Despite grand debates on world order, the act of humanitarianism comes down to one thing: individual human beings reaching out to their counterparts who find themselves in the most difficult circumstances. One bandage at a time, one suture at a time, one vaccination at a time. All this in the hope that the cycles of violence and destruction will not continue endlessly.
—Dr James Orbinski Excerpt from Médecins Sans Frontières Nobel Lecture, 1999
Global health education is a profound way to teach medical students about health and health inequities. Global health education encompasses discussions around social determinants of health including access to health care, income, social support networks, poverty, physical environments, and gender. These discussions have important applications locally and abroad. Global health, in general, refers to the similar health issues many countries around the world share. By addressing these issues collectively, countries can work together to share solutions and build capacity, ultimately improving the health of populations worldwide.
Organization
At the Michael G. DeGroote School of Medicine at McMaster University in Hamilton, Ont, 2 groups—the Canadian Federation of Medical Students and Student Physicians for Global Survival—have been working together to increase awareness on global health issues to medical students. The Canadian Federation of Medical Students elects International Health Liaisons (IHLs) each year at all English medical schools across Canada to run programs related to HIV and AIDS, reproductive health, public health, and human rights and peace. The IHL at McMaster works with the Central Canada Representative of Student Physicians for Global Survival, a group that provides a network for residents, students, and physicians to exchange resources, dialogue, and information on endemic health issues. At McMaster, representatives of these 2 groups work together as the “Global Health Committee,” enabling other partnerships and greater participation of students in various awareness and action events.
Initiatives
McMaster’s Global Health Committee ran events under 4 major themes from 2005 to 2007: awareness, education, international elective planning, and service. These awareness events included a week-long speaker series where 3 physicians discussed their work abroad. Each spoke about his experiences practising medicine in developing countries and how he became involved in this type of work. Students also ran a large event for World AIDS Day, featuring talks by the Head of Infectious Disease at St Joseph’s Hospital in Hamilton and an HIV and AIDS support worker from the AIDS Network (who is also a local immigrant living with HIV). Other awareness events included the Make Poverty History Campaign (encouraging the Canadian government to drop debt in developing nations), journal clubs discussing the ethics of Western-led health research in developing countries, documentary screenings, and a fund-raising drive for Pakistan earthquake relief.
The Department of Family Medicine has been very supportive of McMaster’s global health education efforts. Two half-days of formal academic teaching have been added to the clinical clerkship curriculum. Beyond McMaster, the IHLs are working with the Association of Faculties of Medicine of Canada to distribute materials for global health education to all Canadian medical schools.
The Global Health Committee at McMaster also supports students who are interested in international electives. Two manuals have been created: one provides feedback and advice from upper-year students who have gone abroad for electives; the second is a handbook distributed to all elective students on practical medical management of common conditions encountered in the developing world. A student-led predeparture in-service was organized for all international elective students to discuss issues like cultural sensitivity, health and safety awareness, and the ethics of international aid. A project was also started to create a directory of medical students who can provide translation services to new immigrants and refugees in the Hamilton community. This involves medical students attending appointments with patients to translate and provide cultural support. The new program has met with early success according to patients and providers alike.
Motivation
Why should medical students be involved in global endeavours? The most salient reason is moral obligation. Every medical student enters medicine with the desire to “help others.” Global health work is a way of helping others without allowing geographical, cultural, or political boundaries to sequester that moral desire. Global health work is also a way to help students understand health concerns that are common across different countries. Professionally, physicians are in a position to provide neutral aid, without taking sides in conflicts. Physicians’ points of view are often considered the most objective in times of conflict and their comments on global health are often heeded. Being involved with global health work also helps with broader skill development—like political advocacy, policy writing, and epidemiologic research—and enables students and physicians to constantly appreciate how patients’ health encompasses more than biological disease.
There are equally important broader reasons for learning about global health. The United Nations designed 8 Millennium Development Goals to be achieved by 2015. Canada was one of the countries that adopted this commitment. Three goals focused specifically on health: reducing child mortality, improving maternal health, and combating HIV and AIDS, malaria, and other diseases. Promoting global health education within medical schools increases awareness and encourages action among health professionals in training.
According to the CanMeds Physician Competency Framework, a framework for medical education created by the Royal College of Physicians and Surgeons of Canada, Canadian medical students should graduate with the following “hats”: communicator, health advocate, professional, scholar, collaborator, and manager. Global health education provides a vehicle for medical students to develop and hone these competencies in a socially beneficial framework.
Conclusion
McMaster students have taken steps to promote global health education within the campus community, nationally, and internationally. Through strong mentors in the field of global health, students at McMaster have learned that it is possible to balance one’s career as a local health care provider with advocacy on broader issues. This work might take the form of campaigning for access to essential medicines, advocating for equity in gender and health, or medical outreach through travel and clinical service work. By having the opportunity to attend the International Federation of Medical Students’ Associations meetings and convening with students from over 100 countries around the world, students collaborate, share ideas, and are motivated to make changes within their communities for the betterment of patients’ health. Students involved with global health work also develop constructive ways of “thinking globally, acting locally,” through the obvious relationships between health outcomes abroad and health outcomes in their own communities. For each of these reasons, the Global Health Committee at McMaster has created momentum and action toward equity and justice in health services worldwide.
Resources
CanMeds Physician Competency Framework: http://rcpsc.medical.org/canmeds/index.php
McMaster International Health Committee: www.macmeds.ca/ihc
United Nations Millennium Development Goals: www.un.org/millenniumgoals
International electives
An important way that medical students can gain momentum to become involved in global health work is through international clinical electives. Below are the authors’ experiences of global health electives:
I had the opportunity to complete an elective at the World Health Organization’s Department of Reproductive Health and Research, where I learned about social determinants of health and how to work in a multidisciplinary team with individuals from various backgrounds. Working on several projects helped me gain an understanding of why policy makers, health care professionals, public health specialists, and community members should work together toward planning health priorities
—Avita Sooknanan
I had an international elective experience with a clinical perspective. I spent 2 months in Africa, working alongside physicians at large public hospitals in Zambia and Kenya. The experience increased my understanding of developing-world health concerns, the necessity for a multi-disciplinary approach to building infrastructure, and the consequences of a struggling public health system.
—Nikhil Pai
Footnotes
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Competing interests
None declared
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