1. 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)

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

3. The Trip Begins......

4. 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

5. 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

6. The State of Maternal and Child Health

7. 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:
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.

8. The Disparities in MCH...

9. Causes of Maternal Death
Estimated >90% preventable

10. Causes of Neonatal Death
USAID

12. 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

13. 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.

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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

22. 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.

23. 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

24. 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

25. 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

26. 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

27. Global Health Initiative in Malawi Embangweni Hospital

31. 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

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