For more than four decades, Albert Einstein College of Medicine has been a leader in developing global health fellowships for its medical students. The programs respect and benefit host communities while exposing students to the strengths and challenges of healthcare systems in low-resourced countries. In the last 10 years alone, more than 900 medical students have traveled to over 30 countries to provide care, conduct research, initiate projects to help improve health, and build lasting relationships with local organizations and healthcare providers.
Jill Raufman, M.P.H., M.S., director of medical student global health programs, together with Montefiore Global Health and Clinical Skills Fellowship Program faculty members, recently created and hosted a 10-part video lecture series to help students develop a deeper understanding of key social, political, economic, and medical issues around the world. National and international experts, including faculty from Einstein and Montefiore Health System who lead global health research projects, share lessons learned and emphasize the importance of working closely with local partners to ensure successful, long-lasting initiatives.
“We have a very strong emphasis on making sure our programs are sustainable, ethical, and true partnerships,” said Ms. Raufman, who is also associate director of the Global Health Center at Einstein. “We want our students to understand those important concepts but to also be aware—before they travel on one of our global health fellowships—of broader ethical issues, disparities, and the forces that shape the health experience of the majority of the world’s population.”
One World, One Health
The lectures, which are now publicly available, include an overview of numerous global health issues, such as the burden of disease in the developing world, and the effects of unbalanced political power and resource control, poverty, and infrastructure challenges on the health of billions of people.
Understanding the concept of “one health,” an approach to health which stresses the intertwining of humans, wildlife, and the environment, is essential, said Ms. Raufman. She organized Einstein’s conference on the topic in 2018 and invited one of the event’s speakers, Neil Vora, M.D., of Conservation International, a nonprofit environmental group, to present a lecture in the series. In it, Dr. Vora discusses his work in identifying emerging infectious diseases that often occur because of unsafe human and animal interactions. He urges the adoption of a “planetary health paradigm” where health professionals are involved in supporting efforts to prevent environmental degradation.
“Conservation is public health,” said Dr. Vora. “People need nature to survive.”
Other lecturers in the series note how the actions or projects planned by governments, foundations, or businesses often ignore the opinions or desires of local communities. One of the presentations includes two examples: the Bolivian “water wars” caused by a controversial water privatization effort that wrested control of wells from the local municipality, and the multibillion-dollar oil pipeline between Chad and Cameroon, the subject of an award-winning documentary that depicts its negative impact on local residents and communities despite promises of prosperity from its champions.
Other lectures cover a range of topics:
- Einstein’s longstanding global health projects and partnerships in Chile and Uganda, a popular fellowship in the Himalayas, and trips that involve challenging treks through Tibet and China to deliver healthcare in villages and a monastery;
- The importance—and shortage—of healthcare workers in low- and moderate-income countries, who are trained to bring care directly to people in towns, villages, and rural areas;
- Maternal health and family planning, particularly the influence of cultural and social norms, how access to resources and men’s attitudes affect women, and an in-depth look at a Ugandan women’s health clinic;
- The differences in disease prevalence and mortality between the developing world and the West, including the concept of “disability adjusted life years” (the sum of the years of life lost due to premature death and the years lived with a disability due to a disease) and poverty as a complex social, economic, and health issue; and
- Social responsibility in global health and Einstein research in Rwanda, led by Kathryn Anastos, M.D., including the community-based organization Women's Equity in Access to Care and Treatment (WE-ACTx), which has developed out-patient medical services for HIV-infected women in Rwanda.
Continuing Post-Pandemic Research
While the COVID-19 pandemic forced the cancellation of global trips last year, the fellowship programs remained viable as students conducted research virtually. For example, a project that began in the Dominican Republic several years ago continued to evolve last summer: Students reviewed data collected from previous students, analyzed it, and came up with new research questions for others to pursue about the high prevalence of cesarean sections in the country. So far this summer, all global health fellowships continue to be virtual.
A second-year student who hopes to travel for a future project said she appreciated the breadth and depth of the lecture series.
“I don’t have to wait until I am a physician to serve people in global health—I can start now as a student through research and clinical activities,” said Shusmita Roy. “As a physician, I aim to heal, serve, empower, and help people live a healthy life to the fullest in underserved areas around the world. With this lecture series, I increased my understanding and awareness, and I learned about the foundational concepts of global health, issues that affect it, and ways to get involved.”
Ms. Raufman added, “The more knowledge and background the students have, the better their experience—and the experience of those they come into contact with—because they’ll understand ideas like cultural humility and power imbalances.” She hopes to plan a new series of lectures next year. “So many students are excited about global health,” she said, “and this lecture series gives them a solid base of awareness of many issues they need to consider as they pursue projects with our partners around the world.”
Posted on: Friday, July 16, 2021