I sat in the clinic working on the multiplication table problems my mom had assigned me earlier that morning. Working next to the patients waiting to see my parents, I tried not to let myself become distracted by the elderly Nepali women who liked running their grubby old fingers through my blonde hair. When it was a busy day in the clinic and we had to stay late, my dad would give me a writing assignment to pass the time. People would walk for days to visit the clinic my parents ran in Bandipur, in the foothills of the Himalaya. They were the only physicians for nearly a 50 mile radius, so I tended to get a lot of writing assignments. The model of global health I witnessed at age nine in Nepal represents the traditional and now outmoded style of practicing medicine in an international setting, a model often referred to as the “medical tourism” model of global health. The standard was for Western physicians to set up shop in remote parts of the developing world and serve those most in the need: people with no other access to health care. While well-meaning, this approach to practicing medicine abroad has fallen by the wayside as we trend toward more sustainable models that emphasize a long term commitment from students, as well as bi-directional exchange and capacity building. I’ve seen this new model in action through time I spent in Borneo, and I’m living it now through the global health work I’m doing as a rising second-year med student at the University of Vermont College of Medicine.
Less than a year after graduating college, my father and I joined Health in Harmony, a conservation medicine NGO working in West Kalimantan, Indonesia on the island of Borneo. Here we witnessed an approach to global health that differed markedly from our former experience working on the slopes of the Himalaya. Visiting physicians, including my father, worked strictly in a teaching capacity, training young Indonesian practitioners who came to the clinic to gain experience in rural healthcare delivery. Though dramatically different from his prior experience working internationally, my father was able to learn how local physicians were able to practice extraordinary medicine in a severely resource limited setting. Indeed, recognizing the value of tapping into the immense clinical expertise of these local practitioners, Yale and Stanford had both sent students to work in the Health in Harmony clinic on a global health elective. In turn, Indonesian practitioners traveled to Yale to learn from the opposite side of the resource spectrum, allowing for a truly bi-directional exchange.
In addition to capacity building, new models of global health training seek to integrate international electives into a larger framework of global health education. Currently, many students participate in international electives during their fourth year, rarely leading to any lasting commitment. Part of this problem can be attributed to structural issues including debt repayment and finding employment where international work can be accommodated. However, as with the problem of bi-directional exchange, the fact that so few medical students engage in global health in the long term can be ascribed to the holdover medical tourism paradigm of the global health elective. We cannot expect students to fully appreciate the value that comes from working internationally after a single global health attachment, haphazardly inserted into an education largely devoid of supplementary global health training. The elective that I am participating in through UVM addresses these problems by integrating global health training with the four years of medical school. My education as a global health scholar began with a six-week rotation in Zimbabwe’s Parirenyatwa (Pari) Hospital in Harare following my first year in medical school. I’ve learned a great deal about clinical medicine, as well as how culture and medicine intersect. Walking through the wards of Pari, it was not uncommon to see patients in status epilepticus, patients with HIV encephalitis, and patients with miliary TB. Though I have seen first-hand the efficacy of traditional healing practices, the result of relying solely on traditional practices, particularly in a country where the prevalence of HIV is estimated at around 16 percent, can be devastating—and in our case, difficult to stomach. Too often we encounter patients with CD4 counts in the single digits. When asked why they defaulted on their Highly Active Anti-Retroviral Therapy (HAART), many of these patients will tell you that their traditional or spiritual healer told them that they were negative. While, according to the local medical students, this problem is improving and patients are recognizing the need for a combined approach to their ailments, it can be heart wrenching to hear these stories.
My experience in Zimbabwe accounts for just the beginning of my education in global health. Over the next three years as a medical student, I will participate in further training and ultimately return to Pari Hospital as a fourth-year student. This early exposure combined with the continuing education represents a new model of the global health elective aimed at developing a new generation of physicians who appreciate the increasingly globalized nature of healthcare and who are more likely to remain committed to integrating global health service into their careers. I am excited to be a part of this program—a collaboration between UVM and Western Connecticut Health Network—that seems uniquely poised to help transform the way we think about global health education.
To read more from students and faculty about their global health experiences, visit the UVM College of Medicine’s Global Health Diaries blog.