[Jasmine Jorden]

Ro, you’ve identified critical barriers to faculty development in LMIC settings, especially the financial constraints and the shortage of qualified faculty. These challenges undeniably hinder the growth and effectiveness of educational programs. Addressing these issues requires strategic investment and innovative solutions to optimize available resources and develop faculty capabilities. Regarding exemplary clinical teaching habits, I agree that thinking out loud is highly translatable. This approach fosters a deeper understanding and helps learners grasp the rationale behind clinical decisions. In my own experience, having professors walk through their thought processes has also significantly enhanced my clinical skills. It’s a powerful teaching method that could greatly benefit LMIC settings.

[Jasmine Jorden]

Question #1: What barriers exist to expansion of faculty development programming in LMIC (low and middle income) settings?

Barriers to expanding faculty development programming in LMIC settings include limited financial resources, insufficient infrastructure, and lack of local expertise. In particular, political instability and changes in government can disrupt ongoing programs and funding, as seen with the closure of the Brazil FAIMER Regional Institute in 2017 due to a government change and loss of funding. Additionally, there is often a reliance on Western educational models, which may not be fully applicable or effective in different cultural contexts. An interesting barrier that the article discusses is the pervasive neocolonialism in global partnerships, which necessitates ongoing honest dialogue to maintain mutually respectful relationships. This barrier highlights the importance of culturally adapting programs to meet local needs and ensuring bidirectional learning.

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?

One translatable habit of exemplary clinical teaching to LMIC settings is “thinking out loud.” This habit involves the teacher making their clinical reasoning process transparent to learners, which helps them understand the general framework for solving clinical problems. I often find that thinking out loud helps concepts to be better understood by both the learner and the teacher. An example of effective implementation from my life is when I worked in study groups with my fellow medical students. Each of us would consistently verbalize our thought process for various topics while solving practice questions. This not only improved my reasoning skills but also encouraged us to ask questions and engage deeply with the material. Implementing this habit in LMIC settings can foster a deeper understanding of clinical reasoning despite resource limitations, making it a valuable teaching strategy.

[Jasmine Jorden]

Question 1: What additional elements would be necessary for universal health coverage to be effective?

I believe that the article discuss a few ways for this but there were 2 that I particularly liked. First, community participation and engagement (CPE) is needed. By involving community members in healthcare decisions, educators ensure that services are culturally sensitive and tailored to the community’s needs. This approach builds trust and improves health outcomes, as demonstrated in Nepal’s female community health volunteer program, which became integral to their healthcare system. Also, there is a need to address the healthcare inequities. Focusing on equity ensures that all community members have access to healthcare services regardless of socioeconomic status. Implementing policies that promote equitable access can mitigate disparities and foster a more inclusive healthcare environment. These strategies will not only enhance the effectiveness of healthcare delivery but also ensure that it is respectful and responsive to the cultural contexts of diverse populations.

Question 2: What actions could improve community health workers career prospects?

Improving community health workers’ (CHWs) career prospects can be achieved by first enhancing training and professional development. Providing CHWs with ongoing education and training opportunities ensures they remain current with medical advancements and improves their service delivery. This approach not only boosts their confidence and skills but also enhances their career mobility and job satisfaction. Next, incorporating a formal recognition and integration process. Recognizing CHWs as essential components of the health workforce by formalizing their roles and integrating them into national health systems can enhance their career prospects. This recognition often comes with better job security, benefits, and career advancement opportunities. Throughout my time in the military, these two things were implemented at every base; especially for our civilian employees. It helped improved work performance, security, and enhanced buy in from the employees.

[Jasmine Jorden]

Pho,

Thank you for your thoughtful responses. You had two interesting points from your discussion that I wanted to highlight:

You emphasize the importance of strengthening food systems to enhance food security and improve nutrition. This approach not only combats malnutrition and diet-related diseases but also promotes overall health by ensuring access to essential nutrients. Additionally, you highlight the broader socioeconomic benefits, such as creating employment opportunities, boosting local economies, and increasing resilience to crises, which can lead to a stable food supply and consistent nutritional intake. I believe this to be very important. Additionally, your observation that NCDs are the greatest obstacle to global health progress is particularly insightful. The chronic nature of NCDs strains healthcare systems, leading to prolonged illness and disability. You also point out the substantial economic burden, including both direct medical costs and indirect costs like lost productivity. Moreover, you highlight how NCDs disproportionately affect vulnerable populations, exacerbating health inequities due to limited access to healthcare and resources. This underscores the need for targeted interventions to address these disparities. Both points reflect a comprehensive understanding of the multifaceted challenges and potential solutions in global health and nutrition.

[Jasmine Jorden]

Charity,

Thank you for sharing your insightful response. Two interesting points stand out from your discussion:

– Team-Building Workshops and Activities
The concept of integrating team-building exercises into new hire orientations and ongoing training is intriguing. I believe that these activities could create a dynamic environment for open dialogues about cultural challenges and experiences. Your example of the Spanish-speaking housekeeper training an English-speaking colleague highlights the practical benefits of such interactions, demonstrating that team-building can foster communication and cooperation despite language barriers.

– Continuity of Care for Refugees
Your experience with the Afghan refugee patient in Columbia, Missouri, underscores the importance of maintaining continuity of care for displaced individuals. The suggestion to explore telehealth volunteers as a means to provide ongoing support regardless of location is innovative. This approach could ensure that patients receive consistent care, reduce the risk of missed follow-up appointments, and help manage medical records effectively across multiple regions.

Both points emphasize practical, innovative solutions to complex issues, enhancing cultural competence and improving healthcare outcomes in challenging situations.

[Jasmine Jorden]

Question 1 Response:
Healthcare educators can take several actions to help learners reduce cross-cultural barriers:

Encouraging learners to engage in reflexivity and critical reflection can create new knowledge and promote cultural competence. This process involves continuously reflecting on personal biases, power structures, and the impact of these elements on healthcare delivery. Skilled facilitation of safe discussion is also crucial to create safe spaces for discussing power, equality, and inclusion. Educators should model cultural competence and help learners become comfortable with discomfort, allowing for deeper exploration and understanding of complex cultural issues. Applied learning, including real-world encounters with diverse cultures, social group learning, and integrating cultural competence throughout the curriculum, is essential. This holistic approach moves beyond theoretical knowledge to foster attitudinal shifts and behavioral changes, essential for sustainable cultural competence.

Question 2 Response:
To reduce the consequences of complex humanitarian emergencies resulting from wars, prevention interventions should focus on the following three main areas:

Improve Surveillance and Early Warning Systems by establishing or adapting current systems for the surveillance and early warning of emerging and re-emerging infectious diseases (EIDs/REIDs). This would be critical. These systems must be flexible, able to function under various conditions, and include enhanced laboratory services, such as mobile and field laboratories, for rapid disease diagnosis and monitoring. Additionally, ensuring access to safe drinking water, sanitation, and hygiene (WASH) is essential. Implementing basic sanitation facilities and regular disposal of waste can significantly reduce the risk of disease outbreaks in post-disaster settings. Vector and rodent control measures should also be planned and executed, especially around temporary shelters for displaced populations, Finally, creating a comprehensive national action plan that includes risk assessment, roles and responsibilities of each sector, and a coordination mechanism is vital. Local action plans should consider specific epidemiological conditions, response capacities, and additional needs. Coordination with NGOs and international agencies can enhance these efforts by providing necessary resources and support.

[Jasmine Jorden]

Question 1: What actions are most important to improve global nutrition?

The article talks about various ways to improve global nutrition but I will focus on the ones I think will have a significant impact. To improve global nutrition, I believe that the 3 following actions are most important, as highlighted in the article.

1. Focus on Healthy Diets and Food Systems: The article stresses the importance of promoting diets that prevent both undernutrition and diet-related chronic diseases. I really appreciate how is addresses the contradictory advice on healthy diets, and ensures clear and evidence-based guidelines are available.

2. Address Micronutrient Deficiencies: The article emphasize the importance of essential nutrients such as choline, NAD-replenishing nutrients, and xanthophyll carotenoids. In order to appropriately address the deficiencies there should be a plan to implement public health measures throughout the community. This will ensure adequate intake of these nutrients, especially for vulnerable groups like preschool children and women of reproductive age.

3. Implement Effective Public Health Policies: I believe that by creating policies that transform agriculture and trade a country can ensure access to nutritious food for its people. Additionally, it would be beneficial for the government systems to protect and promote policies that support universal healthcare and effective social protection to address malnutrition.

By addressing these key areas, the global community can make significant strides in improving nutrition and health outcomes for populations worldwide.

Question 2: In your opinion, what are today’s greatest obstacles to progress in global health?

I believe that today’s greatest obstacles to progress in global health include the following key issues:

1. Inadequate Funding and Resource Allocation: Many global health initiatives and programs, particularly those targeting infectious diseases such as HIV/AIDS and tuberculosis, require substantial funding. Despite the immense need, high-income countries have been reducing their funding for these initiatives, posing a significant challenge to achieving global health goals such as ending HIV/AIDS as a public health threat by 2030. Without adequate funding, the battle against these diseases will be uphill.

2. Non-communicable Diseases (NCDs): The rise of NCDs, such as cardiovascular diseases, diabetes, and mental health disorders, presents a growing challenge. These conditions now represent a significant portion of the global disease burden as referenced in the article, especially in low- and middle-income countries, where there is often limited access to effective treatments and preventive measures already.

3. Inequities in Health Access: There are significant inequities in access to health services, particularly for lower socioeconomic groups, rural populations, and ethnic minorities. These inequities contribute to uneven progress in health outcomes and exacerbate the burden of disease in disadvantaged communities. Both articles stress this important issue.

Addressing these obstacles requires a multifaceted approach that will require much effort from those in power to induce change. Enhanced global cooperation and innovative policy solutions are essential to overcome these challenges and advance global health.

[Jasmine Jorden]

Milove, I agree with your emphasis on maternal health interventions and education as powerful pathways to improving infant growth in lower-income communities. The points you made about the impact of maternal mental health and education on caregiving practices and infant outcomes are well-founded. As you noted, maternal health severely impacts infant care practices and family outcomes. Providing mental health support, such as counseling and group support, indeed leads to better caregiving practices and improved infant growth. Furthermore, I’d like to expand on your concept of breastfeeding support. While promoting breastfeeding education is crucial, integrating comprehensive community-based programs that include peer support and lactation consulting can further enhance breastfeeding practices. These programs not only provide education but also create a supportive environment where mothers can share experiences and solutions to common breastfeeding challenges. Such interventions have been shown to significantly improve breastfeeding rates and duration, leading to better nutritional outcomes for infants and stronger community bonds. Thank you for allowing me to really understand this article further.

[Jasmine Jorden]

Question 1 from article #1: Which, in your opinion, are the two most powerful pathways to improving infant growth in lower income communities?

Two powerful pathways to improving infant growth in lower-income communities are “education and counselling interventions” and “women’s empowerment.” Education and counselling, especially when combined with food supplementation or conditional cash transfers, positively impact infant growth by improving maternal nutrition and feeding practices (pg. 5). “Community health worker home visits combined with mother/peer support groups showed a positive effect on reducing the risk of wasting, but no effect on stunting or underweight” (pg 6). Women’s empowerment interventions, such as enhancing control over income and resources, also significantly improve children’s nutritional outcomes. “Higher levels of decision-making power were associated with improved nutritional status in children and a reduced risk of stunting” (p. 11). Additionally, multi-sectoral programs that integrate these pathways with other interventions, such as m-health technologies and water, sanitation, and hygiene (WASH), will tend to have increased effectiveness in improving infant growth and nutritional status.

Question 2 from article #2: In the context of India, what are potentially the most powerful interventions to broadly improve maternal health?

In the context of India, potentially the most powerful interventions to broadly improve maternal health include enhancing education and socioeconomic status, and addressing health system factors. “Education enables women to exercise greater autonomy” and “economic status was directly linked to out-of-pocket expenditure to access maternal healthcare” (p. 14). Health system improvements, such as the “Janani Suraksha Yojana (JSY)” which provides “conditional cash incentives” also plays a crucial role. Additionally, addressing structural factors such as caste/ethnicity, gender, and religion is essential as they significantly influence maternal health service use and maternal mortality. Effective interventions must also tackle “community-related factors” such as the concentration of wealth and education, distance to health facilities, and caste dynamics. Comprehensive strategies that integrate these elements can potentially yield significant improvements in maternal health outcomes across diverse Indian contexts (p. 12).

[Jasmine Jorden]

Charity, I appreciate your comprehensive discussion on the factors contributing to TB prevalence in low and middle-income countries, particularly highlighting the importance of a strong healthcare system to address all communicable diseases. Your emphasis on government ownership and collaboration with international organizations is spot-on and crucial for sustainable solutions.
To expound on what you said, I feel the focus on public health education for improving sanitation could be expanded to include the implementation of basic infrastructure projects, such as building latrines and safe water sources, which can have a more immediate impact. While technology for public health education is promising, the logistical challenges in extremely remote areas might limit its effectiveness initially. To improve understanding amongst citizens, I would consider integrating both education and infrastructure development to address sanitation comprehensively.

[Jasmine Jorden]

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?

People living in poverty are disproportionately affected by TB due to several interrelated factors. Crowded and unsanitary living conditions in impoverished communities facilitate the spread of TB. Additionally, malnutrition, which is prevalent among those in poverty, weakens the immune system, making individuals more susceptible to infections, including TB. Another factor is the lack of education. This further exacerbates the problem, as those in poverty often lack the knowledge to recognize TB symptoms or understand prevention and treatment methods. Efforts to control TB should prioritize improving access to healthcare for underserved populations. While it requires substantial investment and time, targeting overcrowded areas to enhance sanitation and ventilation can significantly reduce TB transmission.

Question #2: What, in your opinion, are two interventions that would be most effective against neglected tropical diseases?

Two highly effective interventions against neglected tropical diseases are large-scale preventive treatment and improving access to water, sanitation, and hygiene (WASH). Preventive treatment involves administering medications to at-risk populations to reduce disease prevalence. Improving WASH infrastructure addresses the root causes of disease transmission by promoting hygiene and sanitation at the community level. Together, these interventions target the fundamental factors contributing to the spread of neglected tropical diseases, thereby significantly reducing their impact.

[Jasmine Jorden]

I agree with your assessment cstalcup5 (it isn’t showing full name for some reason). Achieving high vaccination rates is critical for measles elimination and there are most definitely cultural considerations that are essential for effective outreach. The tailored approaches you discussed must surely respect the diverse worldviews and dissuade mistrust in these communities, especially post-COVID. Engaging trusted conservative voices could help bridge the gap in vaccine hesitancy in the US. Overall, culturally sensitive and context-specific strategies are key to improving global vaccination efforts. You hit it right on the head!

[Jasmine Jorden]

Article 1: To successfully increase worldwide food security, several system-wide changes are recommended based on the article “Research Priorities for Global Food Security Under Extreme Events.” I will list what I believe should be the top 3 ways a government should start their plan. Implementing these changes requires coordinated research efforts and significant investments to transform global food systems and ensure food security under the threat of extreme events.

1) Transforming Food Systems: Addressing structural constraints within food systems is critical. This involves developing resilient agricultural practices that can withstand extreme events such as droughts, floods, and pest outbreaks.

2) Governance and International Cooperation: Effective governance frameworks and international cooperation are vital. Addressing challenges, geopolitical conflicts, and ensuring peace are essential for enhancing food system resilience​​.

3) Social and Institutional Adaptations: Enabling social change and building trust at multiple levels is necessary. Developing mechanisms to enhance the resilience of food systems through governance and policy interventions that are inclusive and equitable is fundamental​​.

Article 2: The most substantial barriers to global measles elimination include poor access to immunization services, dissemination of misinformation eroding vaccine confidence, and the recent diversion of public health resources to combat the COVID-19 pandemic.

Achieving and maintaining high vaccination coverage, particularly in resource-limited settings, is challenging due to logistical issues, financial constraints, and political instability. Furthermore, I believe that vaccine hesitancy has significantly impacted immunization efforts globally. Therefore, to overcome these barriers, I believe we should strengthen the public health infrastructure. This will help eliminate the financial and physical constraints with receiving vaccinations. Additionally, the dissemination of information needs to be more comprehensive and without compromise in order to combat misinformation that leads to mistrust of vaccines. Finally, I believe that there should be a plan in place that ensures the allocation of resources for these immunization programs is consistent. The last thing needed is an outbreak of Measles with no way to help the population because of lack of resources. I believe that the global burden can be reduced if these methods are implemented.

[Jasmine Jorden]

Hey all. I am Jasmine. I am a second-year DO medical student.

1. Your healthcare experience

I worked as a Medical Laboratory Technician in the United States Air Force. Additionally, I have participated in several health care related international mission trips.

2. Why you are taking this course

I am taking this course because I want to eventually navigate my career to serving both locally and internationally. I want to understand as many aspects of Global health as I can in order to eventually made a well informed decision about the path in which I will guide my career. Additionally, I seek to be apart of Doctors Without Borders or Wilderness Medicine.

3. What are your future plans

After graduation, I will return to active duty in the military. Once I retire from the military, my goal is to open a clinic in my hometown for the underserved community that I grew up in. I also hope to work overseas in different countries providing care to those who need it.

I look forward to learning a lot from this course.

[Author]

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