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Pancheshnikov A, Cuneo CN, Matias WR, Cázares-Adame R, Santos López AG, Paxton RM, Chen CCG. Case studies in adaptation: centring equity in global health education during the COVID-19 pandemic and beyond. BMJ Glob Health 2023; 8:bmjgh-2023-011682. [PMID: 37085270 PMCID: PMC10123849 DOI: 10.1136/bmjgh-2023-011682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/09/2023] [Indexed: 04/23/2023] Open
Abstract
The COVID-19 pandemic disrupted all aspects of life globally and laid bare the pervasive inequities in access to education, employment, healthcare and economic security in both high-resource and low-resource settings. The global health field's brittle attempts of addressing global health inequities, through efforts that in some cases have evoked the colonialist forces implicated in shaping these disparities, have been further challenged by the pandemic. COVID-19 has forced global health leaders to reimagine their field through innovation such as shifting the application of global health to a local focus, collaborating with community organisations and exploring virtual education technologies. We present four case studies illustrating this promising movement towards a more sustainable, ethical and equitable model of global health education practice.Case 1: trainees from the Massachusetts General Hospital Center for Global Health partnered with the Board of Health of Holyoke, a majority Latinx city with high poverty levels, to respond to the COVID-19 pandemic through research and intervention. Case 2: Prevencasa, a community health organisation in Tijuana, Mexico, providing healthcare to local underserved communities, shifted its focus from hosting international trainees to developing a multidisciplinary training programme for Mexican healthcare professionals. Case 3: the Johns Hopkins Global Health Leadership Program adapted its curriculum into a hybrid online and in-person migrant health and human rights elective, collaborating with local organisations. Case 4: a US-based and a Latin American-based organisation collaborated to create a longitudinal, virtual urogynaecology training programme with hybrid simulation practice to increase accessibility of procedural-based training.
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Affiliation(s)
- Anna Pancheshnikov
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
- UGHI: Urogynecology Global Health Initiative, Santo Domingo, Dominican Republic
| | - C Nicholas Cuneo
- Department of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Migrant Health and Human Rights Program, Center for Public Health and Human Rights, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wilfredo R Matias
- Division of Infectious Diseases and Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Abner Gamaliel Santos López
- Division of Urogynecology, Department of Gynecology and Obstetrics, Hospital Centro Médico de Guatemala, Guatemala City, Guatemala
- Scientific Committee, ALAPP (Latin American Association of Pelvic Floor), Guatemala City, Guatemala
| | - Ryan M Paxton
- Health Inspector, Holyoke Board of Health, Holyoke, Massachusetts, USA
| | - Chi Chiung Grace Chen
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Global Health Leadership Program, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Pancheshnikov A, Boddu R, Rubenstein LS, Cuneo CN. Unstable gynaecological patient with an ankle monitor: implications of US Immigration and Customs Enforcement's Alternatives to Detention programme in the healthcare setting. BMJ Case Rep 2022; 15:15/6/e246515. [PMID: 35764334 PMCID: PMC9240831 DOI: 10.1136/bcr-2021-246515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We review the case of an unstable gynaecological patient in the USA who presented with profuse vaginal bleeding after spontaneous miscarriage and was ultimately diagnosed with a uterine arteriovenous malformation managed with interventional radiology embolisation of her uterine artery. Her case was complicated by the presence of an ankle monitoring device which had been placed by US Immigration and Customs Enforcement as part of the Alternatives to Detention programme in which she was enrolled during her immigration proceedings. The device prompted important considerations regarding the potential use of cautery, MRI compatibility and device-related trauma, in addition to causing significant anxiety for the patient, who was concerned about how the team's actions could affect her immigration case. Discussion of her course and shared perspective highlights the unique clinical and medicolegal considerations presented by the expanded use of ankle monitoring devices for electronic surveillance (or 'e-carceration') of non-violent immigrants and others.
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Affiliation(s)
- Anna Pancheshnikov
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rohini Boddu
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Leonard S Rubenstein
- Program on Human Rights, Health and Conflict, Center for Public Health and Human Rights; Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - C Nicholas Cuneo
- Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA .,Program on Migrant Health and Human Rights, Center for Public Health and Human Rights; Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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