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Question #1 Existing barriers to faculty development in LMIC settings include:
Not understanding the culture of the host country and imposing own culture on the host nation
Not knowing the true needs of the host country but come with one’s own preconceived notions of their needs
Lack of commitment to establish partnerships as colleagues and not as superior to inferiorQuestion #2 Link learning to caring. Demonstrate to students that practicing medicine is not robotic but that they have to be responsive to the medical, emotional, and social needs of their patients. Students from LMIC will be responsive to non-native teachers when they see these teachers being compassionate to the native patients. In the reverse, I have developed respect for my students who come from the U.S. mainland and demonstrate compassion when caring for the immigrant populations.
Responses
I agree with Alice about teaching in the native language. I have not had to teach students who are non-English speaking, however I do have to communicate with non-English speaking patients daily and they appreciate when I can converse or instruct in their native language. Disclaimer: I have not achieved fluency in any other language but can speak enough Spanish to communicate with my patients and I know some words in Haitian-Creole.I agree with Johnathan that having a high patient volume and a lot of clinical responsibility is a major barrier to teaching. A good teacher should have adequate time to instruct and observe their patients, especially in healthcare.
I agree with Rebecca, if we improve the conditions of those in poverty, global health with should be improved. According to the International Bill of Human Rights, health care is a basic right of all people and should be treated as such.
I also agree with Monica that there should be an effort to make more nutritious foods available by governments. It is not enough to educate people on proper nutrition. If the overabundance of junk food was eliminated, people would have no choice but to eat healthier.Question #1 The three broad areas to improve global nutrition are food safety, food security, and global warming. Food safety can be improved if health protocols are followed universally. Every country cannot have its own standards to define safety. Pathogens are universal and their eradication should be addressed the same way by each country to eliminate these outbreaks. Food security can be achieved by eating “in season”. For example, in most Caribbean islands, the delicacy of conch cannot be fished at certain times of the year, this gives the conch population a chance to replenish itself. The same can be done with crops. Crops can be rotated which helps keep the soil rich and fertile to improve production. To reduce the effects of global warming, their need to be continued education about the things that accelerate its effects such as reducing carbon emission and recycling more just to name a few.
Question #2 Global health can be improved with effective communication among world leaders. Information about new medical knowledge or surgery techniques should be shared and not kept secret in a bid to have world domination.Jeanne, I agree with you that patients say that they understand when they really don’t. At my office, we utilize a phone translation service also and sometimes the patient does not understand the translator who is speaking their language. This is evident in the patient seeks out the employees who speak their native language and then the employee will come to me and ask me the questions for the patient.
Monica, for your example of the trips to Costa Rica, I think that the briefing/orientation should be done before leaving the home base. Then once the party arrives in Costa Rica they can go straight to healthcare.Question #1 In an effort yo decrease cross-cultural barriers, healthcare providers can learn about the culture of their patients by using open ended questions. For example, I have a large Haitian immigrant patient population and I have learned that most of them seek permission from their husband before making healthcare decisions such as starting contraceptives. Healthcare providers can also invest in cultural competency courses to address any biases or stereotypical ideas about their patients. Healthcare providers should utilize trained language interpreters to ensure that their instructions are understood.
Question #2 Efficacy of short term healthcare trips can be improved by the following:
1. Goals and purpose of the trip should be explicitly outlined before embarking on the trip
2. A plan for continuity of care for each patient seen by the visiting team should be discussed with the local doctors so that their is no loss to follow-up or lapse in care. This should be explained to the patient that the local doctor will assume care and continue the care of the patient. This will help the patient not become dependent solely on the care of the visiting providers.
3. The visiting team should make provision for contact for the local doctors can consult with them if needed.I think we all have similar ideas in regards to community health workers becoming educated in neonatal resuscitation. The cell-phone idea that Jeanne brought up would be terrific, but a lot of these communities do not have modern conveniences such as electricity and cell-phones. To get anything accomplished will more than likely have to be word of mouth and textbooks with pictures.
I do agree with Jeanne that WASH an nutrition supplementation is variable by infant and by culture and that a cultural approach should be taken in the care of thes infants.Question #1 In an effort to improve neonatal resuscitation in low resources communities, local leaders should offer free CPR and neonatal resuscitation classes to community health workers who may double as attendants at home births. Also, local leaders along with the governments can appeal to foundations that can supply neonatal resuscitation equipment. Additionally, an improvement in infrastructure can ensure that women can get to the hospital to deliver their babies in a safer setting.
Question #2 WASH is important and complements nutrition efforts by promoting cleanliness. A cleaner environment reduces the risk of contamination in foods which may lead to the development of certain diseases such as diarrheal diseases. Infection with some pathogens can lead to diseases that affect absorption through the gut and therefore the beneficial nutrients are then loss. The children may become malnutritioned which then affects their cognitive and physical abilities.Chering’s illustration of how the woman is fed last after the entire family has eaten and is usually given the scraps identifies how the importance of the woman to her household is negated in many societies. The man is the head of the household, but the woman is the nurturer and should be respected as such. If the woman is ill or weak, she cannot take care of the household as she needs to. In these societies emphasis needs to be placed on the value of the woman to the family.
Shirene, you have brought up a very good point about increased communicable diseases due to living in cramped quarters after relocating from an are in conflict. I agree this can severely impact the health of the pregnant woman.
Question #2
Maternal healthcare should be rebranded as women’s health and encompass the time of pregnancy of child birth as well as the years before and the years after. An OB/GYN takes care of a woman’s health needs regardless of pregnancy status. Therefore, there should be a focus on the health of the woman in advertising, in advocacy that concentrates on the whole life cycle of being a woman. Healthcare programs should focus on good nutrition and exercise through the life cycle of women which may reduce the development of NCDs. Campaigns that promote getting pap smears and breast exams are very important. These two things really need to be destigmatized as painful and uncomfortable but promoted as necessary to ensure health.Question #1
From reading the article, I think the biggest impact of conflict on the health of the pregnant woman is the inability for her to access care. Yes, care is improved thanks to humanitarian efforts and the appropriate health care providers being deployed to the conflicted area. However, for many women they do not have transportation to get to the healthcare services. The significant other may be directly involve in the fighting as a soldier therefore he is not available to help her get to the clinic or healthcare site. It may be to dangerous to embark on a journey to the clinic especially if the woman lives far from the clinic. These factors may lead to the woman having to deliver at home in possibly in unsanitary conditions and without the help of a skilled worker which can lead to infection and failure to recognize other complications such as post partum hemorrhage and preeclampsia.Question #1
The largest remaining barriers against worldwide HIV control are continued lack of education and controlling the virus. Communities in the hardest hit areas specifically in sub-Saharan Africa continue to put their own customs over practicing safe sex and reducing the transmittal of HIV. Those who are affected continue to be ostracized and ridiculed which makes them not reveal their status and seek the treatment that they need. (This is not from personal experience, but from what I have gathered from multiple sources that I have read) Scientifically, there is a continued need to understand the virus as it continues to mutate and make treatment more difficult.
Question #2
Pediatric control is lagging behind adults because children are not responsible for themselves. Children are usually taken to the doctor by parents. This cannot happen if the children are abandoned by their parents or if the parents are in denial and do not want to acknowledge their child/children’s diagnosis. As children are diagnosed their names should be entered into a database for community HIV workers and HIV specialist health care practitioners to do periodic well-checks including home visits for these children and initiation of meds if not already started.I agree with Jonathan, lack of education and poverty will continue to be barriers to worldwide control of HIV. Efforts should be concentrated on continuously educating the population on HIV prevention and help people to not become lackadaisical in safe practices. For those in poverty, programs must be developed to help them get treatment. I know these program already exist but we have to be sure that every person that needs the care is getting it.
I also agree with Alice, a message of monogamy for men is essential and will reduce the spread of HIV.
I think we all recognize that crowded living conditions and lack of access to healthcare makes people living with poverty more susceptible to getting TB. Regarding NTDs, I agree with Jonathan that a global effort has to be made to fund the most afflicted countries. I also believe that an effort has to be made to educate healthcare providers on a whole about these NTDs because some of them have asymptomatic carriers that may migrate to other countries.