Involvement in Global Health as a Family Physician Calvin Wilson MD

Objectives Provide a general framework for consideration of global health involvement Discuss possible options for involvement in global health activities

Why?? Why do you want to do this? Be clear on motives and objectives for Global Health involvement “Adventure and tax write-off” “Join colleagues on a fun excursion” “Learn about another part of the world” “Help those less blessed” “Make a difference in the world”

Timeframe Short term – 1-3 weeks Medium term – 1-6 months Long term - >6 months Repeating commitment – repeated (annual or biannual) short or medium term visits to same place

Range of Involvement √ Activity Short Term Medium Term Long Term Repeating Tourism -Exploration √ Medical Services Teaching Program Development Faculty Development Program Leadership

Preparation and Orientation Always necessary Degree of preparation/orientation depends on: Timeframe of visit (short, medium, long term) Degree of westernization (vs. eastern/traditional orientation) Degree of clinical sophistication and infrastructure Setting of visit (village, urban, university) Clinical problems anticipated (tropical, poverty-related, social, war/violence)

Preparation and Orientation Where to find mentors/orientors FMG or internationals from same area Returned long-term workers in same area – missionaries, NGO workers, professional consultants Experienced long term workers in same region with some overlap to area of interest Fact-based resources – guidebooks (Fodors, Lonely Planet, etc.), CDC, WHO, Dept. of State, CIA

Short Term Options (<3 weeks) Ad hoc groups Church related, faith-based organizations Almost every denomination represented Mission-based groups (orphans, disability specific) Hospital-based groups (ie, Catholic or Adventist hospitals) Established groups Physicians with Heart Medical Missions International Project CURE (Denver) Child Family Health International (students)

Short Term Options Profit-based groups Personal arrangements Based in specific country or region Have often agreed to provide specific services with intermittent short term groups May be effective, but need to investigate agenda Charges often far in excess of normal travel costs Personal arrangements Local contact willing to help arrange a short-term trip Requires planning, flexibility, and sense of adventure! Better for more experienced international travelers

Medium Term Options (1-6 months) Faith-based or mission based organizations and hospitals Personal arrangements with national FM program Short-term teaching contract – paid or unpaid Faculty development Program development “Beltway Bandit” program managers - PHC development consultation

The “Beltway Bandits” Eg., Johns Hopkins, Abt Associates, Family Health International, University Research Corp., Engender Health, John Snow Inc. Compete for and manage large government international development contracts Focus on family planning, maternal/child health, HIV/AIDS/TB, malaria control, institutional capacity building Administer USAID, PEPFAR, Global Fund funding Recruit experienced consultants for specific tasks Requires persistence and flexibility

Long Term Options (>6 months) Faith-based or mission based organizations and hospitals Doctors without Borders Mercy Ships, Project Hope “Beltway Bandits” – long term assignment Personal arrangements with national FM program or University Teaching Faculty development Program development

Long Term Options Special consideration Dept. of State physician (attached to embassy) Fulbright Grant (negotiated with local Fulbright Commission in country of interest) Military physician Peace Corps (maximum 3 years) Volunteers of America Telemedicine conferencing and teaching with specific program or hospital

Repeating Commitment Deserves strong consideration with: Desire to make a sustainable impact on health and national health workers - BUT Currently available only for short term visits Build trust and confidence by focus on one place and limited objectives over multiple visits Mentoring small group of doctors or healthcare providers Introducing a few new skills or concepts Continued involvement between visits via email, phone conversations, telemedicine link Possibly sponsoring visit to U.S. for specific training or skill development

Repeating Commitment Responsibility for development and maintenance of relationship depends on US Requires persistence, faithfulness, keeping one’s promises, caution with perceived expectations Based on development of personal relationships, not on gifts of equipment and supplies Teaching and training should be mutual and bilateral, and maintain the dignity of national colleague

Other Options for Global Health/ Cross-Cultural Involvement U.S. Indian Health Service Federally Funded Health Center for minority groups/immigrants Refugee resettlement programs Practice outreach to specific local immigrant groups