Einstein Hosts Conference to Address Key Issues Common to Global Health Programs

Einstein’s Global Health Center (GHC) hosted a conference to address problems shared by universities, medical schools, non-government organizations and others setting up global health programs. The conference, “Advancing Global Health: Ethical and Logistical Issues,” was designed to encourage dialogue that could lead to effective guidelines on these topics.

Louis Weiss, M.D., co-director of Einstein’s GHC, welcomes attendees
Louis Weiss, M.D., co-director of Einstein’s GHC, welcomes attendees
“These conferences evolve as new issues arise,” said Jill Raufman, associate director of the Einstein GHC and director of the Medical Student Global Health Fellowship program, who organized the daylong program held on December 5, 2016—the third such conference she has offered to colleagues, with each conference addressing different concerns of those who work in the field.

Administrators of academic and nonprofit GHCs want to prevent tragedies such as the January 2016 bus crash in Honduras in which three Columbia University students died. They also are dismayed when they learn that a pre-med or first-year medical school student was asked to sew cuts, drill teeth or deliver babies—actions they are not properly trained or equipped to carry out at such an early stage of their medical education.

“There’s a movement to improve pre-departure preparation to ensure students don’t perform procedures abroad that they aren’t permitted to do here,” said Ms. Raufman. Global health centers are also concerned with student safety and creating an engaging and enriching educational experience.

First Do No Harm

At Einstein, students may participate in global health fellowships during the summer between the first and second year, and during the fourth year. Every year Einstein sends roughly 100 students to global health programs all over the world.

“Idealistic students often believe global health fellowships will provide an opportunity to ‘save the world,’ but the reality is more nuanced,” noted Ms. Raufman. “This can lead to frustration, if students hold unrealistic motivations and expectations before they set out. It’s important to frame the experience so that expectations can be met.”

King Holmes, M.D., Ph.D., of University of Washington, was among the event’s presenters
King Holmes, M.D., Ph.D., of University of Washington, was among the event’s presenters
During the conference, prominent healthcare practitioners, faculty and administrators of GHCs in the United States, Canada and Denmark gave presentations on several issues that global health professionals agree need urgent attention. For example:

  • Because of limited resources in low-income countries, some programs allow inexperienced students to do too much too soon. “Students are put in high-risk environments where small mistakes can have fatal consequences,” said Dr. Jessica Evert, executive director of Child Family Health International, and a clinical faculty member at University of California, at San Francisco.
  • Few students receive adequate pre-departure training that includes language proficiency; cultural sensitivity, particularly with respect to differences in standards of care; strategies to avoid situations in which they deliver clinical care; and health and safety risks they are likely to encounter. On this last point, Stephen Hargarten of the Medical College of Wisconsin noted, “We don’t know the scope and risk for injury, illness and deaths because this information for study abroad students is fragmented, siloed and unavailable.”
  • Even fewer students are debriefed when they return to deal with “reverse culture shock” and potential health issues. “Some students feel a tremendous amount of guilt and a sense of isolation, because they cannot describe their experiences and feelings to friends and family,” said Dr. Gabrielle Jacquet, of the Boston University School of Medicine, and one of the authors of The Practitioner’s Guide to Global Health.

An Action Plan

In the absence of regulations and oversight, the number of short-term volunteer programs is “mushrooming,” warned Dr. Judith Lasker of Lehigh University. She added that no agency vets and evaluates these programs the way Charity Navigator rates charitable organizations in the United States.

Presenters and attendees separated into four breakout sessions over lunch to draft guidelines for supervising students and keeping them safe without unduly burdening hosts in low-resource environments; identifying ways to assess programs; and involving partners in host countries to develop programs based on their needs.

After each group shared its proposed guidelines, a lively discussion followed on how to put them into action. Ideas included requiring global health guidelines for university and medical school accreditation; making the regulatory bodies of medical schools responsible for enforcement; and withholding fellowship grants or academic credits to students in programs that didn’t follow best practices.

Lillian Butungi Niwagaba, director of the Center for Global Health at New York Institute of Technology, attended the conference “to learn more about how other programs are grappling with the challenges of pre-planning, monitoring and adequate supervision.” She plans to make her pre-trip training more robust by incorporating information the presenters shared. “Hearing from my colleagues in the field has been tremendously helpful,” she said.

 

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