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Safia, I am grateful to you for sharing some of your own experience with training midwives and nurses in postpartum care – especially your observation about how the concept of family centered care was often lacking. For most all settings, the most powerful modality of training is actually role modeling. That is, the teacher both demonstrating the approach to care and then guiding the learners in themselves utilizing that approach. Wouldn’t it be fascinating to somehow follow up on these midwives with whom you interacted to detect any change in their approach to patient care!
Charity, you highlighted how sustainability of the healthcare education program in Brazil was closely tied to funding. We see this in graduate medical education in the United States as well. Almost all the dollars for training resident physicians comes through the Medicare program. But, Medicare insolvency looms in the coming decades, and there certainly is a risk that as Medicare cuts back funding then resident education dollars will become fewer. What would be a more durable model for sustaining such education? This is really the realm of expertise of economists.
Emily, thank you for sharing with us some of your experience this summer at UPMC. This process of “thinking out loud” – or at least sharing with the learner ones clinical thought process – can be very valuable not simply for a learner but also for the clinician. It helps to clarify one’s own rationale. In the US, I do some emergency medicine, and I often share with the nursing staff what is my thought process and rationale for patient care. One benefit of this is that the nurses will then share with me their own ideas; ones that are often better than my own.
Rabeea, thank you for eliminating some of the barriers to faculty development and teaching in low–middle income nations. In my own experience, I have observed how the need to generate income often dissuades potential faculty from teaching – mainly because they do not receive any financial reimbursement for teaching. Creating paid positions whose primary responsibility is teaching would be a novel approach. Even in the United States, many medical school faculty or not actually paid anything to teach. Their salary is mostly derived from patient care charges.
David, you addressed the importance of solid healthcare infrastructure. In doing so, you mentioned the role of “doctors, administrators, and nurses” and drew comparisons with the world’s largest government-run public health system, that in Brazil! With this background, I’d like to emphasize the role of administrators. Without such individuals to create the budget, policy, employment, and standards the healthcare professionals (doctors, nurses, technicians) would not be able to function effectively. Let’s continue to respect those leaders who make possible the work we do “in the trenches”.
Safia, I am especially grateful to you for bringing to light your own experience with community health workers in Ethiopia, with their dissatisfaction regarding pay and continuing education opportunities. I have frequently heard similar complaints from nurses and doctors who work with the United Nations in that region of the world. Their salaries are very low and employment contracts are often quite short, maybe only one or two years at a time. It’s hard for them to support their families and make any long-term life plans.
Charity, I am grateful for your observation that the effectiveness of universal health coverage depends, most elementary, on “making peace in conflict zones, improving preventive healthcare and personal health responsibility, and increasing global and political cooperation.” As I read your words I am immediately struck by the powerful factors of self interest which usually stand against such virtuous positions. Yet, there is hope – especially because of individuals like yourself who pushed beyond self interest and quite intentionally towards the welfare of others!
Emily, thank you for emphasizing the role of experience, such as those ICU nurses with 30 years behind them. I anticipate that many of those nurses did not earn a bachelors degree, for that was not the standard decades ago. But their experience and in-service education, has given them the credentials to orient younger nurses who have high academic credentials but little application experience. Of course we see this phenomenon in medicine as well, with new physicians still able to recite the Krebs cycle but unable to manage a myocardial infarction. Overtime, preferably under the guidance of experienced faculty, those latter skills will develop.
Sabeea, you wisely included the element of social health protection as an important component of comprehensive universal health insurance. I believe we would all agree that provision of safe drinking water, safe housing, safe air, etc., are essential for health. Unfortunately, the infrastructure and finance required for SHP often outstrips any available resources. For low income nations, which often provide only about $10 per person per year for healthcare, just giving basic vaccinations may be a stretch from a financial standpoint.
David, you mentioned experience in different settings. I am thinking of your own experience in Ethiopia, and what a contrast that must be from Brazil and the United States. Having those three different perspectives must bring a rich point of view when you consider any number of subjects. This has been my experience, looking at issues from my three major cultural endeavors: China, Angola, and the US.
Safia, I am grateful to you for sharing your experience from Somalia in 2022 and the lessons you observed firsthand regarding measles control. It is quite timely that we regularly remind the general public that this disease is extremely contagious and it can easily be imported or spread locally. Therefore, our need for constant surveillance and prevention.
Charity, yours is a particularly touching account of housekeeping personnel of different language backgrounds assisting one another with language acquisition. Such a process requires humility, vulnerability, and patience – virtues from which we all could benefit.
Niharika, you rightly emphasized the importance of economic development as a means for boosting the baseline health and ability to provide basic human needs of a population. Thus, when disaster occurs, the community should be more capable of responding – given the resources in reserve.
Emily, you were especially thoughtful to mention the significant of the Ramadan holiday and how your hospital helped to make the staff aware of accommodations that might be necessary. Such personal experiences with people from other cultures are particularly powerful in creating a sense of shared humanity among those who are quite different from one another.
Milove, Reading your post immediately causes me to think help disasters and complex human emergencies are most likely to occur in the very nations who have the fewest resources to respond. Therefore, any advance in resilience within communities will also make such communities more resistant to the catastrophic impact of disasters.
