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Hi Maliha,
Thank you for sharing this emotional experience. In a hectic, fast-paced environment, it’s easy to overlook small details that might seem unrelated to patient care. As a young and relatively healthy individual, I may not fully understand the challenges of being a patient, enduring pain and illness. Therefore, observing physicians who lead by example, demonstrating the healing power of compassion, and paying attention to the little things have left a profound impact on me as a student. These are the teachers I remember most and aspire to become as I continue to grow in my career.
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?
Barriers exist to expansion of faculty development programming in LMIC settings are limited resources, limited educational opportunities for field development, alignment challenges with local needs, persistent dependency, and development of trust. A crucial strategy for enhancing global education development involves a “pull” approach, wherein low-resource institutions define the direction and scope of the program, rather than a “push” approach from high-resource institutions.
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?
Exemplary clinical teaching habits that can be applied in LMIC settings include making the teacher’s own clinical reasoning transparent to learners, which involves thinking out loud, engaging the learner actively, and demonstrating kindness. As a medical student who has encountered various clinical teaching styles, I highly value educators who vocalize their thought processes and guide us through the diagnostic and treatment decision-making. Their willingness to express uncertainty and vulnerability helps me appreciate the complexity of clinical medicine. I find it easy to connect with and relate to teachers who employ this approach. Even if my treatment plan isn’t entirely accurate, being able to see the similarity between my thought process and the teacher’s, and recognizing that my thinking was on the right track is really motivating.Hi Khanh,
Thank you for sharing your answers. You’ve raised a valid point about diversifying the roles of community health workers. I agree that expanding the scope of community health workers’ roles can bring several benefits, such as improving healthcare access and raising public awareness of their vital contributions to the healthcare system. However, there are some challenges to consider: As community health workers take on more diverse roles, they may require additional training to effectively fulfill these responsibilities. The increase in training may pose a financial burden on the healthcare system, particularly in resource-limited settings. Furthermore, clear guidelines and boundaries must be defined to prevent overburdening CHW with responsibilities beyond their capacity. I’m curious to hear your thoughts on this.
Question 1: What additional elements would be necessary for universal health coverage to be effective?
As the article mentions, providing more resources for universal coverage is not enough to improve health; we also need to ensure a good quality of care. Quality care means ensuring patients receive timely and accurate diagnoses and evidence-based treatments while maintaining patient safety and patient-centeredness. We often assume the lack of access accounts for the biggest challenge to universal health coverage, and the focus has been on getting people in the door. However, studies involving the use of standardized patients to assess quality demonstrated that the actual problem lies in the low quality of care patients receive when they access healthcare providers. Hypotheses for the poor quality of care may include overwhelmed primary care providers who see too many patients and do not have time to evaluate carefully, a large number of informal providers, and the failure to translate clinical knowledge into practice. Approaches to improve the effectiveness of universal health coverage include addressing the systems that produce poorly trained and undermotivated medical professionals and bringing patients from rural areas to urban centers with better facilities instead of placing doctors in rural areas where they only see a few patients a day.Question 2: How could low-resource communities better make use of community health workers?
Community health workers are an essential component of the health system. However, there are many challenges that community health workers are facing, including limited resources, lack of training, overwork with low compensation, and a lack of recognition and respect. Low-resource communities could better utilize community health workers by working with local governments to provide adequate training for them, ensure reliable supplies and data systems, address inherent gender inequality, and ensure sufficient and sustainable financing.Hi Khanh,
I appreciate your perspective on the significance of increasing diversity in healthcare education and emphasizing cultural competency training for future healthcare providers. It’s crucial to equip students with these skills during their education, as it can be more challenging to provide comprehensive training once they are in active practice. Here are some of my thoughts: Incorporating cultural competency training directly into the healthcare curriculum; increasing the availability of cross-cultural learning experiences, such as clinical rotations in diverse communities or international healthcare settings, to expose students to a wide range of cultural perspectives; encouraging diversity within the student and staff populations, fostering an inclusive environment that reflects the diversity of the patient populations students will encounter in their future careers.
Questions 1:
Several actions can be taken to reduce cross-cultural barriers in healthcare including implementing cultural competency training, improving language access, and promoting workforce diversity. It is important to implement cultural competency training that addresses patients’ social, cultural, and linguistic needs. Such training helps healthcare providers become more aware of their biases and stereotypes, enabling them to develop strategies for delivering culturally sensitive care. Language barriers can be eliminated by ensuring access to professional interpreters and translation services. Healthcare providers should be trained to identify patients with limited English proficiency, use plain language in communication, and understand the limitations when relying on interpreters. A healthcare workforce should reflect the patient population. A diverse staff can better relate to and understand the unique needs of patients from various cultural backgrounds.
Question 2:
According to the article, a humanitarian crisis occurs in a country, region, or society when there is a total or considerable breakdown of authority resulting from civil conflict and/or foreign aggression. Humanitarian emergencies put populations at risk due to large-scale displacement, overcrowding, lack of clean water, poor sanitation, malnutrition, and low healthcare and vaccine coverage. Interventions that could help reduce the consequences of such emergencies include: Investing in disaster preparedness and resilience-building programs, improving access to safe water and sanitation, increasing vaccine coverage in developing countries prone to emergencies, prioritizing adaptable healthcare infrastructure, and strengthening coordination among humanitarian agencies, governments, and local organizations.Hi Savannah,
Thank you for your answer. I also share the same thought that health equity is today’s greatest obstacle to progress in global health. These inequities are often driven by a complex interplay of social, economic, political, and environmental factors. The other obstacles you mentioned, including conflict, malnutrition, public trust, and environmental factors, all contribute to widening the disparity gap. I appreciate that you brought up the fact that people most heavily impacted by these obstacles are those who already have poor health, which further emphasizes the detrimental consequences of health inequity. To address this challenging problem, I believe there is a need for international organizations, governments, and non-governmental organizations to provide policies, initiatives, and funding mechanisms for regions and populations that are most disadvantaged. What is your thought on this? I’d love to hear your approach to improving global health inequity.
#1. As discussed in this week’s reading, nutrition and food production have become increasingly multifaceted and global. Consequently, the effort to enhance access to sufficient, nutritious, and safe food goes beyond governmental responsibility. Instead, it necessitates transdisciplinary collaboration from the global community and must address challenges spanning from food production and distribution to consumption. Action must be taken to ensure the sustainability of food and agricultural systems while also reducing greenhouse gas emissions, which contribute to global warming. As climate change reduces agricultural output, it places increased pressure on the need to produce more food, further straining land and water resources. To address these challenges, I believe it is imperative to implement policies and regulations that promote sustainable agriculture practices, such as enhancing crop diversity, improving soil health, and reducing reliance on chemical inputs. Additionally, other crucial actions include mitigating the risks of food contamination by microorganisms and toxins, thereby reducing the incidence of foodborne and infectious diseases.
#2. In my opinion, today’s greatest obstacle to progress in global health is the health inequities within and between countries. From 1990 to 2015, we witnessed a rise in global life expectancy as well as a decline in maternal and child mortality, thanks to socioeconomic development and scientific advances. However, in several countries and regions, mortality rates remain high, underscoring the urgent need for health policy development and system responses. Disparities in access to healthcare services are often most pronounced in countries experiencing conflicts or among low-income and marginalized populations. To address these inequities, it is crucial to focus on ensuring social stability, preventing crime, and controlling arms proliferation. Additionally, countries should strive to increase income levels and improve educational opportunities.
Hi Betty, thank you for bringing up women’s empowerment. I agree that it is one of the most powerful pathways to improving infant growth. In low-income communities, women’s voices are not always heard. This could be due to many factors such as religious and cultural norms, lack of economic independence, and lack of education. Growing up in a developing country, I’ve witnessed many women around me struggling to stand up for themselves and their children. I believe the first step to women’s empowerment could start with creating organizations and policies to support and protect women.
Question 1:
In my opinion, the two most powerful pathways to improving infant growth in lower-income communities are providing adequate antenatal and postnatal care as well as improving nutritional support for infants.
Ensuring that pregnant mothers receive adequate prenatal and postnatal care is crucial. Screening for maternal illnesses, malnourishment, and infection could lead to early identification and addressing issues that might affect infant growth and development. Providing postnatal care with regular check-ups and timely vaccinations is essential to ensure adequate infant growth. Other maternal physical and psychosocial issues could also be addressed during these visits.
Health education should be incorporated as a critical component of a prenatal/postnatal visit. Providing mothers and caretakers with information about breastfeeding, proper sanitation, and signs of growth-related issues can enhance infant growth.
The second pathway to improve infant growth is to improve nutritional support. This includes providing breastfeeding guidance and intervention with appropriate introduction of complementary feeding if needed. In addition, addressing household food security issues can indirectly impact infant nutrition.
Question 2:
In the context of India, the most powerful intervention to broadly improve maternal health is reducing inequalities in the utilization of maternal health services between states and various population groups. Studies show that the utilization of antenatal care and skilled birth attendance in rural/poor mothers is substantially lower than that of mothers living in urban areas and higher socioeconomic positions. In order to address inequalities relating to maternal health, it is crucial to address the determinants that produce such gaps in healthcare. Some examples include socioeconomic position, place of residence, education, age at childbirth, and issues existing in the current health system. Interventions that help to address these problems include promoting women’s education, eliminating cultural or religious beliefs that negatively influence maternal health, and increasing the availability, and accessibility of maternal health services. I believe education is the most powerful intervention as it enables women to exercise greater autonomy to travel and seek care, demand services, and make decisions to use modern healthcare.Hi Savannah, you brought up a really interesting point regarding the relationship between TB and poverty, and how they mutually affect one another. Knowing this relationship, I agree with you that we must address underlying socioeconomic determinants in order to effectively control the disease. Creating policies to relieve poverty, providing psychosocial, financial, and structural support measures will bring long-lasting outcomes. However, I think it’s important that we also implement interventions that provide rapid relief to decrease the disease burden. Many people are suffering from TB due to limitations in diagnosis and treatment. Addressing this problem could rapidly and substantially reduce mortality, mobility, and financial costs due to the disease. Therefore, I believe efforts to control TB should include both rapid-impact solutions and lasting solutions.
#1
From my perspective, people living in poverty are most likely to suffer from TB due to a combination of factors. People living in poverty typically have limited access to healthcare services, including TB diagnosis and treatment. Poor living conditions with limited access to clean water and sanitation promote the spread of TB bacteria.
Understanding the barriers to controlling the disease, I think efforts should be focused on developing more effective preventative methods and improving treatment strategies. From the first detection of Covid, there have been substantial political and financial investments leading to the development of effective vaccines against covid infection. Thus, there is a need for a similar focus on the development of new vaccines for TB utilizing new technological methods. In addition, there is a large proportion of missing people with TB that are not treated, including children under 15 years, and people who were diagnosed with TB but were not reported to public health authorities. Therefore, we need to focus on identifying and treating missing people with TB by increasing the availability of rapid TB diagnostic services in high TB endemic countries. Poor adherence to treatment has been a major problem in controlling the disease. The development of shorter TB regimes and directly observed of treatment are strategies that have been utilized to improve treatment adherence.
#2
Neglected tropical diseases are a group of diseases that are intimately linked to poverty. They occur in areas with inadequate sanitation, clean water, limited healthcare, and people living in proximity with animals and infective disease vectors. Two interventions that would be most effective against neglected tropical diseases are intensifying disease-management and improving safe drinking-water, sanitation, and hygiene. Intensifying disease management includes developing safer oral medicines and better diagnostics. In the past, large-scale donation of medicines by pharmaceutical companies has greatly contributed to the search for improved medicines. Addressing socio-economic determinants is also an important component to consider in the fight against NTDs. I believe local governments need to focus on providing basic water supply, adequate sanitary infrastructure, and coordinating vector control response with agriculture and livestock management.Hello everyone,
My name is My Nguyen. I am a 4th-year medical student at TCOM in Fort Worth, Texas. I am taking this course because I’m interested in international medicine and want to learn more about it. I’m also taking this course in preparation for an international rotation in Thailand next year. I want to pursue internal medicine and I’m interested in practicing medicine internationally in the future.Hi Betty,
I agree with your assessment of the multiple barriers impeding global measles elimination, with particular emphasis on the escalating concern of vaccine skepticism in contemporary society. Undoubtedly, primary healthcare providers bear a pivotal responsibility in educating patients regarding the imperative nature of vaccinations. However, I believe that a more pronounced impact can be achieved by directing our efforts on a broader canvas. For instance, formulating comprehensive public health campaigns aimed at fostering vaccination advocacy and eliminating misinformation holds substantial promise. Simultaneously, while examining the barriers to worldwide measles eradication, it remains imperative to account for regions constrained by limited resources. The deficits in both healthcare infrastructure and vaccine accessibility emerge as impediments to the realization of measles elimination goals.Question #1: In my opinion, the most successful system-wide change that would increase world-wide food security is establishment of political stability. According to the article, “more than 50% of the world’s hungry live in conflict region”. In zones characterized by civil unrest, acts of terrorism, or armed hostilities, reduction in agricultural output coincides with an escalated demand food and resources. Efforts aimed at resolving geopolitical conflict and trade barriers are imperative prerequisites to safeguarding the integrity of food security on a worldwide scale.
Question #2: There are multiple barriers to global measles elimination, however I believe the lack of infrastructure, physical and financial access barrier to measles vaccination are the most substantial barriers to achieving and maintaining the measles herd immunity. To overcome these challenges, a concerted effort should be directed towards resource-constrained environments that are deficient in robust healthcare systems. This strategic approach would serve to expedite the management of measles. For instance, the innovation of alternative vaccine delivery modalities that eliminate the need for cold-chain transportation will increase vaccination coverage in resource-limited settings.
