knowledge into a single simple decision – “do this, or do that”, and this is easily demonstrated for students. This habit is most useful and translatable to education in LMIC settings because clinical learners in such settings need the “boiled down” general principles to tackle a lot of the problems they will encounter with patients. Also this habit taught in LMIC settings will help clinical learners become practitioners who are able to communicate in clear terms with their patients. And when these learners become teachers in the future, they too will teach the next generation of clinical learners using the “concise and clear expressions” they were taught. This does not mean that they sacrifice the broad and complex clinical knowledge necessary for healthcare delivery, it just means they teach in a manner that is devoid of convolution.Question 1
A number of barriers exist to expansion of faculty development programming in LMIC (low and middle income) settings. These barriers are lack of funding; lack of partnerships and an academic community to foster such development. Most pressing is a lack of leadership to promote the development of faculty.
Dr. Burdick also mentions persistent dependency as well as variation in academic cultures and incentives as challenges towards the development effort. With such variation, matching international partnerships with local needs is problematic.
Some other challenges not mentioned by Dr. Burdick but also present as barriers to faculty development are the emigration of existing faculty in LMIC settings; infrequent curriculum review; inadequate training in various disciplines of education, particularly in medical education; poor investment in infrastructure; and lack of programs for faculty development [1]. The principle of using “pull” in these low-resource setting in efforts towards local capacity building to expand faculty development is judicious because it will ensure sustainability of programs created towards this effort.1. Matsika A, Nathoo K, Borok M, Mashaah T, Madya F, Connors S, Campbell T, Hakim JG. Role of Faculty Development Programs in Medical Education at the University of Zimbabwe College of Health Sciences, Zimbabwe. Ann Glob Health. 2018 Apr 30;84(1):183-189. doi: 10.29024/aogh.5. PMID: 30873802; PMCID: PMC6748263.
Becca,
You have beautifully tied the two discussion points for this week. Yes, community health workers could play a pivotal role in achieving effective universal health coverage. The question is why hasn’t this been the case? To find answers, I discovered a paper that listed reasons for the failure to integrate CHWs into health systems for the purpose of achieving universal health coverage. Reasons include: poor planning; multiple competing actors with little coordination; fragmented, disease-specific training; donor-driven management and funding; tenuous linkage with the health system; lack of supervision and support; and under-recognition of CHWs’ contribution [1]. If these challenges are seriously examined by health governing bodies like the WHO, then CHWs will then begin to play that pivotal role towards achieving universal health coverage.1. Tulenko K, Møgedal S, Afzal MM, Frymus D, Oshin A, Pate M, Quain E, Pinel A, Wynd S, Zodpey S. Community health workers for universal health-care coverage: from fragmentation to synergy. Bull World Health Organ. 2013 Nov 1;91(11):847-52. doi: 10.2471/BLT.13.118745. PMID: 24347709; PMCID: PMC3853952.
Gareth,
“Frontlines”, now that’s a good and more fitting term. Perhaps, another way to esteem the work of the community health workers is to view them as frontline healthcare providers – the first on the scene to provide care, and the last on the scene for follow-up. It may be a bit wordy, but Community Frontline Healthcare Providers is what I would like to call the CHWs. To me it demonstrates their importance as far as disease prevention, care intervention, and follow-up is concerned. They certainly would no longer be an afterthought in the minds of other community members when there is a clear understanding of the invaluable service provided by these frontline healthcare providers. Your idea of having a supervising physician from an urban area overseeing the work of the Community Frontline Healthcare Providers in the rural areas can go far in solving the problem of the lack of specialized medically-trained personnel in remote areas.Question 2:
Low-resource communities will make better use of community health workers if they first learn to recognize the worth and value of these workers. The article opens with the quote “community health workers are desperately needed globally but often still stand…at the fringes of the health system, undefined and unsupported and therefore unable to completely fulfill their potential”. This situation can only arise if low-resource communities do not know or value the worth of these workers. Perhaps, more help is needed from the outside, from the international health community. Let’s say, WHO’s Director General goes from one low-resource community to another for the sole purpose of praising these community health workers; such “pomp and fanfare” may help to elevate the status of these health workers. In succession, this will help others from the community attain a sense of the invaluable healthcare personnel they possess within their community.
I know education is often limited to community health workers to prevent them from leaving the community for better opportunities elsewhere. Perhaps, this line of thought in terms of limited education is sequestering these workers and keeping them at the fringes of the health system. If that philosophy were reexamined and changed to push for more education for these health workers, while at the same time offering them good incentives to remain within the community, they would stay and the investment would certainly induce a community to make better use of their community health workers.
Question 1
To begin to ensure proper universal health coverage in low and middle income countries, medical training in these countries needs a reboot. Before stating why that is necessary, one must understand that it would be difficult to change the nature and practice of the doctors who already have the qualifications and yet are not providing quality healthcare towards patients. Among the various reasons for why this is the case, the authors point out that the reasons for such poor quality health outcomes in patients is due to a lack of clinical knowledge in spite of the qualifications of a doctor. The authors also point out that the doctors may have the clinical knowledge but do not care enough to spend quality time with patients to make the right diagnoses and offer the right treatments.
Now for those doctors who simply lack clinical knowledge, but wish to offer quality care to patient, continuous education is needed. Along with education, a system of accountability must be instituted to ensure that these doctors are improving patient care. For the doctors who simply do not care, well, their license to practice medicine should be revoked, assuming there is a government authoritative body that cannot be bribed into turning a blind eye.
And now getting back to my idea of the reboot, the concept of Servant Leadership needs to be incorporated into medical training within these countries. This week, we are learning about Health Leadership; therefore talking about servant leadership is fitting. The Greenleaf Center for Servant Leadership defines the concept as “a non-traditional leadership philosophy, embedded in a set of behaviors and practices that place the primary emphasis on the wellbeing of those being served” [1]. At the start of medical training, an individual should be taught to examine their motives for wanting to serve as a medical doctor. The individual must be advised to honestly examine their character as a person. Do they have compassion for the poor and the sick or are they seeking the profession for prestige or money? Through the period of training assessment and feedback should be made to help the student engage in sincere self-appraisal for the vocation of medicine. In addition, the student must grow towards wholehearted commitment for continuous medical education all through their professional life. If the idea of Servant Leadership is applied in medical training, we may begin to see a change in universal health coverage in low and middle income countries.1. What is Servant leadership? Greenleaf CENTER FOR SERVANT LEADERSHIP
Accessed February 20, 2023.Abi,
It is interesting how the term “herd immunity” was almost non-existent prior to COVID-19. However, you are right concerning the fact that a generation of the unvaccinated can weaken herd immunity. Thereby possibly reintroducing diseases that were successfully eradicated in the past. Two examples cited in the article are the re-emergence of polio in Syria in 2013 and in Cameroon in 2014. Complex humanitarian emergencies, I believe, will always be a part of life. And so vigilance in vaccinations, and the increase in coverage in areas where these emergencies frequently occur is necessary to prevent disease outbreaks.
Becca,
I appreciate your honest revelation of healthcare providers wanting to be viewed as “all-knowing”, and how this consequently limits their capacity to be vulnerable. I wonder if this posture of coming across as “all-knowing” is discussed by professors during one’s medical training. Perhaps, if this is the case more healthcare providers may find it natural and okay to be vulnerable and honest about their limitations particularly as it applies to cross-cultural competencies. Nevertheless, I do not think it easy for one in a position of power to risk vulnerability of lack of knowledge even if that vulnerability pertains to interacting with a patient from an unfamiliar culture. Also, I wonder how many healthcare providers are intentional about continuing cross-cultural education post med. school via CMEs. If this also is the case, healthcare providers will certainly get to learn more and more of the nuances of patients’ cultures and how to handle delicate cultural matters. Good Post!
Question 2:
One key intervention that could go a long way in reducing the consequences of complex humanitarian emergencies is strengthening the capacities of geographical leading bodies in different regions of the world. The African Union (AU) is an example. This organizational body should have the capacity to intervene when countries within the continent of Africa are experiencing complex humanitarian emergencies. I do not believe this body is well equipped with such capacity. With the various emergencies plaguing the continent, the AU does not seem active and able enough to help. Perhaps, the UN, INGOs, and NGOs can help fortify this body so that it is able to provide governance, conflict resolution, and humanitarian aid when complex humanitarian emergencies occur across Africa.
Question 1:
Healthcare providers can take two actions that can decrease cross-cultural barriers. These are:
First – Intentionally engaging in Cultural Immersion activities
Second – Development of friendships with others from various cultures.
The definition of Cultural Immersion can be quite broad, but essentially it is “integrating oneself into other cultures, by interacting with others from those cultures.” Such interactions are very possible in cities with diverse populations. Take the city of Houston, which has been dubbed “one of the most diverse cities in the nation” for example. Houston, according to Greater Houston Partnership, “is home to many cultures, given that one in four are foreign-born and over 145 languages are spoken in the city, giving individuals various opportunities to immerse into different cultural backgrounds through ongoing events in the city” [1]. Events include EID parties, the Naija Beat Cultural festival, which celebrates the Nigerian culture, Houston Greek Fest, Texas Haitian Flag Day, Houston Luck of the Irish St Patrick’s Day, Houston Caribbean Festival etc.
Healthcare providers can organize and go in groups to attend such festivals where they can begin to interact and learn about other cultures in a fun way. Healthcare providers from those other cultures can serve as cultural ambassadors helping their colleagues learn what may be unfamiliar to them concerning the new culture.Actively seeking to develop friendships with others from various cultures can prove daunting at times. However, if one is open to repeatedly visiting festivals as those mentioned above, the likelihood of making a new friend in such cordial atmosphere is possible. These are both useful ways to overcome cross-cultural barriers.
Upcoming International Cultural Festivals in Houston. Greater Houston Partnership
https://www.houston.org/news/upcoming-international-cultural-festivals-houston. Accessed February 19, 2023Hello Taylor,
Question 1
Global nutrition indeed is a complex problem, one that may take several years to solve. I admire the ambition of the UN in tackling this problem as their 2nd SDG goal; although, some may not think that the goal is not ambitious enough given the time-schedule aimed at reaching the goal. My concern is that the SDGs will end like the MDGs, not fully met; I guess they have to start somewhere and persevere by continuing efforts on goals not yet met.Question 2
In addressing your response to the second question, I am in complete agreement with you as you state the following “War and conflict has always been a part of history and I don’t know if it will ever be something of the past.” As you know the UN, which was created at the end of the Second World War, has made it part of its ambitious goals to strive for Peace, Justice, and Strong Institutions – Goal 16. The bold description of the goal does not include the language of ending wars and preventing conflict. I guess the UN shares a bit of our sentiment that you so honestly express – “War and conflict has always been a part of history and I don’t know if it will ever be something of the past.” Perhaps, in some way the UN leaders feel the same way too. Well done!Question 2.
I imagine that the second article, if it were written four years from its published date of 2016, would read very differently. The disease COVID-19 would very likely be implicated as the foremost obstacle and burden that challenges global health. Some have suggested that there will be more pandemics like the one we have all witnessed. According to researchers from Duke’s Global Health Institute, statistics say large pandemics are more likely than we thought [1]. The report further states there is data, which shows that the risk of intense outbreaks is growing rapidly, and the probability of novel disease outbreaks will likely grow three-fold in the next few decades. For all our sakes, I hope the data is wrong. However, global preparedness, global surveillance, and global vigilance is required to prevent the next outbreak and pandemic. It is one major way to make progress in global health.
1. Statistics Say Large Pandemics Are More Likely Than We Thought. Duke Global Health Institute.
https://globalhealth.duke.edu/news/statistics-say-large-pandemics-are-more-likely-we-thought
Accessed February 12, 2023Question 1.
I believe two actions or interventions must be considered and employed to improve global nutrition.
The first is highlighted in the article and this has to do with water supply and sanitation. A number of infectious diseases that we have examined in the clinical portion of this course have pointed out how contaminated water supply and inadequate sanitation are a source of some of these diseases of poverty. When food products are washed and cooked using water from such contaminated water systems, the consumers are certainly at a high risk for infection, which takes away from what nutrition they could receive. Water supply and sanitation must be globally improved and subsequently global nutrition will be improved.The second action must involve Peacebuilding in order to prevent and resolve conflict across nations. It is no news that other than the loss of lives, conflicts destabilize the lives and livelihood of many. Among the many ills they face, refugees are subjected to malnutrition. Peacebuilding and all other forms of conflict resolution are very important and should be made part of interventions to improve global nutrition.