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Hi Kathryn, I agree that trust can be a very large barrier when it comes to teaching. If your students aren’t willing to trust you, it doesn’t matter what you teach them because it will go in one ear and out the other.
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 the article, Dr. Burdick points out some of the biggest barriers in faculty development, such as alignment with local needs, avoiding persistent dependency, and development of trust. He also points out that underestimation of personal effort needed, variation in academic cultures and incentives, as well as limited resources all play a role in preventing the expansion of faculty development. I think the first step in developing faculty is to establish trust. You won’t get very far without the trust of the community. Whatever efforts you put into developing your program, they will fall short without the community accepting the program and backing its missions. Next, aligning those missions with the local needs and avoiding dependency go hand in hand. One of the needs of the community is the ability to be self-sustaining, and programs should focus on that.
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 think that all 8 of these habits of exemplary clinical teaching could be translatable to education in LMIC settings in one way or another. I believe that the best habits of teaching should apply to any teaching setting, whether that is a LMIC or a high income setting. One of the 8 habits that stood out to me was to keep it simple. Keeping clinical teaching simple in LMIC settings can help learners progress faster and feel more competent in what they are learning and their skills as a clinician. Keeping it simple could also be effective in LMIC settings where language or culture may be a barrier. An example of this comes from my education. In class, our professor was a wonderful clinician and provided us with all the details that we could have hoped for on a variety of diseases. Unfortunately this information was provided in a format that was disorganized. In learning the subject from a different professor, they began with the big picture and gave hints that link diseases into groups before diving into the details on each one. Keeping the organization simple made it much easier to comprehend the different diseases.
Hi Linabelle, I agree that community health workers should be better compensated for their work and receive better training. I really liked how you stated they need more opportunities to apply their training as well. I think that application of knowledge would be extremely beneficial to them. Through applying their knowledge in a controlled environment under supervision, they can learn and turn their knowledge into wisdom.
Question 1: What additional elements would be necessary for universal health coverage to be effective?
I think the first step in universal health coverage requires that we have a clearly defined standard of care that must be met to achieve it. In the article, it states that “…translating healthcare into health outcomes requires that services meet some basic standard of quality.” It fails to mention what this basic standard is and goes on to say that it was assumed that well trained doctors and nurses in places with good infrastructure would be good enough. This assumption appears to be false. For universal health coverage to be effective, there should be universal standards. There should also be universal teaching standards and competency requirements for physician and non-physician workers. Implementing these could help to improve the quality of healthcare people receive.
Question 2: How could low-resource communities better make use of community health workers?
I think that community health workers could be more effective with better training, improved access to resources used in treating and preventing common community health problems, and a leader to help them direct their efforts. Better training would likely help the workers to handle a broader variety of situations, and handle common problems more effectively and efficiently. A leader for the workers would help them understand the ways in which they could improve their practices in the communities and address more problems effectively.
Hi Ally, I really like what you have said about bias. I think it is extremely important to do our best to recognize our own biases and how they affect the care we provide to our patients. Then with that knowledge, we can work towards overcoming those biases, or at least limiting their effects
Question 1: What actions can healthcare providers take to decrease cross-cultural barriers?
Learning about cultures in general and the behaviors and customs of each will help to reduce cross-cultural barriers. Learning opportunities can be cultural competency training like discussed in the article, or it can be as simple as seeking out a Youtube video on a culture, preferably from one who is a part of that culture and/or from a reliable source. Another way to reduce cross-cultural barriers is by having well trained interpreters. I had an experience where a native Spanish speaker was required to do multiple rounds of pulmonary function testing because they weren’t able to adequately complete the test. After their 3rd doctor visit, an interpreter was provided for them and they passed their pulmonary function test easily because they understood what they were supposed to do during the test. Had an interpreter been provided earlier, they would have been able to receive treatment for their condition sooner, and they wouldn’t have had to endure the economic hardship placed on them due to the cost of 3 doctor visits and 3 missed days of work.
Question 2: What prevention interventions could best help reduce consequences of complex humanitarian emergencies?
From the article, it states that outbreaks are more likely to occur in complex humanitarian emergencies. It also states that outbreaks that are associated with complex emergencies are more likely to be vaccine preventable diseases. Thus, one of the most effective prevention interventions is to vaccinate. Teaching those most likely to be affected by complex emergencies about the importance of vaccines could help limit the number of people who refuse or are ignorant of vaccinations. Tracking vaccination status is also important and if tracking is improved, it could increase rates of vaccination and may help us understand why certain groups remain unvaccinated. Partnering with organizations, churches, and governments could also improve vaccination rates.
Hi Abanda, I agree with you that empowering women improves nutrition, among many other beneficial effects. It is something that is often not thought about when discussing nutrition, but empowering and educating women and reducing gender inequalities can go a long way in improving all aspects of health within a population.
Question 1: What actions are most important to improve global nutrition?
I think that bringing attention to nutrition and the impact that good nutrition can have on the lives of people, especially mothers and children, is one of the biggest actions we can take. Helping others to understand how malnutrition plays a role in the world’s top causes of DALYs lost may inspire nations to improve their policies regarding nutrition. America and many other developed countries tend to focus more on the disease and how to treat it, rather than measurements (such as nutrition) that can be taken to prevent disease in the first place. That stance is slowly changing, but efforts to educate politicians and those in leadership roles could help speed up the process.
Question 2: In your opinion, what are today’s greatest obstacles to progress in global health?
I think the pandemic brought unprecedented challenges and obstacles to global health. The Human Development Index for most countries has decreased over the past 2 years, and, as usual, is worse in developing countries with high levels of poverty. This is likely caused by a combination of things, such as supply chain disruption, lockdowns, life expectancy decreasing due to the virus, loss of trade, and disruption of education and the workplace. Another big obstacle to progress in global health is war. War has many of the same effects as discussed with the pandemic. Supply chain disruption, especially medical supply chains, are oftentimes disrupted in conflict zones. Poor living conditions in these areas make diseases and outbreaks much more likely. At the same time, it is difficult to track these diseases and outbreaks that occur in these areas. People can also be displaced from their homes, leading to loss of work, not being able to receive the food they need, and becoming victims of war or refugees in a new country, which as we learned this week leads them to becoming part of the forgotten people.
Luc, I agree with what you said about continuing through school during puberty having better outcomes than getting married and having children. I also think that education is extremely important when it comes to women’s sexual health. Education is one of the most important ways that women can become empowered and have control over family planning.
Question 1: What is the mechanism, in your opinion, through which WASH and promotion of nutrition complement one another?
Having access to water, sanitation, and handwashing works together with nutrition to promote health. Without clean water, sanitation, and handwashing, infections become more common. If someone is infected, they are likely not gaining the adequate nutrition that they need. Certain infections have a dramatic effect on the nutritional status of an individual, such as bacteria that cause frequent diarrhea or parasites that steal nutrition from their host. Also, clean access to water, sanitation, and handwashing leads to better living conditions. A person who doesn’t have to focus on difficult methods of obtaining water, or paying for clean water, can focus on other aspects of their life, like work and education. By increasing these areas, they will likely have a greater understanding of the importance of nutrition and may have the income necessary to purchase those foods with the nutrients they need.
Question 2: In your opinion, how should maternal healthcare be best expanded to protect women throughout their lives?
From the article listed, we read that “the current global health use of maternal health concentrates attention to a narrow period of women’s lives—pregnancy, childbirth, and 6 weeks’ postpartum.” These are certainly important times to focus on but as it says in the article, this is a narrow view. The care provided during this time is important, but often comes too late. I think the brief video we watched about the girl effect had the best mindset to solve this problem: focusing on adolescent females. I think this focus would be the best way to expand healthcare for women. By reaching adolescent girls before they are married, become pregnant, and/or become involved in prostitution, we can improve health outcomes for their entire lives. If we empower adolescent females with knowledge on how to avoid these situations and emphasize the importance of staying in school to improve education, then they can make the decisions for themselves on when these important events in life should be occurring.
Hi Lois,
I agree that stigma plays a big part in preventing HIV infections. Like you said, whatever methods we have at our disposal, it won’t do us any good if our patients aren’t willing to use them. The perpetual nature of testing and treatment also makes it difficult for patients who suffer from the stigma surrounding HIV, as they could end up revealing to friends, family, or their community that they have HIV each time they go in for testing or when they take their medications.
Question #1: From your perspective, what are the largest remaining barriers against worldwide HIV control?
One of the largest barriers to HIV control is the stigma surrounding the disease. This can lead to a great deal of hesitancy for those who are at risk for HIV infection. Many people at risk do not want to go to a clinic and be diagnosed with HIV and take medication for fear of the repercussions. These repercussions could be bullying by peers, exclusions from groups, social isolation, being fired from jobs, or even violence, especially against women.
Question #2: Why, in your judgment, is pediatric HIV control lagging behind that of adults and what should be undertaken to reverse this status?
Women are at higher risk for HIV infection due to violence against them, social and economic circumstances that limit the power and control they have over their situations, and being forced into prostitution or choosing to engage in prostitution because they need the money. These women with HIV then have a high chance of passing on HIV to their children during delivery or while breastfeeding if untreated. The vast majority of new HIV infections in children is due to maternal transmission. Thus, if we are to treat the pediatric HIV population, we need to treat the maternal HIV population. Better education on the risks of transmission during delivery and while breastfeeding could help to limit new cases of children with HIV. Empowering women to have more control over their financial and sexual situations would help limit spread as well. Providing alternative jobs that pay well for women, especially those who engage in prostitution, as well as preventing sex-trafficking would also help to prevent spread.
Hi Lucio, I agree with all of the points you made in discussing health policies regarding TB. It is so important to reduce poverty and malnutrition and improve living and working conditions. Carrying out these actions would reduce TB, but these actions are also the answer to reducing many other diseases as well.
Question #1: From your perspective, why are people living in poverty most likely to suffer from TB, and how should this fact influence efforts to control the disease?
Living in poverty increases the likelihood of contracting TB through overcrowding and increased susceptibility to armed conflict. Malnutrition is prevalent among those living in poverty and can also play a role in reactivation of TB. Living in poverty also increases the likelihood of contracting HIV, which can cause immunosuppression and subsequently increases TB rates of infection and severity of disease. Getting sick with TB can also exacerbate the effects of poverty due to being unable to work and medical costs. Effective drug therapy is also difficult among those living in poverty. The current regimen is taking 4 drugs for 2 months, then 2 drugs for 4 months. The long duration of treatment, multiple medications, and multiple side effects from each medication are likely contributors to poor treatment adherence. Poor treatment adherence in communities with high levels of poverty leads to those same communities being introduced to new strains of TB that are drug resistant. Taking these considerations into account, it would be wise to focus on improving health systems overall, education on prevention of HIV and TB, performing DOTS strategy, and research into better TB diagnostic tests and HIV and TB treatments.
Question #2: What, in your opinion, are two interventions that would be most effective against neglected tropical diseases?
It might not be a specific intervention, but I think an eclectic approach to all facets of a nation (not just healthcare) would be most effective. As an osteopath, we are encouraged to look at multiple aspects of health (body, mind, and spirit) and how they all work together to promote health in an individual. I think this approach would work the same on a national level. If we only focus on health interventions, we would still likely see progress but it may not be as effective as if we had focused on health, economics, trade, politics, infrastructure, etc. In an ideal situation, improving all of these systems simultaneously would help reduce poverty and, by extension, reduce the impact of NTDs. Another effective intervention would be identifying and treating outbreaks of NTDs as soon as they occur.
Hi Reese, I definitely agree that misinformation is a huge barrier to measles vaccinations, as well as other vaccines. During the last year that the COVID-19 vaccines have been available, we have seen an incredible amount of misinformation surface. Through social media platforms, it has never been easier to share information with others, whether accurate or not. I agree that underserved communities are predominantly affected by misinformation. That’s not to say others aren’t as well though. I have many well-educated family members (some of which are even in healthcare) that no longer trust doctors and/or vaccinations due to this misinformation. Education and empathy will be key to overcoming misinformation and distrust in all populations.