Essential Clinical Global Health

Brett D. Nelson

• Publisher: Wiley-Blackwell
• Year: 2014
• Print ISBN: 9781118638446
• eBook ISBN: 9781118638439
• Edition: 1
• Topic: Medicine
• Subtopic: Clinical Medicine

Essential Clinical Global Health is a brand-new, pioneering, and evidence-based textbook that provides a clinical overview of the increasingly prominent specialty of global health. Originally developed from a course at Harvard Medical School, and now with contributions from nearly 100 world-renowned global health experts from across the globe, this textbook presents vital information required of students, trainees, and clinicians during their international experiences and training.

Essential Clinical Global Health introduces readers to the up-to-date knowledge, skills, and approaches needed for productive and rewarding global health experiences. It provides essential clinical information on the diagnosis, management, and prevention of the leading causes of morbidity and mortality in low- and middle-income countries. The textbook also includes practical guidance on topics such as health systems, population-based approaches, cultural awareness and sensitivity, travel preparedness and safety, and career development in global health.

With key learning objectives in each chapter, practical clinical advice, setting-appropriate guidelines, personal field experiences from student and clinician contributors, Essential Clinical Global Health is the first global health textbook with a clinical focus for healthcare students, trainees, and providers.

A companion website at www.wileyessential.com/globalhealth features self-assessment questions and videos.

Part 1
Introduction

CHAPTER 1
Working Clinically in Resource-Limited Settings

Ronald Pust¹, Peter S. Azzopardi^2,3, and Shreya Patel⁴

¹University of Arizona, Tucson, AZ, USA

²Royal Children's Hospital, Murdoch Children's Research Institute, and University of Melbourne, Melbourne, Australia

³Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia

⁴Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA

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Key Learning Objectives

• Discuss the similarities and differences among clinical roles in resource-rich countries and resource-limited settings.
• Review the evidence-based rationale for relying on patient demographics, history, and physical examination in any clinical setting, whether or not resource-constrained.
• Cite additional resources for acquiring the skills and knowledge for working effectively in resource-limited settings, including books, websites, and courses emanating from and/or designed for low- and middle-income countries.

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Abstract

Learning to provide quality medical care in a resource-limited setting can be both challenging and rewarding if the clinician is prepared with global health knowledge, problem-solving skills, and cultural humility. Although clinical resources may be limited in global health practice, the underlying bases of diagnosis and therapy are not fundamentally altered by resource level. However, the application of those principles in a resource-limited setting differs significantly from typical practice in resource-rich countries, where patient demography, cultural contexts, disease epidemiology, and cost-effectiveness may be viewed differently by clinicians. This chapter concentrates on these differences and the similarities in underlying clinical principles, illustrating several implications for a clinician's role in resource-limited settings. It concludes with an extensive list of resources, including international clinical reference books that can facilitate practice in sustainable, equitable partnerships with host-nation clinicians and mentors.

Key words: global health, international health, cross-cultural, advocacy, evidence-based medicine, syndromic diagnosis, resource-limited settings, cost-containment, clinical decision-making, medical ethics, case studies, bibliographies

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Introduction

Working as a healthcare professional in resource-limited settings is both a rewarding and an enriching experience (Pust, 1984a; Azzopardi & Gray, 2010). Professionally, providing clinical care in the context of limited resources nurtures development of clinical diagnostic and therapeutic skills, which are widely valued in any setting (Palfrey, 2011). Working in diverse sociocultural settings promotes the development of communication skills, confidence, flexibility, adaptability, and resilience (Parker et al., 2011). Global health also fosters a more sound understanding of health, well-being, and their complex determinants (Ventres & Wilson, 1995).

A goal of healthcare professionals working in a resource-limited setting is to promote attitudes and approaches that foster respectful and collaborative relationships within each uniquely diverse culture, community, and health system (Nelson et al., 2012). This chapter begins by considering the role and responsibilities of visiting health professionals and the importance of understanding local context, capacity, and priorities. We introduce broad concepts of providing cross-cultural clinical care to build on a foundation of existing clinical skills. The underlying premise is that an accurate medical history and physical examination, judicious use of investigations, coupled with knowledge of local prevalence of diseases and health resources, will enable clinicians to provide good clinical care. We illustrate syndromic approaches to diagnosis using a case study of a child with fever. The chapter concludes with a comprehensive list of books and websites that may serve as additional resources.

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Orientating to the Health System

Resource-limited settings are largely characterized by high burdens of disease and injury, economic disadvantage, political turmoil, natural disaster, racial and gender-based discrimination, or marked socioeconomic disparity. “Developing country” is an alternate term; however, it sometimes implies a Western concept of development, viewed as derogatory by some. The World Bank utilizes terminology based on gross per-capita income level (e.g., low- or middle-income country, or LMIC). Over the past 15 years, the term “international health” has increasingly become “global health,” the latter term encompassing an interdisciplinary cooperative approach to health and its determinants (Koplan et al., 2009).

Perhaps what these terms do not reflect is the great heterogeneity both within and across these settings; consequently, experience in one setting may not necessarily translate to another. Most importantly, communities that have limited material resources are likely to be wealthy in terms of cultural, communal, and environmental resources (Marsh et al., 2004).

The determinants of health and well-being are complex, and many health-related programs in resource-limited settings focus on health outcomes or disease, often distinct from promoting health and wellness. Focusing on disease is a pragmatic response to the combination of overwhelming disease burden and limited resources (Jamison et al., 2006). However, the opportunity that each clinical interaction provides to address broader health and well-being should be maximized whenever possible, especially as people living in resource-limited settings often experience significant barriers in accessing healthcare. Initiatives such as the Integrated Management of Childhood Illness (IMCI) include this strategy of making the most of each clinical encounter.

Health systems, as described in Chapter 2, include organizations, policies, resources, and people whose primary purpose is to improve health (WHO, 2010). Global health systems are growing increasingly complex. Every country, as well as differen...

Table of contents

• Cover
• Table of Contents
• Website ad
• Title page
• Copyright page
• Editor and Editorial Board
• Contributors
• About the Editor
• Preface
• How to Use Your Textbook
• About the Companion Website
• Acknowledgments
• Part 1: Introduction
• Part 2: Newborn and Child Health
• Part 3: Adolescent, Reproductive, and Maternal Health
• Part 4: Infectious Diseases
• Part 5: Non-Communicable Diseases
• Part 6: Other Global Health Topics
• Index
• End User License Agreement