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Going to a land far far away! Thoughts about an International Health elective

February 20, 2009

I have a big interest in International Health. But I’m keen on doing it properly, and that’s a difficult thing to do, especially when my idea of ‘proper’ is ever-changing. My personal interest is not so much in the clinical aspects of overseas projects, although it’s always good to gain some educational exposure to tropical/remote illnesses, alternative medicines, addressing social determinants of health, and working with limited resources. Rather, I prefer to learn the strategies used to create successful initiatives in underserviced communities. In Northern India, I saw how primary care could be brought to remote populations, and how preventative medicine (eg. sunglasses) could have an enormous impact on health. In Nepal, I saw how healthcare can suffer in a country without government and investment, and how even in that environment, dedicated groups employing micro-insurance schemes, community outreach, and patient education strategies can succeed. Much of what I learned I have already applied to treating marginalized groups in my own country, whether homeless IVDUs on Vancouver’s Downtown Eastside, aboriginals on remote reserves, or refugees in Montreal from French-speaking Africa.

Public Health jargon like “sustainability” and “capacity building” actually do mean something. The projects that are successful know this, even if they don’t use those words.

When medical students choose to go overseas, it’s for a number of reasons. I spent a lot of time working on a manual for choosing ‘ethical’ placements, stressing that students join well-established programs that have low administrative costs, involve more local than foreign direction, have a well-defined curriculum or learning goals for students with adequate supervision, facilitate cross-cultural communication, and have thorough training and debriefing opportunities. Students also need to develop their personal expectations before they go, prepare by learning about the local culture and politics, and never compromise their ethics (don’t do things not properly trained to do, treat patients and staff with respect, etc.) and be prepared to help in non-medical ways (stocking shelves, moving equipment, doing paperwork, or whatever is needed). There’s no reason not to enjoy yourself while you are there. I feel that using time off to be a tourist and learn about the culture of the area in which you are working is worthwhile, insofar as it contributes to better understanding the people we treat. This is all so long as one doesn’t neglect their clinical duties, as I’ve unfortunately seen happen on one occasion. In Canada, when I’m done a shift, I get to do hobbies, sports, enjoy culture and generally be a normal human, which helps me relate to my patients. I think the same will be true – if not more so – when in another world.

I’ve been through this discussion enough with my old blog, before I travelled to Northern India and Nepal. Now, I’m making plans for another foray into International Health.

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