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Buser JM, Auma AG, August E, Rana GK, Gray R, Jacobson-Davies FE, Tufa TH, Endale T, Mukeshimana M, Smith YR. Sexual and reproductive health research capacity strengthening programs in low- and middle-income countries: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003789. [PMID: 39361709 DOI: 10.1371/journal.pgph.0003789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 09/12/2024] [Indexed: 10/05/2024]
Abstract
Sexual and reproductive health (SRH) research capacity strengthening (RCS) programs in low- and middle-income countries (LMICs) are needed to foster the discovery of context-specific solutions to improve patient outcomes and population health. There remains a limited understanding of SRH research strengthening programs to raise skill sets, publications, and infrastructure and ultimately influence health policy and patient outcomes in LMICs. More information is needed to understand how SRH research is sustained after program completion. To inform efforts to implement programs that strengthen SRH research and foster sustainability, we conducted a scoping review to identify and synthesize strategies used in SRH research strengthening programs in LMICs. A literature search of nine scholarly databases was conducted. We synthesized data extracted from included articles and presented results highlighting the format, duration, and topics covered of program interventions to strengthen SRH research in LMICs. We organized information about primary outcomes into themes and summarized how SRH research capacity was sustained after program completion. Twenty-four articles were included in the scoping review. The articles generally focused on outcomes within the themes of advocacy/capacity, education, policy, project life cycle, and writing/publication. Few articles reported metrics or other evidence of long-term program sustainability of SRH RCS projects in LMICs. Results from this scoping review can be used to strengthen SRH research programs in LMICs. More energy must be directed toward correcting power imbalances in capacity strengthening initiatives. To address additional gaps, future directions for research should include an exploration of SRH research mentorship, the cost of SRH RCS interventions, and how to foster institutional support.
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Affiliation(s)
- Julie M Buser
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Anna Grace Auma
- Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Ella August
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America
- PREPSS (Pre-Publication Support Service), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Gurpreet K Rana
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Rachel Gray
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | - Faelan E Jacobson-Davies
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Tesfaye H Tufa
- St. Paul Institute for Reproductive Health and Rights (SPIRHR), Addis Ababa, Ethiopia
| | - Tamrat Endale
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
| | | | - Yolanda R Smith
- Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States of America
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Airhihenbuwa CO, Ford C, Iwelunmor J, Griffith DM, Ameen K, Murray T, Nwaozuru U. Decolonization and antiracism: intersecting pathways to global health equity. ETHNICITY & HEALTH 2024; 29:846-860. [PMID: 38959185 DOI: 10.1080/13557858.2024.2371429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
In this paper, as Black scholars, we address ways that interventions designed to promote equity in health can create pathways for coupling decolonization with antiracism by drawing on the intersection of the health of Africans and African Americans. To frame this intersection, we offer the Public Health Critical Race Praxis (PHCRP) and the PEN-3 Cultural Model as antiracism and decolonization tools that can jointly advance research on colonization and racism globally. We argue that racism is a global reality; PHCRP, an antiracism framework, and PEN-3, a decolonizing framework, can guide interventions to promote equity for Africans and African Americans.
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Affiliation(s)
| | - Chandra Ford
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Juliet Iwelunmor
- Washington University School of Medicine, Washington University in St. Louis, Saint Louis, MO, USA
| | | | - Khadijah Ameen
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Teri Murray
- Trudy Busch Valentine School of Nursing, Saint Louis University, Saint Louis, MO, USA
| | - Ucheoma Nwaozuru
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
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Sims DA, Naidu T. How to … do decolonial research. CLINICAL TEACHER 2024:e13806. [PMID: 39293474 DOI: 10.1111/tct.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 08/13/2024] [Indexed: 09/20/2024]
Abstract
The imperative for decolonial research in health professions education (HPE) is rooted in a resistance to coloniality, which characterises modern medicine and HPE. Coloniality is a residual effect of colonialism, which upholds White, Western, Eurocentric knowledge systems while simultaneously marginalising diverse epistemologies. We outline the problematic nature of coloniality in HPE typified in unequal research partnerships, skewed student exchanges and poor representation of diverse authors. Decoloniality advocates for the active disruption and dismantling of colonial hierarchies to promote epistemic justice. We suggest a practical framework for applying decolonial principles in research, emphasising awareness (critical consciousness), deliberation (reflexivity) and action (transformative praxis). Practical steps for decolonial practice include interrogating research conceptualisation, sharing power and diversifying research teams, adopting participatory and reciprocal (mutually beneficial) methodologies, (re)centring marginalised voices and amplifying 'Other' knowledges, and disrupting hegemonic dissemination practices. By employing decolonial strategies, researchers can produce equitable, socially accountable and epistemically just scholarship, ultimately enhancing the relevance and impact of HPE research for all people globally.
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Affiliation(s)
- Danica Anne Sims
- Faculty of Education, University of Oxford, Oxford, UK
- Biomedical Engineering and Healthcare Technology Research Centre, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Thirusha Naidu
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada
- Department of Psychiatry, University of KwaZulu-Natal, South Africa, Durban
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Chell MA, Smith C, Leader Charge DP, Sun SW, Sundberg MA, Gampa V. Community Collaboration to Develop a Curriculum on Settler Colonialism and the Social Determinants of Health. TEACHING AND LEARNING IN MEDICINE 2024:1-8. [PMID: 39286916 DOI: 10.1080/10401334.2024.2403991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/17/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024]
Abstract
American Indian/Alaska Native (AI/AN) communities continue to experience health disparities and poor health outcomes, which are influenced by social determinants of health. The theory of settler colonialism provides a framework for understanding the structures that affect social determinants of health and the resulting health disparities. Western biomedicine and medical education have been implicated in perpetuating settler colonialism, and as a result Indigenous medical educators and leaders have called for increased education and understanding of the structural and social determinants of health affecting Indigenous populations. One important method is through community-based approaches to curriculum design. In collaboration with community leaders and experts, we identified the need for a curriculum on health in the context of settler colonialism, with a focus on resilience and community-directed efforts to improve wellness and care. Alongside Indigenous leaders and educators, we developed a unique curriculum focused on settler colonialism, the social determinants of health, and the assets inherent to the Native Nation where we work. Developed for non-Native learners and clinicians, the curriculum is designed to help provide context for the historical and political etiologies of health inequities experienced by the local community. Local educators helped shape a video lecture series associated with readings and experiential learning activities in 10 domains, providing an overview of settler colonialism and how it affects the social determinants of health. Our model of education draws upon the strengths and assets of communities and can improve health outcomes as well as learners' understandings of AI/AN-specific needs. We expect that our collaborative approach results in improved relationships among the Non-Native learners and providers and community members.
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Affiliation(s)
- Margaret A Chell
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Caroline Smith
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Damon P Leader Charge
- Office of Academic Affairs/Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Stephanie W Sun
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael A Sundberg
- Departments of Medicine and Pediatrics, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA
| | - Vikas Gampa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Blaaza M, Iqbal S, Ramalingam V, Laage Gaupp FM, Morgan R, Shaygi B. Expanding global health opportunities for UK-based interventional radiology trainees. Clin Radiol 2024; 79:690-696. [PMID: 38880676 DOI: 10.1016/j.crad.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 06/18/2024]
Abstract
AIMS As the future workload of interventional radiologists in the UK continues to expand, it is imperative that current IR trainees are given maximal opportunities to expand their skill sets. This paper argues that opportunities for involvement in international collaborative fieldwork should be expanded for interventional radiology trainees in the UK, as a means of maximising their future competency and positive contribution to the advancement of global healthcare. The study builds upon first-hand experience of the authors in the field and a review of the relevant literature. MATERIALS AND METHODS This scoping review aimed to ascertain the current global health opportunities for interventional radiology trainees primarily in Resource Limited Countries (RLCs). This review further contrasted these opportunities with ones provided to trainees within North America and European countries. RESULTS This review found that the opportunities for international collaborative fieldwork for UK interventional radiology trainees are sparse. The availability of such opportunities in the US is significantly greater as is the awareness and appreciation of the benefits of such international collaborations for trainees. Benefits include greater experience with a variety of pathologies, a potentially larger volume of workload, improved cultural competency and proficiency and greater cost-conscious and more sustainable practices. It is also pertinent that any future global partnership opportunities for UK clinicians are crafted with care to benefit both UK and international healthcare professionals, institutions and patients within RLCs. CONCLUSION Significant work is needed to expand opportunities for global health for interventional radiology trainees in the UK. It is incumbent upon the major radiology societies and educational bodies within the UK to expand upon such opportunities to develop a robust, world-leading workforce, which would subsequently enhance our global health positionality and reflexivity.
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Affiliation(s)
- M Blaaza
- Academic Foundation Year 1 Doctor, The Hillingdon Hospitals NHS Foundation trust, London, England, United Kingdom.
| | - S Iqbal
- Harvard Medical School, Mass General Imaging, Interventional Radiology, 55 Fruit St., Boston, MA 02114, USA.
| | - V Ramalingam
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - F M Laage Gaupp
- Assistant Professor of Radiology and Biomedical Imaging, Yale Institute for Global Health, New Haven, CT, USA.
| | - R Morgan
- Professor Interventional Radiology FRCR EBIR-ES, St George's University Hospitals NHS Foundation Trust and St George's, London, United Kingdom.
| | - B Shaygi
- Interventional and Diagnostic Radiologist, London North West University Healthcare NHS Trust, Imperial Academic Tutor, Imperial College School of Medicine, London, United Kingdom.
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McKimm J, Balasooriya C, Fyfe M, Aboulsoud S, Brouwer E, Nadkar AA. International collaboration in health professions education. MEDICAL TEACHER 2024:1-8. [PMID: 39186666 DOI: 10.1080/0142159x.2024.2391440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/08/2024] [Indexed: 08/28/2024]
Abstract
This article explores the essential elements for achieving excellence in international collaborations within health professions education (HPE), drawing on the Association for Medical Education in Europe (AMEE) ASPIRE Award criteria for International Collaboration. The International Collaboration award transcends recognition of excellence through the award; it aims to foster excellence in international HPE collaborations more broadly, by establishing a framework for evaluation and development that functions cross-culturally. This framework is based on five key elements that contribute to successful collaborations: mutually agreed goals; shared responsibilities and leadership structures; processes that support collaboration; demonstrated long-term impact and sustainability, and evaluation and practice sharing. Recognizing the historical context of unequal power dynamics in international partnerships, this article promotes the development of ethical and equitable collaborations. We advocate for integrating cultural competence, epistemic plurality, and leadership skills into HPE curricula to prepare future healthcare professionals for effective international collaboration.
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Affiliation(s)
- J McKimm
- Chester Medical School, Chester University, Chester, UK
| | - C Balasooriya
- Office of Medical Education, Faculty of Medicine & Health, UNSW Sydney, Sydney, Australia
| | - M Fyfe
- University of California San Francisco, San Francisco, CA, USA
| | - S Aboulsoud
- Faculty of Medicine, Cairo University, Giza, Egypt
| | - E Brouwer
- School of Health Professions Education, Department of Educational Development & Research, Maastricht University, Maastricht, The Netherlands
| | - A A Nadkar
- Karl Bremer Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Western Cape, South Africa
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Lenhard NK, An C, Jasthi D, Laurel-Vargas V, Weinstein I, Lam SK. Virtual global health education partnerships for health professional students: a scoping review. Glob Health Promot 2024:17579759241248401. [PMID: 39171491 DOI: 10.1177/17579759241248401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Although there is rising interest in virtual global health (GH) education in light of the COVID-19 pandemic, there has been no report on the body of literature describing virtual education partnerships for health professional students. This scoping review examines virtual GH partnerships involving health professional students, including any barriers identified or best practices and ways to address them. METHODS We searched PubMed for studies describing virtual GH education partnerships using keywords related to GH, virtual learning, and partnerships. Inclusion criteria were that the activity was virtual, involved health professional students in two or more countries, and was reported in English or Spanish. In-person clinical electives and interventions that had not yet occurred were excluded. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS The search algorithm yielded 308 articles. Seventeen studies met full inclusion criteria. Four studies described asynchronous formats, whereas 13 were synchronous. Common challenges included scheduling challenges, language barriers, and technological limitations. Suggested improvements included having increased faculty support and expanding partnerships to multiple languages. The median MERSQI score was 8.25 out of 18 possible points. CONCLUSION There are limited studies investigating the effectiveness of virtual GH education partnerships, and more robust evaluation is needed to further understand the optimal role of virtual education in teaching GH skills. Despite logistical challenges, virtual partnerships can provide innovative GH education through bidirectional educational exchanges that students find valuable.
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Affiliation(s)
- Nora K Lenhard
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Crystal An
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Divya Jasthi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Ilon Weinstein
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Suet K Lam
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Cleveland Clinic Cleveland, OH, USA
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Lencucha R. Transforming global health: decoloniality and the human condition. BMJ Glob Health 2024; 9:e015420. [PMID: 39153753 PMCID: PMC11331859 DOI: 10.1136/bmjgh-2024-015420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024] Open
Abstract
The field of global health is at a pivotal moment of transformation. Decoloniality has emerged as a critical framework to assess and transform the pathologies that mark the field. These pathologies include the inequitable sharing of resources, the power hierarchies that entrench decision-making in institutions largely based in North America and Europe and the general predisposition towards paternalistic and exploitative interactions and exchange between North and South. The energy being generated around this transformative moment is widening circles of participation in the discourse on what transformation should look like in the field. The importance of decoloniality cannot be overstated in driving the transformative agenda. At the same time, the popularity of decoloniality as a critical framework may risk omissions in our understanding of the origins of injustice and the pathways to a new global health. To complement the work being done to decolonise global health, I illustrate how the 'human condition' intersects with the transformative agenda. By human condition, I mean the universal features of humanity that lead to oppression and those that lead to cooperation, unity and a shared humanity.
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Chen MC, Ndiritu J, Bhatta S. Enhancing Perspective in Global Health: A Case Study on an International Ophthalmology Partnership. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11431. [PMID: 39132638 PMCID: PMC11310288 DOI: 10.15766/mep_2374-8265.11431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/10/2024] [Indexed: 08/13/2024]
Abstract
Introduction Global ophthalmology opportunities are becoming increasingly popular, and international partnerships are becoming more common among academic training institutions in the United States. There is need for training in the complex relational, motivational, ethical, and logistical issues that may arise in these partnerships. Methods We developed a 3-hour case-based session featuring four characters in a fictitious international ophthalmology partnership scenario. Facilitators used structured questions for each of the four parts to foster interaction and discussion among learners. After the activity, participants completed an evaluation/questionnaire consisting of Likert-scale and open-ended questions. Results A total of 23 ophthalmology residents and seven medical students underwent the activity over four iterations. The activity was well received, with 100% of learners either strongly agreeing (90%) or agreeing (10%) when asked if the session was worthwhile and 100% of learners either strongly agreeing (87%) or agreeing (13%) when asked if the format was conducive to achieving the learning objectives. Answers to questions on how learners would change how they practice ophthalmology in their residency and in their future careers revolved around the following topics: consideration of other perspectives, humility, self- and situational awareness, complexities of partnerships, reciprocity and exchange, importance of communication, and connection of principles between international and domestic medical practice. Discussion While this case study explores an international ophthalmology partnership scenario, the principles and themes presented can be applicable to other fields of medicine, and can be applicable to the practice of medicine both internationally and domestically.
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Affiliation(s)
- Michael C. Chen
- Associate Professor, Department of Ophthalmology, University of Colorado School of Medicine; Ophthalmology Division Chief, Denver Health Medical Center
| | - Judy Ndiritu
- Consultant Ophthalmologist and Vitreoretinal and Uveitis Specialist, Nyeri County Referral Hospital
| | - Subash Bhatta
- Teaching Ophthalmologist and Vitreoretinal Consultant, Pacific Eye Institute
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Wang Z, Zhao X, Shen H, Wang H, Cheng G, Gao YN, Zuo W, Xu Z, Avallone F, Arora AK, Guo M, Simmons R, Lessard D, Beesley T, Zheng JC, Lebouché B, Bergman H. Evaluation of the McGill-Tongji Blended Education Program for Teacher Leaders in General Practice: The importance of partnership and contextualization in International Primary Care Training Initiatives. HEALTH CARE SCIENCE 2024; 3:238-248. [PMID: 39220432 PMCID: PMC11362659 DOI: 10.1002/hcs2.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 09/04/2024]
Abstract
Purpose Strong primary health care (PHC) systems require well-established PHC education systems to enhance the skills of general practitioners (GPs). However, the literature on the experiences of international collaboration in primary care education in low- and middle-income countries remains limited. The purpose of this study was to evaluate the implementation and perceived impact of the McGill-Tongji Blended Education Program for Teacher Leaders in General Practice (referred to as the "Tongji Program"). Methods In 2020-2021, the McGill Department of Family Medicine (Montreal, Canada) and Tongji University School of Medicine (TUSM, Shanghai, China) jointly implemented the Tongji Program in Shanghai, China to improve the teaching capacity of PHC teachers. We conducted an exploratory longitudinal case study with a mixed methods design for the evaluation. Quantitative (QUAN) data was collected through questionnaire surveys and qualitative (QUAL) data was collected through focus group discussions. Results The evaluation showed that learners in Tongji Program were primarily female GPs (21/22,95%) with less than 4 years of experience in teaching (16/22,73%). This program was considered a successful learning experience by most participants (19/22, 86%) with higher order learning tasks such as critical thinking and problem-solving. They also agreed that this program helped them feel more prepared to teach (21/22,95%), and developed a positive attitude toward primary care (21/22,95%). The QUAL interview revealed that both the Tongji and McGill organizers noted that TUSM showed strong leadership in organization, education, and coordination. Both students and teachers agreed that by adapting training content into contextualized delivery formats and settings, the Tongji Program successfully overcame language and technology barriers. Conclusions Committed partnerships and contextualization were key to the success of the Tongji Program. Future research should focus on how international primary care education programs affect learners' behavior in their practice settings, and explore barriers and facilitators to change.
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Affiliation(s)
- Ziyue Wang
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Xinxin Zhao
- School of MedicineTongji UniversityShanghaiChina
| | - Huixia Shen
- School of MedicineTongji UniversityShanghaiChina
| | - Hao Wang
- School of MedicineTongji UniversityShanghaiChina
- Department of General PracticeShanghai Tongji HospitalShanghaiChina
| | - Gemma Cheng
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Ya Ning Gao
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Wenzhen Zuo
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Zhuyin Xu
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Francesco Avallone
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
- Center for Outcome Research EvaluationResearch Institute of the McGill University Health CentreMontrealQuébecCanada
| | - Anish K. Arora
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Manxi Guo
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Rachel Simmons
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - David Lessard
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | - Theresa Beesley
- Office of Accreditation and Education Quality Improvement, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
| | | | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of MedicineMcGill University Health CentreMontrealQuébecCanada
| | - Howard Bergman
- Department of Family Medicine, Faculty of Medicine and Health SciencesMcGill UniversityMontréalQuébecCanada
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Rashid MA, Grant J. Power and place: Uncovering the politics of global medical education. MEDICAL EDUCATION 2024; 58:930-938. [PMID: 38888045 DOI: 10.1111/medu.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/26/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024]
Abstract
CONTEXT Politics is characterised by power relations, and the deployment of power is inescapably political. In an increasingly globalised and interconnected modern world, politics is shaping the field of medical education more than ever before. Global frameworks that classify peoples and places are political tools that are fundamentally shaped by hegemonic knowledge systems. Despite this, they continue to form the basis for global thinking and practices, including in medical education. Political analysis can help to expose and challenge such thinking. APPROACH To better understand impacts of globalisation in medical education, we explore the previously under-examined political dimensions that underpin it, focusing particularly on deconstructing power relations. We situate our analysis of global medical education in political terms, including through examination of ideology, economics, market and the enduring effects of colonialism. We interrogate the construct of the Global South (GS), considering the geopolitical and historical ideas that have enabled it to be widely propagated. We go on to examine the consequences of the GS construct in medical education and consider what this tells us about how power is enacted in the field. CONCLUSIONS In analysing the politics of global medical education, we shed light on how power is exerted and draw attention to forces that permit and enable trends, policies and positions. Notwithstanding the emancipatory rhetoric that has been associated with the GS construct, we highlight its reductive potential and argue that it can lead to an oversimplification of power relations and vested interests. Given the growing recognition that educational approaches do not transfer well across countries and cultures, we encourage the medical education community to consider why ideas from more dominant countries continue to be imitated so routinely. In doing so, we urge them to use political lenses to recognise the influence of multiple complex and interconnected forces of global power that shape all aspects of medical education.
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Affiliation(s)
| | - Janet Grant
- Faculty of Medical Sciences, University College London, London, UK
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12
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Lam SK, Celix B, Lenhard N, Cobb C, Van Genderen K, Gundacker C, Schleicher M, Colbert CY. A review of local global health education in post-graduate medical education. MEDICAL TEACHER 2024:1-20. [PMID: 39049816 DOI: 10.1080/0142159x.2024.2372086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 06/20/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Global health (GH) education is offered in post-graduate medical education (PGME) programs and local experiences are desired by trainees and educators. This scoping review aimed to map the literature on local GH education in PGME, to describe curricular components, factors facilitating successes, and challenges to implementation using a validated education intervention checklist and inclusion of seven components of local GH programming. METHODS A decolonization conceptual framework informed a 5-step scoping review. In May 2022, eight databases and MedEdPORTAL were searched using key words describing local GH education curricula. RESULTS Sixty-eight full-text articles described local GH education programs in residencies (n = 52; 76.4%) and fellowships (n = 10; 14.7%) spanning multiple specialties, predominantly in North America (90%). Successful programs included faculty mentoring, community-based partnerships, and a multidisciplinary component. Scheduling challenges, cultural and linguistic differences, and trainee workload contributed to implementation difficulties. Only four programs included all seven local GH health equity/decolonization components. CONCLUSIONS Local GH curricula vary widely in clinical experiences, didactic sessions, and inclusion of mentorship and partnerships. Local populations within the communities of these training programs could benefit from standardized inclusion of components for local global health education with careful consideration of health equity.
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Affiliation(s)
- Suet Kam Lam
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Breastfeeding Medicine, Primary Care Pediatrics, Cleveland Clinic, Cleveland, OH, USA
| | - Brianna Celix
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nora Lenhard
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Carmen Cobb
- Department of Internal Medicine & Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Kristin Van Genderen
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Mary Schleicher
- Floyd D. Loop Alumni Library, Education Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Colleen Y Colbert
- Office of Educator & Scholar Development, Education Institute, Cleveland Clinic, Cleveland, OH, USA
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Razack S, Richardson L, Pillay SR. The violence of curriculum: Dismantling systemic racism, colonisation and indigenous erasure within medical education. MEDICAL EDUCATION 2024. [PMID: 38992874 DOI: 10.1111/medu.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/25/2024] [Accepted: 06/12/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Epistemic violence is enacted in medical curricula in mundane ways all the time, negatively impacting learners, teachers and patients. In this article, we address three forms of such violence: White supremacy, indigenous erasure and heteronormativity. METHODS In this article, we examine the knowledge systems of medicine as a global phenomenon, impacted by Western and European ideologies of race and colonisation, both produced by them, helping to reproduce them through authoritative and hegemonic ideologies. We seek not only to problematise but also to propose alternative teaching approaches rooted in the Global South and in Indigenous ways of knowing. Taking inspiration from Paulo Freire, we advocate for the development of critical consciousness through the integration of critical pedagogies of love, emancipation and shared humanity. Drawing on Irihapeti Ramsden, we advocate for cultural safety, which emphasises power relations and historical trauma in the clinical encounter and calls for a rights-based approach in medical education. Deliberately holding space for our own vulnerabilities and that of our students requires what Megan Boler calls a pedagogy of discomfort. CONCLUSIONS AND SIGNIFICANCE Our perspectives converge on the importance of critical consciousness development for culturally safe practice in medical education, acknowledging the need to emphasise a curriculum of shared humanity, introducing the concept of Ubuntu from Southern Africa. Ubuntu can be encapsulated in the phrase 'I am because we are', and it promotes a collective approach to medical education in which there is active solidarity between the profession and the diverse populations which it serves.
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Affiliation(s)
- Saleem Razack
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of British Columbia; Centre for Health Education Scholarship, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Lisa Richardson
- Temerty School of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Suntosh R Pillay
- Department of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Bukenya J, Kebede D, Mwambi H, Pate M, Adongo P, Berhane Y, Canavan CR, Chirwa T, Fawole OI, Guwatudde D, Jackson E, Madzorera I, Moshabela M, Oduola AMJ, Sunguya B, Sall A, Raji T, Fawzi W. The future of public health doctoral education in Africa: transforming higher education institutions to enhance research and practice. Lancet Public Health 2024; 9:e523-e532. [PMID: 38735302 PMCID: PMC11209668 DOI: 10.1016/s2468-2667(24)00056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 05/14/2024]
Abstract
The African Union and the Africa Centers for Disease Control and Prevention issued a Call to Action in 2022 for Africa's New Public Health Order that underscored the need for increased capacity in the public health workforce. Additional domestic and global investments in public health workforce development are central to achieving the aspirations of Agenda 2063 of the African Union, which aims to build and accelerate the implementation of continental frameworks for equitable, people-centred growth and development. Recognising the crucial role of higher education and research, we assessed the capabilities of public health doctoral training in schools and programmes of public health in Africa across three conceptual components: instructional, institutional, and external. Six inter-related and actionable recommendations were derived to advance doctoral training, research, and practice capacity within and between universities. These can be achieved through equitable partnerships between universities, research centres, and national, regional, and global public health institutions.
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Affiliation(s)
- Justine Bukenya
- School of Public Health, Makerere University, Kampala, Uganda.
| | - Derege Kebede
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Henry Mwambi
- School of Mathematics, Statistics, and Computer Science, Durban, South Africa
| | - Muhammed Pate
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Philip Adongo
- School of Public Health, University of Ghana, Accra, Ghana; Association of Schools of Public Health in Africa, Accra, Ghana
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Chelsey R Canavan
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Olufunmilayo I Fawole
- Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - David Guwatudde
- School of Public Health, Makerere University, Kampala, Uganda
| | - Elizabeth Jackson
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Isabel Madzorera
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mosa Moshabela
- Vice Chancellor's Office, University of KwaZulu-Natal, Durban, South Africa
| | - Ayoade M J Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Tajudeen Raji
- Africa Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Wafaie Fawzi
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
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Rennie N, Degraeuwe E, Deltour C, Serry Senhaji M, Brusselmans J, Vandenheede M, Berrevoet F, Van Daele E, Willaert W. Global surgery education in Belgium: Student's knowledge, attitudes and exposure. MEDICAL TEACHER 2024; 46:971-977. [PMID: 38071668 DOI: 10.1080/0142159x.2023.2289849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/28/2023] [Indexed: 06/27/2024]
Abstract
PURPOSE Understanding how medical students perceive global surgery will be essential in strengthening the global surgery workforce by 2030. This study investigated the knowledge, attitudes and exposure of Belgian medical students towards global surgery and identified avenues for medical institutions to include meaningful educational opportunities. METHODS An online survey was distributed to first to final year medical students across Belgian universities using social media. Data were collected on demographics, exposure, knowledge and attitudes towards global surgery. Odds ratios with 95% confidence intervals were calculated. RESULTS A total of 304 medical students participated from four Belgian universities. A minority reported having exposure to global surgery (24.7%), and most wanted more exposure (75.3%). Almost all respondents agreed (94.4%) that it is a relevant topic for medical students, and most agreed (71%) more compulsory education on the topic is needed. Only 13 to 44% of students could correctly answer questions testing global surgery knowledge. Personal/family responsibilities were the most important barrier to pursuing global surgery careers. CONCLUSIONS Global surgery knowledge and exposure is limited among Belgian medical students despite interest in the field. These results advocate for the inclusion of decolonised global surgery education alongside equitable international clinical internships in medical education worldwide.
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Affiliation(s)
- Nicholas Rennie
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Eva Degraeuwe
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University Hospital, Ghent, Belgium
| | - Charlotte Deltour
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | | | - Judith Brusselmans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Margo Vandenheede
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Frederik Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Elke Van Daele
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wouter Willaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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16
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Fruhstorfer BH, Jenkins SP, Davies DA, Griffiths F. International short-term placements in health professions education-A meta-narrative review. MEDICAL EDUCATION 2024; 58:797-811. [PMID: 38102955 DOI: 10.1111/medu.15294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION In order to be prepared for professional practice in a globalised world, health professions students need to be equipped with a new set of knowledge, skills and attitudes. Experiential learning gained during an international placement has been considered as a powerful strategy for facilitating the acquisition of global health competencies. The aim of this review was to synthesise the diverse body of empirical research examining the process and outcomes of international short-term placements in health professions education. METHODS A systematic review was conducted using a meta-narrative methodology. Six electronic databases were searched between September 2016 and June 2022: Medline, Embase, CINAHL, PsycINFO, Education Research Complete and Web of Knowledge. Studies were included if they reported on international placements undertaken by undergraduate health professions students in socio-economically contrasting settings. Included studies were first considered within their research tradition before comparing and contrasting findings between different research traditions. RESULTS This review included 243 papers from 12 research traditions, which were distinguished by health profession and paradigmatic approach. Empirical findings were considered in four broad themes: learner, educational intervention, institutional context and wider context. Most studies provided evidence on the learner, with findings indicating a positive impact of international placements on personal and professional development. The development of cultural competency has been more focus in research in nursing and allied health than in medicine. Whereas earlier research has focussed on the experience and outcomes for the learner, more recent studies have become more concerned with relationships between various stakeholder groups. Only few studies have looked at strategies to enhance the educational process. CONCLUSION The consideration of empirical work from different perspectives provides novel understandings of what research has achieved and what needs further investigation. Future studies should pay more attention to the complex nature of the educational process in international placements.
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Affiliation(s)
| | | | - David A Davies
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa
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Arfeen Z, Diaz B, Whitehead CR, Rashid MA. An opportunity to be grateful for? Exploring discourses about international medical graduates from India and Pakistan to the UK between 1960 and 1980. BMJ Glob Health 2024; 9:e014840. [PMID: 38937271 PMCID: PMC11216068 DOI: 10.1136/bmjgh-2023-014840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/21/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Following India and Pakistan gaining independence from British colonial rule, many doctors from these countries migrated to the UK and supported its fledgling National Health Service (NHS). Although this contribution is now widely celebrated, these doctors often faced hardship and hostility at the time and continue to face discrimination and racism in UK medical education. This study sought to examine discursive framings about Indian and Pakistani International Medical Graduates (IPIMGs) in the early period of their migration to the UK, between 1960 and 1980. METHODS We assembled a textual archive of publications relating to IPIMGs in the UK during this time period in The BMJ. We employed critical discourse analysis to examine knowledge and power relations in these texts, drawing on postcolonialism through the contrapuntal approach developed by Edward Said. RESULTS The dominant discourse in this archive was one of opportunity. This included the opportunity for training, which was not available to IPIMGs in an equitable way, the missed opportunity to frame IPIMGs as saviours of the NHS rather than 'cheap labour', and the opportunity these doctors were framed to be held by being in the 'superior' British system, for which they should be grateful. Notably, there was also an opportunity to oppose, as IPIMGs challenged notions of incompetence directed at them. CONCLUSION As IPIMGs in the UK continue to face discrimination, we shed light on how their cultural positioning has been historically founded and engrained in the imagination of the British medical profession by examining discursive trends to uncover historical tensions and contradictions.
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Affiliation(s)
| | - Brett Diaz
- The Wilson Centre, Toronto, Ontario, Canada
| | - Cynthia Ruth Whitehead
- The Wilson Centre, Toronto, Ontario, Canada
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Han SP, Kumwenda B. Bridging the digital divide: Promoting equal access to online learning for health professions in an unequal world. MEDICAL EDUCATION 2024. [PMID: 38860836 DOI: 10.1111/medu.15455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/18/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024]
Abstract
Online learning has the potential to enhance open and equitable access to medical education resources globally. Conversely, there are also concerns that it can perpetuate and exacerbate digital inequalities between developed (global North) and developing (global South) countries. In this article, we describe the historical lack of representation of the global South in the design of online medical education, as well as the resulting consequences and potential solutions. We compare the Northern and Southern views of online learning in medical education and identify the different types of barriers to its adoption. We describe how socioeconomic disparities and the historical dominance of the global North over the global South have led to systemic digital inequalities in the design and implementation of online learning in education generally, and in medical education particularly. The lack of representation of global South voices hinders the development of digital learning solutions relevant to local contexts, therefore limiting their effectiveness and sustainability. Thus, we propose approaches to build more equitable partnerships by soliciting local input and local expertise. Further, we discuss the need to maintain local relevance while setting global standards. Overall, we hope to inform and guide the development of more equitable and accessible online education training for a diverse global population.
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Affiliation(s)
- Siew Ping Han
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ben Kumwenda
- Centre for Medical Education, School of Medicine, University of Dundee, Scotland, UK
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Dholakia K, Audette J, Gamble A, Hartman J. Examining Opportunities Offered Outside of Home Country in Physical Therapy Education: Considering the Colonial History of Global Health. JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00113. [PMID: 38838289 DOI: 10.1097/jte.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/04/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND PURPOSE Increasingly, PT programs in the United States are providing educational experiences outside of the home country (OHC) where faculty and students engage in global health initiatives. It is important to consider that the field of global health has its historical roots in colonialism, which has led to inequities and injustice. Those who are engaged in this work must assist in reversing this colonial legacy. The purpose of this position paper is to present the colonial history of global health, to provide context, and to spark critical reflection among PT educators about how OHC experiences are developed and configured. POSITION AND RATIONALE As a profession, we must educate ourselves about the history of global health and critically reflect on OHC engagements to ensure that we support equity and justice. DISCUSSION AND CONCLUSION We must start by grounding our OHC experiences in health equity and justice. This should be done by considering the colonial history of global health and the privileges we hold as members of academic institutions in the United States. Why we offer OHC experiences in PT education should be investigated and clear to both faculty and students. Excluding this colonial history and its impacts risks perpetuating the historical harms to the health and well-being of the populations we claim to be serving.
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Affiliation(s)
- Kripa Dholakia
- Kripa Dholakia is the assistant professor in the Institute for Physical Therapy Education at the Widener University
- Jennifer Audette is the associate professor in the Westbrook College of Health Professions in the Doctor of Physical Therapy Program at the University of New England, 716 Stevens Avenue, Proctor Hall 214A, Portland, ME 04103 . Please address all correspondence to Jennifer Audette
- April Gamble is the director of The American Center for Rehabilitation, physiotherapy director at Wchan Organization for Victims of Human Rights Violations, and the senior health advisor for Rehabilitation at UK-Med
- Jeff Hartman is the associate professor in the Doctor of Physical Therapy program at the Department of Family Medicine and Community Health in the University of Wisconsin School of Medicine and Public Health
| | - Jennifer Audette
- Kripa Dholakia is the assistant professor in the Institute for Physical Therapy Education at the Widener University
- Jennifer Audette is the associate professor in the Westbrook College of Health Professions in the Doctor of Physical Therapy Program at the University of New England, 716 Stevens Avenue, Proctor Hall 214A, Portland, ME 04103 . Please address all correspondence to Jennifer Audette
- April Gamble is the director of The American Center for Rehabilitation, physiotherapy director at Wchan Organization for Victims of Human Rights Violations, and the senior health advisor for Rehabilitation at UK-Med
- Jeff Hartman is the associate professor in the Doctor of Physical Therapy program at the Department of Family Medicine and Community Health in the University of Wisconsin School of Medicine and Public Health
| | - April Gamble
- Kripa Dholakia is the assistant professor in the Institute for Physical Therapy Education at the Widener University
- Jennifer Audette is the associate professor in the Westbrook College of Health Professions in the Doctor of Physical Therapy Program at the University of New England, 716 Stevens Avenue, Proctor Hall 214A, Portland, ME 04103 . Please address all correspondence to Jennifer Audette
- April Gamble is the director of The American Center for Rehabilitation, physiotherapy director at Wchan Organization for Victims of Human Rights Violations, and the senior health advisor for Rehabilitation at UK-Med
- Jeff Hartman is the associate professor in the Doctor of Physical Therapy program at the Department of Family Medicine and Community Health in the University of Wisconsin School of Medicine and Public Health
| | - Jeff Hartman
- Kripa Dholakia is the assistant professor in the Institute for Physical Therapy Education at the Widener University
- Jennifer Audette is the associate professor in the Westbrook College of Health Professions in the Doctor of Physical Therapy Program at the University of New England, 716 Stevens Avenue, Proctor Hall 214A, Portland, ME 04103 . Please address all correspondence to Jennifer Audette
- April Gamble is the director of The American Center for Rehabilitation, physiotherapy director at Wchan Organization for Victims of Human Rights Violations, and the senior health advisor for Rehabilitation at UK-Med
- Jeff Hartman is the associate professor in the Doctor of Physical Therapy program at the Department of Family Medicine and Community Health in the University of Wisconsin School of Medicine and Public Health
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Muchatuta M, Patel S, Gonzalez Marquez C, Thilakasiri K, Manian SV, Chan J, Mssika N, Clark T, Burkholder T, Turgeon N, Kampalath VN, Poola N, Offorjebe OA, Dozois A, Hyuha G, Vaughan‐Ogunlusi O, McCammon C, Wells K, Rybarczk M, Castillo MP, Adeyeye AA, Rees CA, Dutta S, Garbern SC. Building a framework to decolonize global emergency medicine. AEM EDUCATION AND TRAINING 2024; 8:e10982. [PMID: 38765709 PMCID: PMC11099782 DOI: 10.1002/aet2.10982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 05/22/2024]
Abstract
Background Global emergency medicine (GEM) is situated at the intersection of global health and emergency medicine (EM), which is built upon a history of colonial systems and institutions that continue to reinforce inequities between high-income countries (HICs) and low- and middle-income countries (LMICs) today. These power imbalances yield disparities in GEM practice, research, and education. Approach The Global Emergency Medicine Academy (GEMA) of the Society for Academic Emergency Medicine formed the Decolonizing GEM Working Group in 2020, which now includes over 100 worldwide members. The mission is to address colonial legacies in GEM and catalyze sustainable changes and recommendations toward decolonization at individual and institutional levels. To develop recommendations to decolonize GEM, the group conducted a nonsystematic review of existing literature on decolonizing global health, followed by in-depth discussions between academics from LMICs and HICs to explore implications and challenges specific to GEM. We then synthesized actionable solutions to provide recommendations on decolonizing GEM. Results Despite the rapidly expanding body of literature on decolonizing global health, there is little guidance specific to the relatively new field of GEM. By applying decolonizing principles to GEM, we suggest key priorities for improving equity in academic GEM: (1) reframing partnerships to place LMIC academics in positions of expertise and power, (2) redirecting research funding toward LMIC-driven projects and investigators, (3) creating more equitable practices in establishing authorship, and (4) upholding principles of decolonization in the education of EM trainees from LMICs and HICs. Conclusions Understanding the colonial roots of GEM will allow us to look more critically at current health disparities and identify inequitable institutionalized practices within our profession that continue to uphold these misguided concepts. A decolonized future of GEM depends on our recognition and rectification of colonial-era practices that shape structural determinants of health care delivery and scientific advancement.
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Affiliation(s)
- Monalisa Muchatuta
- Department of Emergency MedicineSUNY Downstate Medical CenterBrooklynNew YorkUSA
| | - Shama Patel
- Department of Emergency MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | | | - Kaushila Thilakasiri
- Ministry of Health Sri LankaOxford University Hospitals NHS TrustColomboSri Lanka
| | | | - Jennifer Chan
- Department of Emergency MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Ngassa Mssika
- Department of Emergency MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Taryn Clark
- Department of Emergency MedicineSUNY Downstate Medical CenterBrooklynNew YorkUSA
| | - Taylor Burkholder
- Department of Emergency MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Nikkole Turgeon
- Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Vinay N. Kampalath
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Nivedita Poola
- Department of Emergency MedicineSUNY Downstate Medical CenterBrooklynNew YorkUSA
| | - O. Agatha Offorjebe
- Department of Emergency Medicine, Alpert MedicalSchool of Brown UniversityProvidenceRhode IslandUSA
| | - Adeline Dozois
- Department of Emergency MedicineAtrium Health Carolinas Medical CenterCharlotteNorth CarolinaUSA
| | - Gimbo Hyuha
- Department of Emergency MedicineMuhimbili University of Health And Allied ScienceDar es SalaamTanzania
| | | | - Carol McCammon
- Department of Emergency MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Katie Wells
- Department of Emergency MedicineThe University of VermontBurlingtonVermontUSA
| | - Megan Rybarczk
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Maria Paula Castillo
- Department of Emergency MedicineUniversidad de Ciencias MedicasSan JoseCosta RicaUSA
| | | | - Chris A. Rees
- Emory University School of MedicineAtlantaGeorgiaUSA
| | - Sanjukta Dutta
- Department of Emergency MedicineFortis HospitalKolkataIndia
| | - Stephanie Chow Garbern
- Department of Emergency Medicine, Alpert MedicalSchool of Brown UniversityProvidenceRhode IslandUSA
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Adsul P, Shelton RC, Oh A, Moise N, Iwelunmor J, Griffith DM. Challenges and Opportunities for Paving the Road to Global Health Equity Through Implementation Science. Annu Rev Public Health 2024; 45:27-45. [PMID: 38166498 DOI: 10.1146/annurev-publhealth-060922-034822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Implementation science focuses on enhancing the widespread uptake of evidence-based interventions into routine practice to improve population health. However, optimizing implementation science to promote health equity in domestic and global resource-limited settings requires considering historical and sociopolitical processes (e.g., colonization, structural racism) and centering in local sociocultural and indigenous cultures and values. This review weaves together principles of decolonization and antiracism to inform critical and reflexive perspectives on partnerships that incorporate a focus on implementation science, with the goal of making progress toward global health equity. From an implementation science perspective, wesynthesize examples of public health evidence-based interventions, strategies, and outcomes applied in global settings that are promising for health equity, alongside a critical examination of partnerships, context, and frameworks operationalized in these studies. We conclude with key future directions to optimize the application of implementation science with a justice orientation to promote global health equity.
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Affiliation(s)
- Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA;
- Cancer Control and Population Science Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - April Oh
- National Cancer Institute, Rockville, Maryland, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Juliet Iwelunmor
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Tackett S, Steinert Y, Mirabal S, Reed DA, Whitehead CR, Wright SM. Blind spots in medical education - International perspectives. MEDICAL TEACHER 2024:1-7. [PMID: 38688493 DOI: 10.1080/0142159x.2024.2345271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND All individuals and groups have blind spots that can create problems if unaddressed. The goal of this study was to examine blind spots in medical education from international perspectives. METHODS From December 2022 to March 2023, we distributed an electronic survey through international networks of medical students, postgraduate trainees, and medical educators. Respondents named blind spots affecting their medical education system and then rated nine blind spot domains from a study of U.S. medical education along five-point Likert-type scales (1 = much less attention needed; 5 = much more attention needed). We tested for differences between blind spot ratings by respondent groups. We also analyzed the blind spots that respondents identified to determine those not previously described and performed content analysis on open-ended responses about blind spot domains. RESULTS There were 356 respondents from 88 countries, including 127 (44%) educators, 80 (28%) medical students, and 33 (11%) postgraduate trainees. At least 80% of respondents rated each blind spot domain as needing 'more' or 'much more' attention; the highest was 88% for 'Patient perspectives and voices that are not heard, valued, or understood.' In analyses by gender, role in medical education, World Bank country income level, and region, a mean difference of 0.5 was seen in only five of the possible 279 statistical comparisons. Of 885 blind spots documented, new blind spot areas related to issues that crossed national boundaries (e.g. international standards) and the sufficiency of resources to support medical education. Comments about the nine blind spot domains illustrated that cultural, health system, and governmental elements influenced how blind spots are manifested across different settings. DISCUSSION There may be general agreement throughout the world about blind spots in medical education that deserve more attention. This could establish a basis for coordinated international effort to allocate resources and tailor interventions that advance medical education.
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Affiliation(s)
- Sean Tackett
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Yvonne Steinert
- Faculty of Medicine and Health Sciences, Richard and Sylvia Cruess Chair in Medical Education, McGill University, Montreal, Canada
| | - Susan Mirabal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Darcy A Reed
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Division of Community Internal Medicine, Geriatrics and Palliative Care, Mayo Clinic, Rochester, MN, USA
| | - Cynthia R Whitehead
- Department of Family and Community Medicine, Wilson Centre for Research in Education, University Health Network & University of Toronto, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Scott M Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Luthuli S, Daniel M, Corbin JH. Power imbalances and equity in the day-to-day functioning of a north plus multi-south higher education institutions partnership: a case study. Int J Equity Health 2024; 23:59. [PMID: 38491440 PMCID: PMC10943907 DOI: 10.1186/s12939-024-02139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Partnerships between Higher Education Institutions (HEIs) in the global north and south have commonly been used as a vehicle to drive global health research and initiatives. Among these initiatives, include health system strengthening, research capacity building, and human resource training in developing countries. However, the partnership functioning of many global north-south partnerships still carry legacies of colonialism through unrecognized behavior patterns, attitudes, and belief systems in how they function. Even with research literature calling for a shift from equality to equity in the functioning of these partnerships, many still struggle with issues of complex and unspoken power dynamics. To understand the successes and challenges of north-south partnerships, this paper explored partnership development and functioning of a northern and multi-southern HEIs partnership focused on nutrition education and research. METHODS A qualitative research approach was used; data were collected through in-depth interviews (IDIs) with questions developed from the Bergen Model of Collective Functioning (BMCF). Thirteen IDIs were conducted with partners from all institutions including stakeholders. FINDINGS The partnership was built on the foundation of experiences and lessons of a previous partnership. Partners used these experiences and lessons to devise strategies to improve partnership inputs, communication, leadership, roles and structures, and maintenance and communication tasks. However, these strategies had an impact on partnership functioning giving rise to issues of inequitable power dynamics. The northern partner had two roles: one as an equal partner and another as distributor of project funds; this caused a conflict in roles for this partner. The partners distinguished themselves according to partner resources - two partners were named implementing partners and two named supportive partners. Roles and partner resources were the greatest contributors to power imbalances and caused delays in project activities. CONCLUSION Using the BMCF to examine partnership dynamics illuminated that power imbalances caused a hierarchical stance in the partnership with northern partners having overall control and power of decision-making in the partnership. This could impact the effectiveness and sustainability of project in the southern institutions going forward.
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Affiliation(s)
- Silondile Luthuli
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Marguerite Daniel
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - J Hope Corbin
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
- Department of Health and Community Studies, Western Washington University, Bellingham, WA, USA
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Bhatia MB, Anderson CM, Hussein AN, Opondo B, Aruwa N, Okumu O, Fisher SG, Joplin TS, Hunter-Squires JL, Gray BW, Saula PW. Bilateral Exchange: Enteral Nutrition Clinical Decision Making in Pediatric Surgery Patients. J Surg Res 2024; 295:139-147. [PMID: 38007861 DOI: 10.1016/j.jss.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/15/2023] [Accepted: 10/28/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Evidence-based medicine guides clinical decision-making; however, promoting enteral nutrition has historically followed a dogmatic approach in which patients graduate from clear liquids to full liquids to a regular diet after return of bowel function. Enhanced recovery after surgery has demonstrated that early enteral nutrition initiation is associated with shorter hospital stays. We aimed to understand postoperative pediatric nutrition practices in Kenya and the United States. METHODS We completed a prospective observational study of pediatric surgery fellows during clinical rounds in a pediatric referral center in Kenya (S4A) and one in the United States (Riley). Fellow-patient interactions were observed from postoperative day one to discharge or postoperative day 30, whichever happened first. Patient demographic, operative information, and daily observations including nutritional status were collected via REDCap. RESULTS We included 75 patients with 41 (54.7%) from Kenya; patients in Kenya were younger with 40% of patients in Kenya presenting as neonates. Median time to initiation and full enteral nutrition was shorter for the patients at Riley when compared to their counterparts at S4A. In the neonatal subgroup, patients at S4A initiated enteral nutrition sooner, but their hospital length of stays were not significantly different. CONCLUSIONS Studying current nutrition practices may guide early enteral nutrition protocols. Implementing these protocols, particularly in a setting where enteral nutrition alternatives are minimal, may provide evidence of success and overrule dogmatic nutrition advancement. Studying implementation of these protocols in resource-constrained areas, where patient length of stay is often related to socioeconomic factors, may identify additional benefits to patients.
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Affiliation(s)
- Manisha B Bhatia
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| | | | | | - Brian Opondo
- Department of Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Nereah Aruwa
- Department of Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Otieno Okumu
- Department of Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sarah G Fisher
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tasha Sparks Joplin
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - JoAnna L Hunter-Squires
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Anaesthesia and Surgery, Moi University, Eldoret, Kenya
| | - Brian W Gray
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatric Surgery, Riley Hospital for Children, Indianapolis, Indiana
| | - Peter W Saula
- Department of Anaesthesia and Surgery, Moi University, Eldoret, Kenya; Department of Paediatric Surgery, Shoe4Africa Children's Hospital, Eldoret, Kenya
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25
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Acosta D, Stark H, Hack G. The importance of incorporating systems thinking and One Health in global health classrooms: findings from a One Health simulation activity. Front Public Health 2024; 12:1299116. [PMID: 38481838 PMCID: PMC10933002 DOI: 10.3389/fpubh.2024.1299116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/19/2024] [Indexed: 05/04/2024] Open
Abstract
There are several challenges and opportunities in health education in global health. Given the field's rapid expansion, demand for including systems thinking and One Health (a unifying approach that considers human, animal, and environmental health) in global health courses has recently increased. Simulation activities provide an avenue to attain and assess learning objectives that foster critical and systems thinking. This study carried out a One Health simulation activity in an undergraduate global health course, conducted a focus group discussion, and obtained responses from written questionnaires from students who participated in the activity. Data were analyzed using thematic analysis. Results show that the One Health simulation was instrumental for students to understand the complex interactions between different actors and stakeholders in global health systems. The One Health simulation also improved class dynamics, peer-to-peer interactions, and collaborations in the remaining part of the course. The activity helped assess two of the critical thinking learning objectives of the course, and there was some evidence that student agency and confidence may have been improved. Evidence shows that the activity helped students understand the principles of systems thinking and apply them in complex scenarios. Findings support including interactive simulation activities in global health courses to include elements of system science and One Health into classroom activities innovatively and engagingly.
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Affiliation(s)
- Daniel Acosta
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Heather Stark
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - George Hack
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
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Kesande M, Jere J, McCoy SI, Walekhwa AW, Nkosi-Mjadu BE, Ndzerem-Shang E. Self-Determination in Global Health Practices - Voices from the Global South. Ann Glob Health 2024; 90:16. [PMID: 38435470 PMCID: PMC10906336 DOI: 10.5334/aogh.4162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 02/10/2024] [Indexed: 03/05/2024] Open
Abstract
Despite the commendable progress made in addressing global health challenges and threats such as child mortality, HIV/AIDS, and Tuberculosis, many global health organizations still exhibit a Global North supremacy attitude, evidenced by their choice of leaders and executors of global health initiatives in low- and middle-income countries (LMICs). While efforts by the Global North to support global health practice in LMICs have led to economic development and advancement in locally led research, current global health practices tend to focus solely on intervention outcomes, often neglecting important systemic factors such as intellectual property ownership, sustainability, diversification of leadership roles, and national capacity development. This has resulted in the implementation of practices and systems informed by high-income countries (HICs) to the detriment of knowledge systems in LMICs, as they are deprived of the opportunity to generate local solutions for local problems. From their unique position as international global health fellows located in different African countries and receiving graduate education from a HIC institution, the authors of this viewpoint article assess how HIC institutions can better support LMICs. The authors propose several strategies for achieving equitable global health practices; 1) allocating funding to improve academic and research infrastructures in LMICs; 2) encouraging effective partnerships and collaborations with Global South scientists who have lived experiences in LMICs; 3) reviewing the trade-related aspects of intellectual property Rights (TRIPS) agreement; and 4) achieving equity in global health funding and education resources.
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Affiliation(s)
- Maureen Kesande
- University of California, Berkeley, School of Public Health, 2121 Berkeley Way, Room 2220 Berkeley, CA 94720-7360, US
| | - Jane Jere
- University of California, Berkeley, School of Public Health, 2121 Berkeley Way, Room 2220 Berkeley, CA 94720-7360, US
| | - Sandra I. McCoy
- University of California, Berkeley, School of Public Health, 2121 Berkeley Way, Room 2220 Berkeley, CA 94720-7360, US
| | - Abel Wilson Walekhwa
- Diseases Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Bongekile Esther Nkosi-Mjadu
- University of California, Berkeley, School of Public Health, 2121 Berkeley Way, Room 2220 Berkeley, CA 94720-7360, US
| | - Eunice Ndzerem-Shang
- University of California, Berkeley, School of Public Health, 2121 Berkeley Way, Room 2220 Berkeley, CA 94720-7360, US
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27
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Umphrey L, Beck A, Zhou S, Kagoya EK, Paasi G, Coria A, Evert J, Haque M, Rule A, Lamb MM. Access, interest and equity considerations for virtual global health activities during the COVID-19 pandemic: a cross-sectional study. Glob Health Res Policy 2024; 9:8. [PMID: 38317192 PMCID: PMC10845763 DOI: 10.1186/s41256-023-00333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/08/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Global health activities (GHAs) reduce health disparities by promoting medical education, professional development, and resource sharing between high- and low- to middle-income countries (HICs and LMICs). Virtual global health activities facilitated continuity and bidirectionality in global health during the COVID-19 pandemic. While virtual engagement holds potential for promoting equity within partnerships, research on equitable access to and interest in virtual global health activities is limited. METHODS We conducted a cross-sectional, online, mixed-methods survey from January to February 2022 examining access to virtual activities before and during the pandemic across resource settings. Eligible participants were participants or facilitators of global health activities. Closed- and open-ended questions elicited participants' access to and interest in virtual global health engagement. RESULTS We analyzed 265 surveys from respondents in 45 countries (43.0% LMIC vs. HIC 57.0%). HIC respondents tended to report greater loss of in-person access due to the pandemic at their own institutions (16 of 17 queried GHAs), while LMIC respondents tended to report greater loss of in-person activities at another institution (9 of 17 queried GHAs). Respondents from LMICs were more likely to gain virtual access through another organization for all 17 queried VGHAs. HIC respondents had significantly more access to global health funding through their own organization (p < 0.01) and more flexibility for using funds. There were significant differences and trends between respondent groups in different resource environments in terms of accessibility to and interest in different virtual global health activities, both during and after the pandemic. CONCLUSIONS Our results highlight the need to examine accessibility to virtual global health activities within partnerships between high- and low- to middle-income countries. While virtual activities may bridge existing gaps in global health education and partnerships, further study on priorities and agenda setting for such initiatives, with special attention to power dynamics and structural barriers, are necessary to ensure meaningful virtual global health engagement moving forward.
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Affiliation(s)
- Lisa Umphrey
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16th Ave, B302, Aurora, CO, 80045, USA.
- Center for Global Health, Colorado School of Public Health, 13199 E Montview Blvd, Ste 310, A090, Aurora, CO, 80045, USA.
| | - Alyssa Beck
- Department of Epidemiology, Colorado School of Public Health, 13199 E Montview Blvd, Ste 310, A090, Aurora, CO, 80045, USA
| | - Shuo Zhou
- Department of Communication Studies, School of Communication and System Health Lab, Hong Kong Baptist University, No. 5 Hereford Rd, Kowloon, Hong Kong
| | - Enid Kawala Kagoya
- Department of Community Health, Institute of Public Health, Busitema University, P.O Box 1460, Mbale, Uganda
- Mbale Clinical Research Institute, Plot 29, 33 Pallisa, Mbale, Uganda
| | - George Paasi
- Mbale Clinical Research Institute, Plot 29, 33 Pallisa, Mbale, Uganda
| | - Alexandra Coria
- Department of Pediatrics, Maimonides Children's Hospital and SUNY Downstate College of Medicine, 4802 10th Ave, Brooklyn, NY, 11219, USA
| | - Jessica Evert
- Child Family Health International, 11135 San Pablo Ave #929, El Cerrito, CA, 94530, USA
| | - Marina Haque
- Department of Anesthesiology, Wayne State University, Detroit, MI, 48202, USA
| | - Amy Rule
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA, 30307, USA
- Children's Healthcare of Atlanta, 2015 Uppergate Dr, Atlanta, GA, 30307, USA
| | - Molly M Lamb
- Center for Global Health, Colorado School of Public Health, 13199 E Montview Blvd, Ste 310, A090, Aurora, CO, 80045, USA
- Department of Epidemiology, Colorado School of Public Health, 13199 E Montview Blvd, Ste 310, A090, Aurora, CO, 80045, USA
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28
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Crichton L, Daniels K, Merrylees N, Mukanyangezi MF, Sonkwe HM, Nduwayezu R, Thomson E. Teaching Scottish medical students about global health in partnership with LMIC institutions. Does it change their views on volunteering in LMIC settings? BMC MEDICAL EDUCATION 2024; 24:65. [PMID: 38229034 DOI: 10.1186/s12909-024-05034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
CONTEXT An elective placement is a core part of most United Kingdom (UK) medical degrees, and a significant proportion of students choose to pursue their elective in low- and middle-income countries (LMIC). There is a risk that students are ill-prepared for some of the ethical challenges that they will face during these placements, and that they have little appreciation for some of the negative effects that their placement can have on the host healthcare system. This study sought to address some of these negative consequences by exploring the preparation of medical students for these experiences, and the effect of including the LMIC perspective in preparation materials. METHODS This qualitative study used thematic analysis to explore the attitudes of final year medical students at a Scottish medical school to international volunteering, after completing a module on global health. This module was designed and delivered in partnership with academics from Malawi, Rwanda and Zambia, thus incorporating a strong LMIC perspective. FINDINGS This study demonstrated the ability of a global health module with a strong LMIC perspective to influence the attitudes of final year medical students in the following ways: 1) Challenging assumptions around international volunteering and, in particular, around some of the negative effects of international volunteering that had not previously been considered. 2) Changing future practice around international volunteering. IMPLICATIONS This study provides good evidence that having a strong LMIC voice in preparation materials for medical students embarking on LMIC electives has the ability to increase awareness of some of the potential harms, and to positively influence how they plan to have discussions around and approach such experiences in the future.
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Affiliation(s)
| | - Katy Daniels
- School of Medicine, University of Dundee, Dundee, Scotland
| | - Neil Merrylees
- School of Medicine, University of Dundee, Dundee, Scotland
| | | | | | | | - Emma Thomson
- Kamuzu University of Health Sciences, Blantyre, Malawi.
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29
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Bain LE, Adeagbo OA, Avoka CK, Amu H, Memiah P, Ebuenyi ID. Identifying the conundrums of "global health" in the Global North and Global South: a case for Sub-Saharan Africa. Front Public Health 2024; 12:1168505. [PMID: 38288006 PMCID: PMC10822900 DOI: 10.3389/fpubh.2024.1168505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024] Open
Affiliation(s)
- Luchuo Engelbert Bain
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- International Development Research Centre (IDRC), Ottawa, ON, Canada
| | - Oluwafemi Atanda Adeagbo
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, United States
- Department of Sociology, University of Johannesburg, Johannesburg, South Africa
| | - Cephas K. Avoka
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Hubert Amu
- Population and Behavioural Sciences, University of Health and Allied Sciences, Hohoe, Ghana
| | - Peter Memiah
- Division of Epidemiology and Prevention, University of Maryland School of Medicine, Baltimore, MA, United States
| | - Ikenna D. Ebuenyi
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, United States
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30
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Lebu S, Musoka L, Graham JP. Reflective questioning to guide socially just global health reform: a narrative review and expert elicitation. Int J Equity Health 2024; 23:3. [PMID: 38183120 PMCID: PMC10770991 DOI: 10.1186/s12939-023-02083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/15/2023] [Indexed: 01/07/2024] Open
Abstract
Recent research has highlighted the impacts of colonialism and racism in global health, yet few studies have presented concrete steps toward addressing the problems. We conducted a narrative review to identify published evidence that documented guiding frameworks for enhancing equity and inclusion in global health research and practice (GHRP). Based on this narrative review, we developed a questionnaire with a series of reflection questions related on commonly reported challenges related to diversity, inclusion, equity, and power imbalances. To reach consensus on a set of priority questions relevant to each theme, the questionnaire was sent to a sample of 18 global health experts virtually and two rounds of iterations were conducted. Results identified eight thematic areas and 19 reflective questions that can assist global health researchers and practitioners striving to implement socially just global health reforms. Key elements identified for improving GHRP include: (1) aiming to understand the historical context and power dynamics within the areas touched by the program; (2) promoting and mobilizing local stakeholders and leadership and ensuring measures for their participation in decision-making; (3) ensuring that knowledge products are co-produced and more equitably accessible; (4) establishing a more holistic feedback and accountability system to understand needed reforms based on local perspectives; and (5) applying systems thinking to addressing challenges and encouraging approaches that can be sustained long-term. GHRP professionals should reflect more deeply on how their goals align with those of their in-country collaborators. The consistent application of reflective processes has the potential to shift GHRP towards increased equity.
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Affiliation(s)
- Sarah Lebu
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA.
- University of North Carolina, Gillings School of Public Health, Chapel Hill, NC, USA.
| | - Lena Musoka
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA
- Georgetown University, McDonough School of Business, Washington, DC, USA
| | - Jay P Graham
- School of Public Health, University of California Berkeley, 2121, Berkeley Way, Berkeley, CA, 94704, USA
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31
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Fanny SA, Tam RP, Rule A, Barnes A, Haq H. Transforming Pediatric Global Health Education Through Antiracist and Anticolonial Principles. Pediatrics 2024; 153:e2023062612. [PMID: 38173415 DOI: 10.1542/peds.2023-062612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
| | | | - Amy Rule
- Emory School of Medicine, Atlanta, Georgia
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Adelaide Barnes
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Heather Haq
- Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, Texas
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32
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Aryal A, Garcia FB, Scheitler AJ, Faraon EJA, Moncatar TJRT, Saniel OP, Lorenzo FME, Rosadia RAF, Shimkhada R, Macinko J, Ponce NA. Evolving academic and research partnerships in global health: a capacity-building partnership to assess primary healthcare in the Philippines. Glob Health Action 2023; 16:2216069. [PMID: 37249029 PMCID: PMC10231040 DOI: 10.1080/16549716.2023.2216069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. In this paper, we offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions. The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary healthcare in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior healthcare experience. We describe here the progression of the partnership between these institutions to carry out the project and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health.
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Affiliation(s)
- Anu Aryal
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Fernando B. Garcia
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - A. J. Scheitler
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Emerito Jose A. Faraon
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - T. J. Robinson T. Moncatar
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Ofelia P. Saniel
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Fely Marilyn E. Lorenzo
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Roberto Antonio F. Rosadia
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Riti Shimkhada
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
| | - James Macinko
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Ninez A. Ponce
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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Hussain M, Sadigh M, Sadigh M, Rastegar A, Sewankambo N. Colonization and decolonization of global health: which way forward? Glob Health Action 2023; 16:2186575. [PMID: 36940174 PMCID: PMC10035955 DOI: 10.1080/16549716.2023.2186575] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/27/2023] [Indexed: 03/21/2023] Open
Abstract
Despite taking on several forms throughout history such as colonial medicine, tropical medicine, and international health, the field of global health continues to uphold colonialist structures. History demonstrates that acts of colonialism inevitably lead to negative health outcomes. Colonial powers promoted medical advancements when diseases affected their own people, and only did so for locals when in the colonies' best interests. Numerous medical advancements in the United States also relied on the exploitation of vulnerable populations. This history is critical in evaluating the actions of the United States as a proclaimed leader in global health. A significant barrier to progress in the field of global health is that most leaders and leading institutions are located in high-income countries, thereby defining the global standard. This standard fails to meet the needs of most of the world. In times of crisis, such as the COVID-19 pandemic, colonial mentalities may be more evident. In fact, global health partnerships themselves are often ingrained in colonialism and may be counterproductive. Strategies for change have been called into question by the recent Black Lives Matter movement, particularly in evaluating the role that less privileged communities should have in their own fate. Globally, we can commit to evaluating our own biases and learning from one another.
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Affiliation(s)
| | - Mitra Sadigh
- Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Majid Sadigh
- Department of Education and Innovation, Nuvance Health/University of Vermont College of Medicine, Burlington, NJ, USA
| | - Asghar Rastegar
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Nelson Sewankambo
- Makerere College of Health Sciences, Makerere University School of Medicine, Kampala, Uganda
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Makhene A. Decolonisation of the nursing education curriculum in Gauteng province, South Africa: A concept analysis. Health SA 2023; 28:2449. [PMID: 38204864 PMCID: PMC10778403 DOI: 10.4102/hsag.v28i0.2449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 09/05/2023] [Indexed: 01/12/2024] Open
Abstract
Background Decolonisation of the nursing education curriculum has become more important than ever. The nursing profession has been colonised since its founding era by Florence Nightingale. Victorian curriculum has been taught over decades in nursing. There is a knowledge gap of what decolonisation means in the profession. Aim The purpose of this article is to describe the concept analysis process that was followed to clarify the concept of 'decolonisation' of the curriculum, provide conceptual meaning in nursing education, and formulate a theoretical definition. Setting Nursing education practice in Gauteng. Methods Definitions, nature, characteristics, and uses of decolonisation were sought and the researchers explored 52 publications, which included dictionaries, encyclopaedias, thesauri, conference articles, research reports, journal articles and subject-related literature across multiple disciplines, to critically analyse the concept 'decolonisation'. A 10-year period from 2012 to 2022 was used to search several databases. Results Defining attributes that included antecedents, process and consequences of decolonisation emerged. The antecedents were awareness, identification of colonial knowledge and thought, colonial attitudes, colonialism, racism, exclusion, denial of colonial systems and curriculum and colonial legacies in nursing education. Events after decolonisation are called consequences. Conclusion The formulated theoretical definition of 'decolonisation' will be operationalised as further research takes place to come up with a conceptual framework for a decolonised socially just nursing curriculum. Contribution This study aimed to contribute towards the understanding of what decolonisation means within nursing education and lead to development of models, theories, and strategies on how decolonisation of the nursing curriculum can be undertaken.
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Affiliation(s)
- Agnes Makhene
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Scott EM, Enumah ZO, Mehta K, Kontchou NA, Davis RW. Practical and Ethical Guidelines for the Involvement of Trainees in Global Surgery: Consensus Statement and Recommendations from the Resident and Associate Society of the American College of Surgeons Global Surgery Work Group. J Am Coll Surg 2023; 237:885-892. [PMID: 37702398 DOI: 10.1097/xcs.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND The guidelines provided by US professional surgical organizations for involvement of trainees in global surgery are limited. The aim of this consensus statement is to provide surgical trainees with official recommendations from the Resident and Associate Society of the American College of Surgeons Global Surgery Work Group (GSWG) regarding professional, practical, and ethical guidelines for participation in global surgery endeavors. STUDY DESIGN A task force was created within the GSWG to review and define the scope of involvement of trainees in global surgery, and a consensus process was undertaken for the group at large to approve a set of proposed guidelines. RESULTS The list of practical and ethical guidelines for the engagement of trainees in global surgery covering the themes of preparedness, reciprocity and collaboration, ethical considerations, and sustainability was approved with consensus from the GSWG. CONCLUSIONS This consensus statement from the Resident and Associate Society of the American College of Surgeons GSWG outlines the official recommendations for guidelines for involvement of trainees in global surgery, with an aim to support equitable, sustainable collaborations that center on improving access to safe, timely, and affordable surgical care for the global community at large. Future processes seek to involve representation and perspectives from a larger body of low- to middle-income country surgical trainees.
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Affiliation(s)
- Erin M Scott
- From the Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA (Scott)
| | - Zachary O Enumah
- From the Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA (Scott)
| | - Kajal Mehta
- From the Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA (Scott)
| | - Nelly-Ange Kontchou
- From the Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA (Scott)
| | - Rachel W Davis
- From the Department of Surgery, University of Massachusetts Chan Medical School, Worcester, MA (Scott)
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Mehta N, Fernandes C, Llerena C, Weine S, Bosland MC. Developing a global medicine student pre- and post-travel curriculum. BMC MEDICAL EDUCATION 2023; 23:735. [PMID: 37803366 PMCID: PMC10559584 DOI: 10.1186/s12909-023-04606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/22/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND The popularity of short-term global health experiences amongst US medical students has been increasing. However, it remains a challenge for medical schools to comprehensively prepare students to work in an international environment and to contribute in ethically responsible and meaningful ways. Students of the Global Medicine program (GMED) of the UIC College of Medicine Center for Global Health set out to develop a pre-and-post travel curriculum that addresses some of these challenges. METHODS The students surveyed the literature of 66 published global health curricula and identified aspects of pre-and-post travel training that were found to be under-addressed. They then developed a curriculum in conjunction with GMED faculty that incorporated these identified aspects of pre-and-post travel training. RESULTS Five aspects of pre-and-post travel training were identified as being under-addressed in the literature while traveling. These domains include: [1] examining power relations associated with neo-colonization between and within countries; [2] training for bi-directional learning; [3] examining motivations and goals for participating in global health; [4] addressing personal resiliency and psychosocial wellbeing related to students' travel, and; [5] reflecting on the challenging aspects of the fieldwork experience. CONCLUSIONS The student-driven curriculum is being integrated into the GMED program through structured didactic sessions, one-on-one mentor meetings and small group discussions. Once students have traveled, the curriculum will be evaluated with the foreign partners they visited.
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Affiliation(s)
- Natasha Mehta
- Department of Internal Medicine, Stanford University, Stanford, CA, 94304, USA.
| | - Caroline Fernandes
- Center for Global Health, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Christopher Llerena
- Center for Global Health, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Stevan Weine
- Center for Global Health, University of Illinois at Chicago, Chicago, IL, 60612, USA
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Maarten C Bosland
- Center for Global Health, University of Illinois at Chicago, Chicago, IL, 60612, USA
- Department of Pathology, University of Illinois at Chicago, Chicago, IL, 60612, USA
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Kulesa J, Crawford L, Ferrer K, Thahane L, Sanders J, Ottolini M, Chua I. Cultural Considerations for Patient and Community Education in Global Health: A Qualitative Study in Lesotho. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 44:55-63. [PMID: 37724028 DOI: 10.1177/0272684x221074447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Background: In global health, international nongovernmental organizations (NGOs) frequently hire, train, and partner with host-country clinicians who manage public outreach and patient care. Purpose and Research Design: We conducted a general interpretivist study of Basotho clinicians hired by NGOs and academic affiliates in Lesotho to identify cultural barriers and facilitators to community and patient education. Data Collection and Analysis: We conducted 13 interviews involving 16 participants (one physician, one nutritionist, 14 nurses). Using an inductive and iterative approach, we analyzed interview transcripts through the lens of social cognitive theory and identified 15 themes. Results: Major findings highlighted: 1) patient and community learners may view Basotho clinicians as authority figures; 2) family and community power dynamics affect healthcare access for vulnerable patient groups; and 3) village leaders may refuse community education when excluded from problem-solving and early planning. Conclusions: Although local clinicians and community members may identify with the same cultural group, clinicians can encounter cultural barriers to patient and community education.
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Affiliation(s)
- John Kulesa
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | | | - Kathleen Ferrer
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | - Lineo Thahane
- Baylor College of Medicine, Children's Foundation - Lesotho, Maseru, Lesotho
- Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine, International Pediatric AIDS Initiative, Houston, TX. USA
| | - Jill Sanders
- Baylor College of Medicine, Children's Foundation - Lesotho, Maseru, Lesotho
| | | | - Ian Chua
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
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Banerjee AT, Tan A, Boston-Fisher N, Dubois CA, LaFontaine A, Cloos P, Vissandjee B, Adams J, Hafeez H, Bumba S, Kernisan K, Ferlatte O, Razack S, Edwards MM, Evans T. Embedding anti-racism in Schools of Public Health: a pathway to accountability for progress towards equity. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:872-877. [PMID: 37410365 PMCID: PMC10486309 DOI: 10.17269/s41997-023-00796-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
The importance of seeing race as a socially constructed idea continues to produce unfair differences between humans and establishes power relations that lead to injustice and exposure to death. Since the racial justice movement in early 2020, there has been a heightened awareness of, and increased interest in, addressing historic racial disparities across Schools of Public Health (SPH) in Canada. Steps have been taken to recognize systemic racism and increase diversity through structural reforms to advance equity and inclusion; however, addressing racism demands collectively uprooting racist institutional designs still inherent in learning, teaching, research, service, and community engagement. This commentary highlights the need for sustained commitment to establishing longitudinal benchmarks for greater racial equity among students, staff, and faculty; revising curricula to include historic and contemporary narratives of colonialism and slavery; and providing community-engaged learning opportunities as instrumental to dismantle systemic drivers of racial health inequities locally and globally. We also advocate for intersectoral collaboration, mutual learning, and sharing of resources across SPH and partner agencies to accomplish a continual collective agenda for racial health equity and inclusion that is intersectional in Canada, while being held accountable to Indigenous and racialized communities.
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Affiliation(s)
- Ananya Tina Banerjee
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada.
| | - Amy Tan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nikita Boston-Fisher
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada
| | - Carl-Ardy Dubois
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Alika LaFontaine
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Cloos
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Bilkis Vissandjee
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer Adams
- Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Hinna Hafeez
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada
| | - Stephanie Bumba
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | | | - Olivier Ferlatte
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Saleem Razack
- Pediatrics and Institute for Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Mairi McKenna Edwards
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Tim Evans
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada
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Kaufman R, Fair E, Reid M, Mirzazadeh A. Authorship equity in global health research: who gets the credit at University of California, San Francisco? BMJ Glob Health 2023; 8:e013713. [PMID: 37848271 PMCID: PMC10583030 DOI: 10.1136/bmjgh-2023-013713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
Authorship inequity exists in global health research and can be representative of unequal partnerships. Previous studies showed that low-income and middle-income country (LMIC) authors are under-represented in publications from global collaborative research between LMIC and high-income countries (HIC). However, there are little data on trends for how specific HIC institutions are performing concerning equitable authorship. We used Web of Science to find published articles affiliated with the University of California, San Francisco (UCSF), where an LMIC was referred to in the title, abstract or keywords from 2008 to 2021. The country affiliation of each author for all included articles was grouped based on World Bank data. A total of 5805 articles were included. On average, 53.6% (n=3109) of UCSF affiliated articles had at least one low-income country (LIC) or LMIC author; however, this number increased from 43.2% (n=63) in 2008 to 63.3% (n=421) in 2021. Overall, 16.3% (n=948) of UCSF affiliated articles had an LIC or LMIC researcher as the first author, 18.8% (n=1,059) had an LIC or LMIC researcher as second author, and 14.2% (n=820) had an LIC or LMIC researcher as last author. As long as manuscripts produced by UCSF have no LIC or LMIC authors included the university's commitment to authentic equity is undermined. Global health partnerships cannot be equitable without changing authorship trends between HIC and LMIC institutions.
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Affiliation(s)
- Rebekah Kaufman
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Fair
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, USA
| | - Michael Reid
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA
| | - Ali Mirzazadeh
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran (the Islamic Republic of)
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Penner L, Sprague C. Vaccine Inequities and the Legacies of Colonialism: Speculative Fiction's Challenge to Medicine. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:395-399. [PMID: 36740657 PMCID: PMC9899654 DOI: 10.1007/s10912-023-09782-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 06/18/2023]
Abstract
New vaccines to prevent COVID-19 and malaria underscore the importance of scientific advances to promote public health globally. How is credit for such scientific discoveries attributed, and who benefits? The complex narrative of Amitav Ghosh's The Calcutta Chromosome, both historical and speculative, demonstrates how medicine has come to value particular kinds of advances over others, prompting readers to question who controls access to resources and at what cost to global populations. In Ghosh's imagined world, scientific discovery is evaluated and rewarded-and ultimately deemed necessary-for its ability to serve communal, public health needs.
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Affiliation(s)
- Louise Penner
- Department of English, College of Liberal Arts, University of Massachusetts Boston, Boston, MA, USA.
- Honors College, University of Massachusetts Boston, Boston, MA, USA.
| | - Courtenay Sprague
- Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Bjorklund A, Muttineni M, Gladding S, Slusher T, Howard CR. The Changing Landscape of Global Child Health Education in the United States and the Effects of the COVID-19 Pandemic and Civil Unrest. Pediatr Ann 2023; 52:e324-e329. [PMID: 37695284 DOI: 10.3928/19382359-20230720-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The events of recent years have affected the landscape of global child health education (GCHE) in the United States. War, racism, forced displacement, and the coronavirus disease 2019 (COVID-19) pandemic had global repercussions that reached US GCHE. The aim of this article is to examine the effect of these events on the landscape of GCHE in the US. Key areas of GCHE have been reframed, reshaped, and accelerated by these events. Travel restrictions accelerated virtual learning opportunities. Core curriculum needed to be reconsidered to address antiracism, equity, and decolonization. Expansion of GCHE activities, including local-global electives, was needed to meet increased resident demand and help address local community needs. Inequities in international partnerships were further highlighted, requiring new approaches. Global research education and practices were also affected with a rapid expansion in virtual opportunities and further development of education in equitable research practices. [Pediatr Ann. 2023;52(9):e324-e329.].
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Mupeta F, Sivile S, Toeque MG, Fwoloshi S, Zulu PM, Chanda D, Mbewe N, Mwitumwa M, Chanda C, Kandiwo N, Ziko L, Mwansa T, Matibula P, Mugala A, Traver EC, Tripathi RK, Heil EL, Patel DM, Riedel DJ, Hachaambwa L, Mulenga L, Claassen CW. The UTH-UMB Global Health Education Collaboration: Building a Bidirectional Exchange Based on Equity and Reciprocity. Ann Glob Health 2023; 89:52. [PMID: 37575336 PMCID: PMC10418132 DOI: 10.5334/aogh.3718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/26/2023] [Indexed: 08/15/2023] Open
Abstract
The global health exchange program between the University Teaching Hospitals (UTH) of Lusaka, Zambia and the University of Maryland, Baltimore (UMB) has been operating since 2015. As trainees and facilitators of this exchange program, we describe our experiences working in Lusaka and Baltimore, and strengths and challenges of the partnership. Since 2015, we have facilitated rotations for 71 UMB trainees, who spent four weeks on the Infectious Disease (ID) team at UTH. Since 2019 with funding from UMB, nine UTH ID trainee physicians spent up to six weeks each rotating on various ID consult services at University of Maryland Medical Center (UMMC). Challenges in global health rotations can include inadequate preparation or inappropriate expectations among high-income country trainees, low-value experiences for low- and middle-income country trainees, lack of appropriate mentorship at sites, and power imbalances in research collaborations. We try to mitigate these issues by ensuring pre-departure and on-site orientation for UMB trainees, cross-cultural mentored experiences for all trainees, and intentional sharing of authorship and credit on scientific collaborations. We present a description of our medical education collaboration as a successful model for building equitable and reciprocal collaborations between low- and middle-income countries and high-income countries, and offer suggestions for future program initiatives to enhance global health education equity among participants and organizations.
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Affiliation(s)
- Francis Mupeta
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
| | - Suilanji Sivile
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
- Ministry of Health, Ndeke House, Lusaka, ZM
| | - Mona-Gekanju Toeque
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sombo Fwoloshi
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
| | - Paul Msanzya Zulu
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
| | - Duncan Chanda
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
| | - Nyuma Mbewe
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
- Department of Internal Medicine, Ndola Teaching Hospital, Ndola, ZM
| | - Mundia Mwitumwa
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
| | - Chitalu Chanda
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
- Zambia National Public Health Institute, Lusaka, ZM
| | - Nyakulira Kandiwo
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
| | - Luunga Ziko
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
| | - Tilele Mwansa
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
| | - Peter Matibula
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
| | - Anchidinka Mugala
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
| | | | | | - Emily L. Heil
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Devang M. Patel
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - David J. Riedel
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lottie Hachaambwa
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lloyd Mulenga
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
- Ministry of Health, Ndeke House, Lusaka, ZM
| | - Cassidy W. Claassen
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, ZM
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, ZM
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland School of Medicine, Baltimore, MD, USA
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Dixon SL, Isaac M. No One-Size-Fits-All: Critical Narrative Intervention and Archeology of Self as Anti-Racist and Anti-Colonial Practices in Body-Focused Repetitive Behaviors. HEALTH EDUCATION & BEHAVIOR 2023; 50:508-516. [PMID: 37537906 DOI: 10.1177/10901981231177081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Health education and research has historically relied on partnerships between institutions that focus on prescribing interventions rather than working with communities to identify and address systemic violence and oppression as root causes of health inequity. This perpetuates harmful colonial paradigms in health education. We present an autoethnographic perspective of our experiences as Black women with Body-Focused Repetitive Behaviors to reexamine harmful assumptions and practices underpinning the field. Through digital storytelling, a qualitative research method, we explore Critical Narrative Intervention (CNI) and the Archeology of Self (AOS) as key methodological frameworks in decolonizing health education. Using our experiences of navigating complex mental health education and care, we highlight CNI and AOS as creative, asset-based, narrative, and participatory approaches to addressing health inequity and promoting an anti-colonist and anti-racist public health paradigm. We call practitioners to explore these methodologies in reimagining how we engage with diverse, historically excluded communities, while critically interrogating our own biases as we move toward equitable partnerships and caring relationships.
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Fox L, Santaolalla A, Handford J, Sullivan R, Torode J, Vanderpuye V, Pramesh C, Mula-Hussain L, AlWaheidi S, Makaroff LE, Kaur R, Mackay C, Mukherji D, Van Hemelrijck M. Redefining Cancer Research Priorities in Low- and Middle-Income Countries in the Post-COVID-19 Global Context: A Modified Delphi Consensus Process. JCO Glob Oncol 2023; 9:e2300111. [PMID: 37561978 PMCID: PMC10857688 DOI: 10.1200/go.23.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE The post-COVID-19 funding landscape for cancer research globally has become increasingly challenging, particularly in resource-challenged regions (RCRs) lacking strong research ecosystems. We aimed to produce a list of priority areas for cancer research in countries with limited resources, informed by researchers and patients. METHODS Cancer experts in lower-resource health care systems (as defined by the World Bank as low- and middle-income countries; N = 151) were contacted to participate in a modified consensus-seeking Delphi survey, comprising two rounds. In round 1, participants (n = 69) rated predetermined areas of potential research priority (ARPs) for importance and suggested missing ARPs. In round 2, the same participants (n = 49) rated an integrated list of predetermined and suggested ARPs from round 1, then undertook a forced choice priority ranking exercise. Composite voting scores (T-scores) were used to rank the ARPs. Importance ratings were summarized descriptively. Findings were discussed with international patient advocacy organization representatives. RESULTS The top ARP was research into strategies adapting guidelines or treatment strategies in line with available resources (particularly systemic therapy) (T = 83). Others included cancer registries (T = 62); prevention (T = 52); end-of-life care (T = 53); and value-based and affordable care (T = 51). The top COVID-19/cancer ARP was strategies to incorporate what has been learned during the pandemic that can be maintained posteriorly (T = 36). Others included treatment schedule interruption (T = 24); cost-effective reduction of COVID-19 morbidity/mortality (T = 19); and pandemic preparedness (T = 18). CONCLUSION Areas of strategic priority favored by cancer researchers in RCRs are related to adaptive treatment guidelines; sustainable implementation of cancer registries; prevention strategies; value-based and affordable cancer care; investments in research capacity building; epidemiologic work on local risk factors for cancer; and combatting inequities of prevention and care access.
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Affiliation(s)
- Louis Fox
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | - Aida Santaolalla
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | - Jasmine Handford
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | - Richard Sullivan
- Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | - Julie Torode
- Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - C.S. Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Layth Mula-Hussain
- Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Shaymaa AlWaheidi
- Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | | | - Ranjit Kaur
- Advanced Breast Cancer Global Alliance, Petaling Jaya, Malaysia
| | - Clara Mackay
- World Ovarian Cancer Coalition, Toronto, ON, Canada
| | - Deborah Mukherji
- Naef K Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
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Krugman DW. Global health and the elite capture of decolonization: On reformism and the possibilities of alternate paths. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002103. [PMID: 37384634 DOI: 10.1371/journal.pgph.0002103] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Global Health is experiencing a moment of reckoning over the field's legacy and current structuring in a world facing multiple, intersecting challenges to health. While "decolonization" has emerged as the dominant frame to imagine change in the field, what the concept refers to and entails has become increasingly unclear. Despite warnings, the concept is now being used by elite Global North institutions and organization to imagine their reformation. In this article, I attempt to provide clarity to the issue of conceptualizing change in Global Health. By first outlining a brief history of decolonial thought and then exploring the current state of the decolonizing global health literature, I show a profound disjuncture between popularized calls for decolonization in Global Health and other theorizations of the term. I then argue that the diluting of "decolonization" into a depoliticized vision of reforming the inherently colonial and capitalistic institutions and organizations of Global Health is an example of "elite capture"-the coopting and reconfiguration of radical, liberatory theories and concepts then used by elites for their own gain. Showing how this elite capture has facilitated harm within the field and beyond, I conclude by calling for resistance to elite capture in all its forms.
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Affiliation(s)
- Daniel W Krugman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Amick E, Naanyu V, Bucher S, Henry BW. Perceptions of Global Health Engagements in Relation to the COVID-19 Pandemic Among Kenyan Health Care Workers and Administrators in Western Kenya: Protocol for Multi-stage Qualitative Study. JMIR Res Protoc 2023. [PMID: 37315197 PMCID: PMC10365599 DOI: 10.2196/41836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND There has been significant interest in global health in low- and middle-income countries (LMICs) among individuals living in high-income countries (HICs) over the past 30 years. Much of the literature on global health engagements (GHEs) has been presented from the perspective of individuals from HIC participants. Local stakeholders such as health care workers and health care administrators represent critical constituencies for global health activities, yet their perspectives are under-represented in the literature. The purpose of this study is to examine local health worker and administrator experiences with GHEs in Kenya. We will explore the perceived role GHEs play in preparing the health system to address a public health crisis, as well as their role in pandemic recovery and its aftermath. OBJECTIVE The aim of this study is to 1) examine how Kenyan health care workers and administrators interpret experiences with global health engagements as having advantaged or hindered them and the local health system to provide care during an acute public health crisis and 2) to explore recommendations to reimagine GHEs in a post-pandemic Kenya. METHODS This study will be conducted at a large teaching and referral hospital in western Kenya, with a long history of hosting GHEs in support of its tripartite mission of providing care, training, and research. This qualitative study will be conducted in three phases. In Phase 1, in-depth interviews (IDIs) will be conducted to capture participants' lived experience in relation to their unique understandings of the pandemic, GHEs, and the local health system. In Phase 2, group discussions, using nominal group technique (NGTs) will be conducted to determine potential priority areas to reimagine future GHEs. In Phase 3, IDIs will be conducted to explore these priority areas in greater detail to explore potential recommendations for potential strategies, policies, and other actions that might be employed to achieve the priorities determined to be of highest importance. RESULTS Study activities will commence late summer 2022, with findings to be published in 2023. It is anticipated that findings from this study will provide insight into the role GHEs play in a local health system in Kenya, and provide critical stakeholder and partner input, from persons hitherto ignored in the design, implementation, and management of GHEs. CONCLUSIONS This qualitative study will examine perspectives of global health engagements in relation to the COVID-19 pandemic among Kenyan health care workers and health care administrators in western Kenya using a multi-stage protocol. Using a combination of in-depth interviews and nominal group techniques this study aims to shed light on the roles global health activities are perceived to play in preparing health care professionals and the health system to address an acute public health crisis. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT PRR1-10.2196/41836.
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Affiliation(s)
- Erick Amick
- College of Health and Human Sciences, Northern Illinois University, DeKalb, US
- Susan and Richard Kiphart Center for Global Health and Social Development, Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E 60th st, Chicago, US
| | - Violet Naanyu
- School of Public Health, Moi University, Eldoret, KE
| | - Sherri Bucher
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, US
| | - Beverly W Henry
- College of Health and Human Sciences, Northern Illinois University, DeKalb, US
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Willows TM, Oliwa J, Onyango O, Mkumbo E, Maiba J, Schell CO, Baker T, McKnight J. COVID-19 and unintended steps towards further equity in global health research. BMJ Glob Health 2023; 8:e011888. [PMID: 37328283 PMCID: PMC10276961 DOI: 10.1136/bmjgh-2023-011888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/29/2023] [Indexed: 06/18/2023] Open
Abstract
There was, and possibly still is, potential for COVID-19 to disrupt power inequities and contribute to positive transformation in global health research that increases equity. While there is consensus about the need to decolonise by transforming global health, and a roadmap outlining how we could approach it, there are few examples of steps that could be taken to transform the mechanics of global health research. This paper contributes lessons learnt from experiences and reflections of our diverse multinational team of researchers involved in a multicountry research project. We demonstrate the positive impact on our research project of making further steps towards improving equity within our research practices. Some of the approaches adopted include redistributing power to researchers from the countries of interest at various stages in their career, by involving the whole team in decisions about the research; meaningfully involving the whole team in research data analysis; and providing opportunities for all researchers from the countries of interest to voice their perspectives as first authors in publications. Although this approach is consistent with how research guidance suggests research should be run, in reality it does not often happen in this way. The authors of this paper hope that by sharing our experience, we can contribute towards discussions about the processes required to continue developing a global health sector that is equitable and inclusive.
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Affiliation(s)
- Tamara Mulenga Willows
- Tropical Medicine and Global Health, University of Oxford Medical Sciences Division, Oxford, UK
| | - Jacquie Oliwa
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Onesmus Onyango
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Elibariki Mkumbo
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Tanzania
| | - John Maiba
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Tanzania
| | - Carl Otto Schell
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Tim Baker
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Tanzania
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Jacob McKnight
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
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Luaces MA, Cochran MS, Finocchario-Kessler S, Connelly K, Polivka B, Young R, Anguyo G, Nwobu C, Evert J. Impacts, Learner Diversity, and Curricular Framework of a Virtual Global Health Elective Catalyzed by the COVID-19 Pandemic. Ann Glob Health 2023; 89:32. [PMID: 37252336 PMCID: PMC10215996 DOI: 10.5334/aogh.4060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/30/2023] [Indexed: 05/31/2023] Open
Abstract
Background Place-based international electives that build global health competencies have existed for decades. However, these electives require travel and are infeasible for many trainees around the world, particularly those with insufficient financial resources, logistical complexities, or visa limitations. The emergence of virtual approaches to global health electives, catalyzed by the travel pause related to the COVID-19 pandemic, necessitates the exploration of learner impacts, participant diversity, and curricular frameworks. Child Family Health International (CFHI), a non-profit global health education organization that partners with universities to expand immersive educational offerings, launched a virtual global health elective in 2021. The elective drew on faculty from Bolivia, Ecuador, Ghana, Mexico, the Philippines, Uganda, and the United States. Objective This study aimed to describe a newly developed virtual global health elective curriculum and evaluate the demographics of and impacts on trainee participants. Methods Eighty-two trainees who were enrolled in the virtual global health elective from January to May 2021 completed both 1) pre- and post-elective self-assessments of domains of competency mapped to the elective curriculum and 2) free text responses to standardized questions. Data were analyzed through descriptive statistical analysis, paired t-testing, and qualitative thematic analysis. Findings The virtual global health elective had 40% of its participants hail from countries other than the United States. Self-reported competency in global health broadly, planetary health, low resource clinical reasoning, and overall composite competency significantly increased. Qualitative analysis revealed learner development in health systems, social determinants of health, critical thinking, planetary health, cultural humility, and professional practice. Conclusion Virtual global health electives effectively develop key competencies in global health. This virtual elective had a 40-fold increase in the proportion of trainees from outside the United States, compared to pre-pandemic place-based electives. The virtual platform facilitates accessibility for learners from a variety of health professions and a wide range of geographic and socioeconomic environments. Further research is needed to confirm and expand on self-reported data, and to pursue approaches to greater diversity, equity, and inclusion in virtual frameworks.
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Affiliation(s)
- Maria Alonso Luaces
- Department of Family Medicine and Community Health, Director-Office of Diversity and Inclusion, University of Kansas School of Medicine, Kansas City, KS, US
| | - Michelle S. Cochran
- Clinical Assistant Professor, University of Kansas School of Nursing, Kansas City, KS, USA
| | - Sarah Finocchario-Kessler
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kimberly Connelly
- KUMC Senior International Officer, Director of the Office of International Programs, the University of Kansas Medical Center, Kansas City, KS USA
| | - Barbara Polivka
- School of Nursing, the University of Kansas Medical Center, Kansas City, KS USA
| | - Robin Young
- Executive Director, Child Family Health International, US
| | | | - Charles Nwobu
- Director ICATCH AAP & Global Health projects, Princess Marie Louise Children’s Hospital, Accra and Medical Director for Ghana, Child Family Health International, US
| | - Jessica Evert
- Assistant Clinical Professor, UCSF Department of Family and Community Medicine, Global Medical Director, Child Family Health International, US
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Tang Y, Zhang F, Xu DR. The implications of decolonization on China's academic global health: a dialogue with Stephen Gloyd at the Luhu Global Health Salon. Glob Health Res Policy 2023; 8:14. [PMID: 37198704 PMCID: PMC10190061 DOI: 10.1186/s41256-023-00299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023] Open
Abstract
The call for decolonization in global health is growing alongside China's increasing involvement in the field. This perspective paper presents and extends with a further literature review of a dialogue with Stephen Gloyd, a global health professor from the University of Washington, conducted in July 2022 at the Luhu Global Health Salon. Drawing from Gloyd's four decades of experiences in low- and middle-income countries, as well as his role in creating the University of Washington's global health department, the doctoral program in implementation science, and the non-governmental organization, Health Alliance International, this paper delves into the concept of decolonization in global health and explores how Chinese universities can expand their participation in global health while striving for equity and justice. Focusing on China's academic global health research, education, and practice, the paper proposes specific recommendations for building an equity-focused global health curriculum, addressing power imbalances and inequalities in university-affiliated organizations, and strengthening South-South cooperation in practice. The paper offers implications for Chinese universities on expanding future global health cooperation, promoting global health governance, and avoiding recolonization.
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Affiliation(s)
- Yu Tang
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Feifei Zhang
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China.
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China.
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China.
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50
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Eichbaum Q, Barbeau-Meunier CA, White M, Ravi R, Grant E, Riess H, Bleakley A. Empathy across cultures - one size does not fit all: from the ego-logical to the eco-logical of relational empathy. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:643-657. [PMID: 36129550 PMCID: PMC9491267 DOI: 10.1007/s10459-022-10158-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/16/2022] [Indexed: 05/11/2023]
Abstract
Empathy is extolled in Western healthcare and medical education as an exemplary quality to cultivate in trainees and providers. Yet it remains an elusive and inadequately understood attribute. It posits a "one size fits all" unidimensional attribute applicable across contexts with scant attention given to its multifaceted dimensions in intercultural contexts. In this article, we uncloak the shortcomings of this conventional empathy in intercultural settings, and instead propound an expanded "relational empathy".
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Affiliation(s)
- Quentin Eichbaum
- Department of Pathology, Microbiology and Immunology, Division of Medical Education and Administration, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, TVC 4511C, 1301 Medical Center Drive, TN37232, Nashville, TN, USA.
| | | | - Mary White
- Boonshoft School of Medicine, Wright State University, Fairborn, OH, USA
| | - Revathi Ravi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Helen Riess
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan Bleakley
- Plymouth University Peninsula School of Medicine, Plymouth, UK
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