Health Care of the Under-Served at Home and Abroad Leto Quarles MD Clinica Family Health Services AAFP Global Health Workshop September 2009

Health Care of the Under-Served at Home and Abroad Medically Under-Served Populations Barriers to Providing Health Care Shortage of Healthcare Providers Insufficient Social Infrastructure Barriers to Receiving Health Care Economic Barriers Geographic Barriers Cultural or Linguistic Barriers

Health Care of the Under-Served at Home and Abroad The Medically Under-Served in the US 60 Million men, women and children 1 in 5 people in the US The Medically Under-Served Globally 2.5 Billion men, women and children 1 in 3 people in the world

Health Care of the Under-Served at Home and Abroad Sources of Care for the Under-Served Community Health Centers Charity Care & Free Clinics Public Health Departments Emergency Rooms Folk and Traditional Healers Unlicensed / Unregulated Sources None: Going Without Care

Health Care of the Under-Served at Home and Abroad In the US, 93% of care to under-served populations is in the US is provided by Primary Care providers (includes MD, DO, NP, PA, CNM): 47% Family Medicine 19% Internal Medicine 19% Pediatrics 9% OB/GYN & Women’s Health

Health Care of the Under-Served at Home and Abroad Many who do this work within the US also seek to do so internationally Many physicians working in Community Health Centers in the US have also worked abroad Many more express interest Many non-physicians have interest and/or experience Skill sets, knowledge and expertise are transferrable and relevant across borders

Health Care of the Under-Served at Home and Abroad How People who work with the Medically Under-Served in the US also Participate in Global Health Activities: Short-Term Projects / Travel Longitudinal Relationships between Sites Academic & Policy Work Hosting International Students Past and Future Full-Time Work

Health Care of the Under-Served at Home and Abroad How to better harness these resources Interested personnel Relevant parallel experience & knowledge Commitment to type & intensity of work Necessary to understand Motivations Rewards Challenges In Order to Design Future Opportunities

Health Care of the Under-Served at Home and Abroad Survey May – September 2009 Online via www.surveymonkey.com Open to “everyone who works in any capacity with healthcare of the under-served in the US and has an interest in global health” 230 respondents

Health Care of the Under-Served at Home and Abroad Respondents main role in providing care to the under-served

Health Care of the Under-Served at Home and Abroad Experience of Respondents: 24.9% working 0-2 years 28.4% working 3-5 yrs 19.7% working 6-10 yrs 27.1% working >10 yrs 28.8% managers 25.9% <30 years old 47.8% 30-50 years old 26.3% >50 years old

Health Care of the Under-Served at Home and Abroad How do respondents get their information?

Health Care of the Under-Served at Home and Abroad Respondents Global Health experience:

Health Care of the Under-Served at Home and Abroad Motivations – All Respondents

Health Care of the Under-Served at Home and Abroad Motivations – w/ International Experience

Health Care of the Under-Served at Home and Abroad Motivations – All Healthcare Providers

Health Care of the Under-Served at Home and Abroad Motivations – Providers w/ Intl Experience

Health Care of the Under-Served at Home and Abroad Comments: Motivations Feel good about helping patients who are underserved The chance to help my hispanic community in any way possible or available All the minor reasons add up to a major reason for my interest. Also, I had a parent and several cousins that have worked outside the U.S. which has influenced me I would like to help in whatever way I can to bridge the gap of economic inequality Desire to help train healthcare providers in "developing" countries

Health Care of the Under-Served at Home and Abroad Comments: Motivations (cont’d) The country I come from, is no more. Now I go back to do what I can for the families who could not leave. Worked as a nurse in Chiapas MEXICO in the 80's before I got my NP I was a medic in Desert Storm 1. It changed my life, I went to PA school. When I came from my country I thought it was for a better life just for me, but now I know I can make a better life for the other people also

Health Care of the Under-Served at Home and Abroad Challenges – All Respondents

Health Care of the Under-Served at Home and Abroad Challenges – w/ International Experience

Health Care of the Under-Served at Home and Abroad Challenges – All Healthcare Providers

Health Care of the Under-Served at Home and Abroad Challenges – Providers w/ Intl Experience

Health Care of the Under-Served at Home and Abroad Comments: Challenges As an administrator I am not sure what role I would have that would be helpful. I have found it difficult to find a way to balance a workable lifestyle in which I can also particpate in international humanitarian programs I would love to participate in this type of work, however due to terrorism I couldn't.

Health Care of the Under-Served at Home and Abroad Rewards – All Respondents

Health Care of the Under-Served at Home and Abroad Rewards – w/ International Experience

Health Care of the Under-Served at Home and Abroad Rewards – All Healthcare Providers

Health Care of the Under-Served at Home and Abroad Rewards – Providers w/ Intl Experience

Health Care of the Under-Served at Home and Abroad Comments: Rewards the work I did abroad changed my perspective on life/world; I think everyone should be required to participate in one international relief program Since my Christian faith in Jesus Christ is my major motivation for my international medical educaiton work, the major benefit is the preparation and empowerment of national physicians to carryout their call and vision. The foreign work I do is my atonement for the reprehensible foreign policies of my government. To do the healign work of Jesus Christ our Savuior but some of them were not True Christians It is a blessing and honor to serve my brothers & sisters anywere

Health Care of the Under-Served at Home and Abroad Discussion: There exists in the US a pool of motivated healthcare professionals with expertise in care of under-served populations, who are already interested in and committed to global heath. How can we make best use of this resource? How can we solicit, support and sustain their involvement?