Global Health

Brian Nicholson, Judy McKimm, Ann K Allen, Brian Nicholson, Judy McKimm, Ann K Allen

• Publisher: SAGE Publications Ltd
• Year: 2015
• ISBN:
  9781473943056
• Edition: 1
• Topic: Médecine
• Subtopic: Politique de santé

The concept of global health has moved on from focusing on the problems of the developing world to encompass health problems with global impact. Global health issues impact daily on local healthcare delivery and professional practice. This illuminating guide for healthcare students and practitioners introduces the major themes, challenges and debates relevant to global health that will equip the reader with the knowledge and skills required to thrive in this multi-faceted area of practice. Key features

• Puts global health in context considering key issues including health inequalities, human health and the global environment and climate change.
• Ideal readingfor international electives, voluntary work, and further qualifications in global health.
• Contains insights from leading experts in the field.
• Relevant to those working in a culturally diverse context whether domestic or international.

Part I Providing Care Globally

1 Studying and Working in Global Health

Michelle Mclean

Trevor Gibbs

Chapter overview

After reading this chapter, you will be able to:

• explain why it is important for healthcare students and professionals to be knowledgeable about global health
• describe the qualities and attributes of global healthcare practitioners
• plan an elective overseas
• prepare for working successfully overseas.

Introduction

Large-scale migration, together with the relative ease of travelling across the globe, improved communication technology, large multinational corporations aggressively recruiting globally and higher education becoming big business, have culminated in an increasing national diversity on all continents. This ‘flattening’ of our world (that is, globalization) has not only created a mobile healthcare workforce but also led to the notion of global health, defined as ‘health issues and concerns that transcend national borders, class, race, ethnicity and culture’ (Global Health Education Consortium, 2011). While globalization has benefits, our connectedness across continents has also facilitated the spread of disease, with pathogens not recognizing national borders.

Medical and health professions education thus needs to train global health practitioners who can translate their knowledge and experience of global health issues into local action. Not only do graduates need to function as members of multiprofessional teams but they also need to be culturally competent in a world in which peers, patients and colleagues often originate from different parts of the world (McKimm and McLean, 2011).

What problems does diversity of the professional workforce bring?

Through the use of scenarios informed by our experiences as international educators and the wealth of literature addressing global health, this chapter explores the challenges students and health professionals may face in an ever-flattening world of travel, study and work. Solutions are explored and recommendations made. The chapter also considers the attributes, qualities and skills for working effectively with a wide range of patients and communities in different parts of the world. The scenarios aim to stimulate discussion on the ethics of international engagement and service learning in global health, highlighting issues arising within multidisciplinary and multicultural teams.

Students: global health electives and international health experiences

Possibly the feeling of enhanced connectedness on a global scale and a sense of global community leads students and graduates to seek educational experiences in other cultures to enrich their understanding of healthcare. International electives and exchange opportunities are probably the main vehicle for engaging students in global health.

Types of global health experiences

Volunteer work was once the most common international health experience for students. Nowadays, a compulsory healthcare elective (in which students have some choice in where they go) is becoming the norm, partly driven by the need to include global health in the core curriculum and in terms of social accountability. The following are three common types of global health experience.

• Voluntary If there is no requirement in the curriculum to undertake an elective, students may choose to volunteer with a range of organizations that work in strife-torn and/or under-resourced areas. Volunteering is often driven by the altruistic motive ‘to help those less fortunate’.
• Compulsory, student-organized Some universities require students to undertake a compulsory elective, but expect them to arrange this themselves. The downside of such an arrangement is that supervision cannot always be guaranteed, nor can the outcomes for the student or the host community. Often the experience will not be formally assessed.
• Compulsory, institution-organized The training institution takes responsibility for students’ experiences before, during and after the elective. A memorandum of understanding between the institution and one or more sites in the host country and community ensures reciprocity in terms of an exchange programme for students and academics and the infrastructure for teaching. It also guarantees an appropriate standard of clinical supervision and learning outcomes for students as well as protecting patients. Examples would include the arrangement between the universities of St Andrews (Scotland) and Malawi and Swansea University (Wales) and The Gambia.

Planning and undertaking the elective

Whatever your healthcare and professional background, thorough planning is critical to ensure that you are adequately prepared personally and professionally (Lumb and Murdoch-Eaton, 2014).

• Make sure that you know the country well, particularly the location in which you will be working, including its climate. Check the country's political stability via the Foreign Office website or equivalent. Ethnic violence is not uncommon in many countries, but may not always be in the news.
• Anticipate the unexpected (being robbed, sick, involved in a motor vehicle accident) and plan what you would do. If you know of others who have visited the area, ask their advice.
• Try to link up with a local volunteer organization working in the country, even if you have arranged the elective through your institution.

Outlined below are key issues that you need to reflect on when planning an international elective as a future healthcare professional.

• Reflect on why you have chosen this particular elective and its location. Although altruism is laudable, evaluate whether or not your aspirations are reasonable in terms of your personal development and if there are beneficial outcomes for the hosting facility and community. At the very least, your presence should ‘do no harm’ and should incur no costs to the hosts.
• In some instances, if you are undertaking volunteer work or a compulsory elective at a facility or in a community not organized by your institution, there may be out-of-pocket costs for the community or facility. As a minimum, you may be expected, implicitly or not, to reimburse your hosts for the professional time and resources used. You may also be expected to bring gifts for your hosts.
• You will need to know in advance what activities you will be undertaking. These should match your level of competence. Working within your scope of practice is important particularly if you are still in the early stages of your studies as you will not be competent to carry out many clinical procedures. If you are required to specify a specialty area in your application, be aware that some disciplines (such as obstetrics and midwifery, emergency medicine, surgery) could result in you being asked to work outside your scope of practice, risking exposure to blood-borne pathogens. There should be a clear understanding between you and your point of contact (an administrator at the facility you will visit, for example), as well as with an academic at your training institution. Working beyond your competence level is a patient safety issue and could lead to unethical practice.
• Before departure, ascertain what resources are available. Speaking to someone who has visited previously gives you a better understanding of what to expect. In a low-resource country, one should always expect patient:health professional ratios to be much higher than in Western countries and there may be equipment and medicine shortages.
• Students should always maintain the same ethical standards they would at home. These include honesty and integrity, treating patients with dignity and respect, placing their needs above all else and being non-discriminatory and culturally accepting. All healthcare students have a duty to report any unprofessional or unethical behaviour of their peers during electives. Writing down such events helps as, later, you are asked to provide evidence.
• Not only is being able to communicate with patients and healthcare professionals important to developing a working relationship but there are also implications in terms of ethical principles. Wherever you practise, obtaining patient (informed) consent before touching them or undertaking any procedure is paramount. This can be difficult if there is a language difference. Learn some key words and phrases in the local language to help with this. It is sometimes possible to acquire the services of someone to translate, but you need to ensure that they translate authentically rather than telling you what he or she thinks you want to hear. Bear in mind that providing this service is an additional cost for...