Global Health After Residency: Making it there and back Katrina Tsang MD Mark Rastetter MD Blanca Baldoceda MD, MPH Antoinette Lullo DO Mark Loafman MD, MPH TJ Staff MD, MPH (virtual attendance)

Outline Introduction PCC Community Wellness Center The state of maternal and child health (MCH) Global Health after Residency Benefits Challenges Our experience Questions & Comments

The Trip Begins......

Who we are...Where we come from... PCC Community Wellness Center West of Chicago, Illinois Federally Qualified Health Center 9 clinic sites 60 providers, majority family physicians Provide Full Spectrum Care Teaching Medical students Residents Fellows in Maternal and Child Health Majority of patients either uninsured or has public aid Mark

Our Desire to Work Abroad... The Demographics of our Providers Most have worked abroad extensively Most maintain a dedication to global health & the underserved   Our Care Model We provide full spectrum family medicine care Our emphasis is on maternal-child healthcare The Reality of Health Care Disparities and lack of access Our desires to affect change Advocate for underserved populations Confront the glaring disparities in maternal-child health To learn! Mark

The State of Maternal and Child Health  

The Disparities in MCH... Maternal deaths 536,000/ year (World Health Organization (WHO)) 1 per minute Neonatal deaths > 3,000,000/ year (WHO) ~6 per minute WHO reference for neo death: http://www.who.int/child_adolescent_health/topics/prevention_care/child/en/index.html peds death: causes Preterm birth, birth asphyxia and infections   29 October 2007 Nearly 10 million children under the age of five die every year - more than 1000 every hour. Almost all of these children could survive and thrive with access to simple, affordable interventions. http://www.who.int/features/factfiles/child_health2/en/index.html

The Disparities in MCH...

Causes of Maternal Death Estimated >90% preventable

Causes of Neonatal Death http://www.usaid.gov/our_work/global_health/mch/mh/techareas/neonatal_death.html USAID

Global Health Benefits Challenges Global Health after residency Current Models PCC's model How it happened Components Monthly Lectures, Monthly dinners, Reading, International site How it's been Future directions

Global Health - Individual Benefits Broaden medical knowledge Reinforce physical examination skills Develop a deeper appreciation for professionalism Positive influence Clinical skills Language skills Awareness of important determinants of health Cultural factors Socioeconomic factors Political factors Continue to work in underserved multicultural populations PK Drain, KK Holmes, KM Skeff, TL Hall, P Gardner. Global health training and international clinical rotations during residency: current status, needs & opportunities. Acad Med. 2009; 84:320–325.

Global Health - Employer Benefits Improve competitiveness in recruitment Improve provider satisfaction Improve provider retention  Good press Global Health - Benefits to global community Relieve Medical Staff Education and training Pharmaceutical and other medical equipment support

Global Health after residency - Challenges Limited vacation/ CME time Burnout Financial challenge Loss of income Additional travel costs Need to pay loans Family commitment Identifying an international collaborative site

Global Health after residency - Models No pay leave Shared full-time position Using vacation/ CME time Sabbatical (if you're very lucky) Grants to finance traveling costs

Global Health after residency - Models Contractual change Configure a 0.9 Full Time Equivalent (FTE) contract Work as a 1.0 FTE for 90% of the year Take the 10% (36 working days) for international clinical work while still getting paid Making up productivity for time spent away Take extra call duties and clinic sessions the rest of the year

Global Health after residency at PCC How it happened Components Monthly Lectures Monthly Dinners Reading Curriculum Scheduled time abroad How it's been Future directions mark

Global Health after residency at PCC How it happened Identify a group of providers with strong interest Come to a consensus Logistics of remaining budget neutral Contractual change vs making up time Adding Global Health as an addendum to contract Presenting it in a strategic manner mark

Contract Addendum The provider will participate in the global health program for 1 calendar month each year. Only one provider to be gone from the system at a time. While a provider is gone, the other providers in the group will cover both the inpatient call and outpatient duties. Providers will make up 3-4 weeks equivalent of clinic time over the year to maintain individual productivity. Medical Directors and the provider will keep track of clinic sessions along with the Global Health Coordinator.

Contract Addendum Providers agree to complete all 12 months of inpatient and outpatient responsibilities in an 11 month time span.  Providers may use CME time and money for global health work. For a provider that has 6 clinic each week: Example 1:  6 clinics/ week    x   4 weeks abroad   = 24 clinics to make up in 11months   = 2.18 extra clinics/ month Example 2: 6 clinics/ week x 3 weeks abroad + 1 week CME     = 18 clinics to make up in 11 months     = 1.63 extra clinics/ month

Contract Addendum Your current clinic requirements are 6 sessions per week.  You have elected to spend 3 weeks in Global Health Initiative.  You have chosen to use 1 week of CME time. You will be responsible for making up 3 weeks of clinic:  18 sessions to be made up over 11 months. All GHI participants agree to participate in covering inpatient call duties of other participating providers. This addendum is valid for one year from the date it is signed.

Global Health after residency at PCC Components Monthly Lectures, Monthly dinners, Reading, Scheduled time abroad/ field work Topics Millennium Development Goals Social Determinants of Health Global Burden of Disease The big three: HIV, Malaria, and TB Gender & Health Humanitarian relief work Refugee care Himalayan Health Care Crisis relief in Haiti Global Health Initiative in Malawi kat

Global Health after residency at PCC Identifying a site for a long term relationship Where everyone is willing to go Accessible Affordable Cost  transportation, housing, and food Language needs Ability to use operative skills Safety Local support and collaboration Interested in training we can offer Networking - International Medical Graduates from residency, overseas trained health care workers

Global Health after residency at PCC Embangweni Hospital, Malawi An American family physician (sister of a PCC midwife) has worked in a hospital in Malawi for 15 years No other physicians at the hospital Need for the physician to travel and work at other sites Large MCH population and need C-sections are performed English is one of the official languages

Global Health after residency at PCC How it's been Monthly lectures & dinners Malawi experience Learning Vertical Skin cesarean deliveries HIV, Malnutrition, Malaria A choice of 5 labs -Hemoglobin, malaria smear, TB smear, rapid HIV, CSF profile Teaching Post-partum hemorrhage Neonatal Resuscitation Program

Global Health Initiative in Malawi Embangweni Hospital  

Global Health after residency at PCC Future directions Research Initiatives Funding Opportunities Expanding the opportunity to others Residents Medical Students Nurses Health Educators Additional global health site

Questions & Comments Mark Rastetter Mark.Rastetter@gmail.com Katrina Tsang kaztkat@gmail.com