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Gareth, I completely agree with your response and specifically love when you discussed that modeled behavior is “priceless” especially when working cross culturally. This increases the likelihood of our patients to gain even more trust with providers if we too believe in the importance of what we are telling them.
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?
As discussed in the article, numerous positive qualities exist relating to the expansion of faculty development programming in low and middle income settings. On the other side of this article lie barriers to expanding programs like these- the major ones including monetary funding, access to resources such as internet and even electricity can be extremely difficult. I have experienced this first hand when visiting rural tribes in India where the people face all of these barriers at the same time, making developments like these extremely difficult.
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?
All of the habits are applicable but I think one of the most relatable includes keeping things simple. In my own experience this was effectively implemented when tribal communities in India were educated on the importance of sanitation facilities in their communities for the prevention of disease. Initially, this initiative was not received well as the community members were found to be using the restrooms for storage. This required the team to take a step back and simplify the main points of why such things were so important to the development of greater health for everyone living in the area.
Dara, when discussing how low resource communities can make better use of community health workers, I love when you say “If there is an awareness, then there will be more of a demand.” I completely agree that this is the bread and butter of what must change to allow communities even more benefit from community health workers. If individuals do not even know a service exists, there is a zero percent chance that they will utilize the service, and just as you said if they do not utilize these programs, the funding will be diverted to different projects. In focusing on awareness, I think an impact could be made on a large scale just by investing in programs that already exist.
Question 1: What additional elements would be necessary for universal health coverage to be effective?
I thought the article discussing improvement of universal health coverage was extremely interesting because it addressed topics for discussion that are often left behind. Often times the focus is set on improving access to healthcare, and as the article states, the reality is that rather than increasing access, we may be better serving patients by turning the focus to providing high quality services. I was not even aware that providers across the globe can be so unqualified and even the providers who are qualified, tend to miss work often, leading patients to not be able to predict when they can receive treatment. When the under qualified providers are treating patients, the article discussed the downfalls including misdiagnosis, over prescription of antibiotics, etc. This really gets at some of the underlying mechanisms preventing the progression to effective universal healthcare coverage. I think that tackling these gaps in provider capability and knowledge/experience is where we must start, and furthermore, we have to look at the institutions producing this type of provider.
Question 2: How could low-resource communities better make use of community health workers?
I believe that the number one way that low resource communities can better make use of community health workers is through education to the communities about what the community health workers do exactly, and what services they can provide. Additionally, the roles of community health workers must be defined explicitly so that they know what the expectations are surrounding their work. By doing these two things, programs like this especially within communities in need can be extremely beneficial when both parties know their role and the collective goal.
Abby, I really enjoyed your emphasis on starting with self awareness surrounding ones own cultural biases. Once we can do this, I think it becomes much easier to identify ways we as healthcare providers can improve relationships with patients across cultures and therefore improve health outcomes. I also liked how you mentioned that this process isn’t straightforward- its something that we must continually work on developing throughout our careers.
Question 1: What actions can healthcare providers take to decrease cross-cultural barriers?
As the article stated, I think that a great starting point is the ability to communicate effectively with patients who speak different languages- through the implementation of adequate translation services from qualified individuals. Additionally, I think one of the biggest things that healthcare providers can do to decrease cross cultural barriers is to get to know the patient really well- allow them to share their story, use active listening, and learn about their cultural norms. By doing this, your patients will develop long lasting trust with you, allowing them to feel more comfortable going to you for guidance with treatment plans for their health. I think one of the most difficult aspects of making this happen (decreasing cross cultural barriers) is access to healthcare as many of those individuals experiencing cultural barriers, may be less likely to seek out care due to inadequate health insurance/funding etc. This is an area we must continue to address.
Question 2: What prevention interventions could best help reduce consequences of complex humanitarian emergencies?
I agree with the points discussed in the article- I think there is room for vaccination rate improvement especially in areas which are under vaccinated. The problem of safety was a topic of discussion though especially in areas with conflict/violence with past history of healthcare providers who have been killed while spreading vaccine awareness and need. I think at this point, the question becomes how do we circumvent these issues and still target the correct audiences while keeping everyone safe. If we can effectively do this then there will be a large reduction in complex humanitarian emergencies. The other aspect to prevention includes having strong protocols/management strategies in place for when natural disasters and complex emergencies occur. Without clear guidelines to follow, there is more room for preventable mistakes especially during high stress events.
Ima, I love how you mentioned COVID19 and how that has drastically impacted global health over the past few years. It was an event that no one saw coming and is something that we may now be more prepared for in the future if further pandemics were to occur. I completely agree that global preparedness and surveillance is of immense importance to continue improving upon in the coming years in order to work towards improved global health.
Question 1: What actions are most important to improve global nutrition?
Improving global nutrition will take much time and effort in order to sustainably combat such a complex problem. There are many perspectives that can be taken on tackling this. One thought that initially comes to mind to improve global nutrition is by starting at home in the US. I think a large improvement would be seen if we focused efforts in on educating children about what they are putting in their bodies and how it may impact them for the rest of their lives. This would also be an opportunity to discuss poor health outcomes related to poor diet including diabetes, so that the children would have a real world picture regarding how food/nutrition can impact us for years to come. This would of course also apply to other countries but in some parts of the world, food insecurity is a larger issue to tackle before moving onto nutritional education. Although, with food desserts present in the states, another area of improvement would revolve around improving food options in low income areas- saving money in the long run by ideally preventing chronic disease.
Question 2: In your opinion, what are today’s greatest obstacles to progress in global health?
The greatest obstacles to progress in global health like many others mentioned, are the countries affected by war and conflict. The article discusses how this disrupts peace, stability, crime and more. If people are fearing for their livelihoods, health is going to take a seat on the back burner as these people are in fight or flight mode. Combating war and conflict is a much larger topic of discussion and I am not sure if there is a clear pathway or answer to improvement. War and conflict has always been a part of history and I don’t know if it will ever be something of the past.
Rebecca,
I love your ideas about focusing on “maternal” healthcare much earlier on in a woman’s life- specifically surrounding contraception, STI screening, and disease prevention through education. It makes complete sense that in order to improve health of women after childbirth, more effort should be focused on the time before a woman is pregnant to create a more encompassing vision of health.
Question 1: What is the mechanism, in your opinion, through which WASH and promotion of nutrition complement one another?
WASH places an emphasis on physical cleanliness including hand washing and other sanitary practices. Through this, communities can improve health by eliminating possible infections spread through fecal/oral routes specifically. This has the potential to decrease childhood mortality as bacterial infections account for many deaths in infants and children. This is complimented by promotion of nutrition because improved nutrition also improves health by enhancing immunity and the body’s physical strength through proper nutrients.
Question 2: In your opinion, how should maternal healthcare be best expanded to protect women throughout their lives?
I think maternal healthcare must expand to include at the very minimum, routine screenings for cancer (breast and cervical) as well as certain offerings earlier in life that would have an impact on the entirety of a woman’s lifetime. This could include education on nutrition, menstrual cycles, contraception, pregnancy, as well as healthy relationships. By implementing a strong health foundation, I think many illnesses/health concerns would be more preventable.
Dara,
I completely agree with you and I had never even considered that children are growing so rapidly that their medication regimens need to change with them as well. This absolutely adds an additional barrier to making progress on the prevalence of HIV in children. I also had no idea that the pharmaceutical development was also lagging- I would think more emphasis would be placed on the development of medications especially in children but clearly that is not the case.
Question #1: From your perspective, what are the largest remaining barriers against worldwide HIV control?
The largest remaining barriers against worldwide HIV control are numerous but the stigma surrounding HIV, access to resources and varying prevalance world wide are major contributors. If stigma continues to linger, it makes it harder to accurately diagnose and treat those who are infected. The stigma causes individuals to avoid getting tested in fear of the ridicule they may receive if others know. Additionally, HIV is more often seen in lower income countries where access to the necessary education, testing facilities and treatment options isn’t as widely available. Also, because the prevalence of HIV in countries such as the US is lower than other parts of the world, people don’t realize how large of a problem this disease is worldwide and therefore are less likely to support programs researching treatment/cures. If more were educated on the scope of the problem, we may be able to gain more support overall.
Question #2: Why, in your judgment, is pediatric HIV control lagging behind that of adults and what should be undertaken to reverse this status?
I think just as the article said, the focus has primarily been on adults- how to prevent transmission from adults to other adults or children, how to treat it, and how to provide communities education. The narrative needs to also include more effort towards the treatment of children as the detection of HIV continues to lag- more emphasis must be placed on earlier detection and treatment with continued follow up. In some cases children may lack the family support to continue receiving the treatment they need to survive and they are unable to bear that responsibility on their own.
Rebecca,
I think you have a great point about one of the main focuses being public education on neglected tropical diseases. Even as someone in healthcare, I hadn’t even known about the ongoing outbreaks of some of these diseases. If there was more widespread education, I think everyone would be more willing to show support. If the need is not widely known, its less likely to get the attention it needs for adequate improvement.
Hi Dara, I love the point you brought up about pharmaceutical companies. With the profits these companies are making, their funds would be well invested in the prevention of disease, even if its just a small portion like you said. In the long run, there would be great benefit although these companies seem to be unwilling to decrease profits at the cost of helping the larger picture.
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 most likely to suffer from TB due to a few main reasons including poor/crowded living conditions, decreased immune systems from a lack of nutritious foods making them more susceptible to illness and decreased access to medical care and newer more effective TB treatments. This fact should increase efforts to combat TB or else it will continue to spread throughout these communities. In order for this to happen more funding needs to be funneled into endemic areas to combat the malnutrition, poor housing conditions and increased access to new affordable drug therapies. Additionally, education should be provided to community members surrounding what to look out for if potentially infected with TB.
Question #2: What, in your opinion, are two interventions that would be most effective against neglected tropical diseases?
One of the most important aspects we can still work towards is ensuring safe water access, and hygiene in areas of neglected tropical disease. We can also evaluate current protocols to analyze where there are pitfalls/short comings and what things are working. I think the biggest barriers to accomplishing these things is funding and the changing political climates with areas of civil unrest. These events make it more difficult to ensure that protocols are being followed and community members are getting the treatment they need along with education.