Best Practices for Global Health Programs

Identifying interesting approaches to global health education

Reciprocity

Topic Status: 

Identify programs that may exhibit the potential for “multichannel” reciprocity with an equity focus.

Comments

Login (UCSF | non-UCSF) to comment on this Topic.

IGOT's Global Knowledge Exchange Program has historically been focused on the Reisdent Global Elective but has expanded to include bilateral exchange, research fellowship & observerships.

The logistics & organizational infrastructure needed to manage these programs are significant & limitations in funding, housing & administrative support limit growth. The University requirments for clinical observership are significant & prevent offering more robust clinical experience for our partners.

IGOT has been successful in focusing on research capacity building in-country along with GPAS/U-STOP to support research fundamentals to help our partners answer their own questions & encourage academic collaboration. This is a strength of UCSF & an area where as a collective we can build upon. This expertise combined with on open-source portal for communication (posting of clinical case consultation, review of documents, registry/data share & education/lectures/videos) is a low risk meaningful tool that would greatly enhance our efforts.  

Over the past 12 years, the Roatan Program has developed great trust with the island population in general, as well as local medical and political leadership, and has developed a growing relationship with national governmental leadership. Beginning in 2005, the Program has sponsored a local Pediatric “Fellowship” to train Honduran general practitioners in Pediatrics (1-3 years/fellow; 5 fellows to date); graduates include the current Medical Director of the Public Hospital Roatan Raymond Cherington; Medical Director of the Flowers Bay public health clinic Charles Welcome; and current clinic physician and Program Site Director Karla Cerritos.  Together with Dr. Omar Brito (MoH Bay Islands Director), they all continue to advocate for growth in the UCSF partnership, including expansion of training and research. Drs. Cherington and Fermin Lopez (MoH representative from Roatan) attended our first UCSF Roatan Symposium, at Mission Bay in November 2014.  They were joined by the Universidad Tecnologica de Honduras’ (UTH) Academic Chancellor Javier Mejia; UTH has recently opened a campus in Roatan and is eager to collaborate with UCSF on research and education, with a goal of improving technological support of local medical care.  The Program has additional relationships with the Honduran Red Cross and the National Autonomous University.

Very nice video about the Roatan collaboration here.

IGOT and the Roatan collaboration have done an excellent job with this. I think GPAS has also made strong efforst in this direction. I look forward to hearing about more programs that have been successful at this as it remains a weakness in general here at UCSF.

As the Student Training Education Program has grown in size and gained in reputation in western Kenya, the question of whether there is an ability for Kenyan learners to visit UCSF for work has continually been raised. Kenyans currently involved in the program are able to work in the clinical sites in the same manner as UCSF participants; however, the loss of subsidized housing for the duration of the elective (1-3 months) has made it difficult for Kenyans to participate in the program in similar numbers. Thus, although the program was founded as a partnership with University of Nairobi, UCSF, and University of British Columbia, the equity of ability to participate could be improved – especially since UCSF offers its medical students research grants.

Do you mean that the loss of housing in Kenya has impacted the ability of Kenyans to participate in clinical sites in Kenya? or the loss of housing in US has impacted Kenyans access in the US?  Housing costs are one of the main barriers here and abroad! Has having an in-country co-ordinator in Kenya helped generate efficiencies on that front?

We were referring to the loss of housing in Kenya impacting the ability of Kenyans to participate in clinical sites in Kenya.  We used to have subsidized flats in every district, and Kenyan participants were usually allowed to stay in these free-of-charge.  However, since the flats were often empty and our program was losing significant money on them, we did not continue to lease flats in some of the districts.  There are still a lot of other housing options at a very economical cost for U.S. trainees, but a prohibitive cost for Kenyan students.  The in-country coordinator has helped as far as researching and updating housing options, communicating with trainees about them, and coordinating reservations.

Given that the lack of housing for visitors and the general cost of living in the Bay Area are such significant barriers, at an entirely practical level, to hosting visitors from our partner sites, what do you think about trying to set up a limited 'home stay' program whereby faculty members who live in San Francisco or close enough to have a reasonable commute by public transportation would host a visitor for a month or two?  Crazy?  

That sounds like a nice idea!  Although we do occasionally have a Kenyan colleague spend some time at UCSF meeting with people, working on papers, giving presentations, etc. (i.e. in particular those who receive CFAR RAP grants), it has been several years since we have had anyone come to participate in clinical training of any sort.  There is apparently a desire by Kenyan learners to do this, but to date we have not had much discussion on the feasibility of this.

The SON Global Health Nursing Fellowship was designed and launched in 2014 in partnership with the international non-profit Partners In Health (PIH), at one rural hospital in Haiti. The program's dual aims are to provide experience in global health competencies for UCSF-graduate Nursing Fellows, and to establish new professional development opportunities for Haitian nurse colleagues. The UCSF-PIH partnership aligns with the PIH model to emphasize local staff capacity building. Through the Fellowship, UCSF SON provides academic support in the development of the newly established PIH Center for Nursing Excellence, which empowers nurse leaders and builds on their role as advocate, both on the levels of the patient and the Haitian health system.

In its pilot year (2014-2015), both partners have learned:

1. UCSF Fellows can provide a new, unique influence at the hospital in Hinche, Haiti, by maintaining focused, continuous attention on professional development in nursing:

  • Fellows model the value of nursing critical thinking, assessment and decision making in forums that otherwise excluded nurses, such as morning reports, case studies, interdisciplinary rounding, etc.
  • Fellows shadow and assist at the bedside, and build relationships and trust that enable them to serve as reference points and eventually educators/mentors for their Haitian nurse colleagues.
  • Fellows support Haitian nursing leadership by creating and consulting on content for nurse education curricula, quality improvement projects and new protocols.

2. The importance of encouraging flexible expectations for and by the Nursing Fellows: 

  • Nursing Fellows should not expect comprehensive and instense clinical learning experience, because their presence in the wards can at some times overburden resources and capacity of the host-hospital.
  • PIH and hospital staff must anticipate a learning curve, while Fellows assimilate to new challenges of language and setting, before the Fellows can contribute to project innovation and implementation.
  • There is a consistent push and pull between providing UCSF Learners with a rich, project-based experience in a limited time frame, and the deliberate, icremental nature of promoting sustainable, long-term change in low-resource setting. 

Evaluation results and deliverables will serve to enhance both future global health education programs at the SON, as well as provide PIH Haiti with data and information to inform their ongoing nurse education initiatives.

Fantasic overview of the program in its pilot year. Are there any synergies in place with the UCSF hospitalists and the HEAL initiative? I know they are active in Haiti, and wonder if there are plans to foster team placements? Am particularly impessed that planned evaluations are in place.

In addition to Teresa's question, I'd be interested in knowing whether you think there is any potential to expand your model to other health professions?  I appreciate that your program is built around strengthening nursing skills and, more broadly, contributing to the formation of professional identity in young Haitian nurses but it wold be great to explore the implicatiosn of what you are doing for the other health professions.  

Greater Bay Area Family Medicine Global Exchange

In 2009, the Aga Khan University (AKU) and UCSF committed to a long-term partnership and in 2012, AKU and UCSF signed an affiliation agreement that defines the special working relationship between the two universities. Twelve UCSF and UCSF-affiliated faculty and learners have visited AKU, and have engaged in primary care research activities, and a wide range of inpatient and outpatient clinical activities. 

In the spirit of reciprocity, three AKU third year family medicine residents will visit UCSF, UCSF-affiliated Contra Costa County Hospital and Stanford to learn about primary care delivery models, research in primary care, family medicine procedures such as bedside ultrasounds, and family medicine education and faculty development in June.

AKU residents will have sessions with faculty of the UCSF Center for Excellence in Primary Care and SFGH Family Medicine Residency program. At Contra Costa, they will observe clinical activities in the hospital, enroll in an NALS course, and participate in the bedside ultrasound course. At Stanford they will tour the simulated patient lab, Center for Primary Care Research, the surgery simulation center, and learn about directly observed clinical assessments.

 

Hi Megan- I was really interested to hear an update on the AKU affiliation! I know that the affiliation was with the AKU in Tanzania, are the planned visitors Tanzanians? Or Pakistani? There was some plan to develop a second AKU in northern Tanzania. Is that still happening, and is there a mechanism being put in place for UCSF to be part of that capacity building piece?

Thanks Teresa for your comments! UCSF has an affiliation agreement with Aga Khan University East Africa. AKU East Africa family medicine residency program was established in 2012 with strong support from AKU family medicine programs in both Dar Es Salaam and Karachi, and UCSF. The AKU undergraduate joint nursing and medical school will open in 2016 at the Nairobi campus with a possible longterm plan of colocating with the planned liberal arts university in Arusha TZ (northern TZ) in the future. AKU has involvement with UCSF in a stem cell program, development of population health sciences, PTBi, and family medicine global exchange. There are several potential educational and research opportunities for UCSF learners as a result. Elisabeth Wilson and Norm Hearst are the main contact persons at UCSF. 

Hi Megan,

 

Thanks for this contribution.  How long are the AKU residents in the Bay Area and how have you dealt with housing and cost of living in general?

although this comment is not specifically about a program, what about a university-owned house in San Francisco to house visiting scholars and global health partners for relatively short-term stints? Often sites have housing for such collaboration/trainings and it would seem a good use of university money plus give our visitors a sense of our committment to them. Am I wildly dreaming here?

It's dream many share, Kim!

Center for Global Surgical Studies (CGSS)

The Kampala Advanced Trauma Training, co-taught with GPAS and local partners, allows for the exchange of specialty-specific knowledge and context expertise for the appropriate training of medical interns.

The building of surgical and trauma surveillance systems in Soroti, Uganda and nationally across Cameroon provides a tool to use towards increasing surgical care capacity through the generation of evidence for efficient resource allocation as well as providing greater understanding of patterns of injury and surgical disease for effective policy development and prevention efforts. Through these projects, UCSF learners gain valuable, hands-on experience in public health research methods, while local partners have the increased technical capacity to build surveillance systems that are sustainable and context-appropriate.

This concept of reciprocity is an important one, but one where I don't think we are doing all that well at UCSF.  That is, we are sending many of our trainees abroad for international experiences, but I believe we are only seeing only a trickle of international students here at UCSF.  In many instances, we may not be able to establish full trust between UCSF and international partners until the international partners see more opportunities for their trainees to get the same world class training that the UCSF scholars get.  That we have no formal short-term housing on-campus (or close to on-campus) housing available for visiting international scholars is all one needs to know about how many visiting scholars are coming here.  

I agree completely with the sentiment that there should be increased effort to build opportunities and infrastructure to host international trainees. 

In the shorter term, while the ability to host international learners is so constrained, there might be a greater return from hosting a relatively smaller number of more advanced learners (e.g. junior or midcareer academics), who could benefit from enhancing their skills in grantwriting or program development and who could then use those skills to build capacity at their home institutions.

Another effort that would benefit our colleagues in all parts of the world would be to place more training content online. It's no match for face-to-face, hands-on interaction, but there are many topics that would be amenable to online, self-paced teaching. UCSF could be an online learning hub. I know the SOD Coursera course on caries management from Dean Featherstone attracts enrollees worldwide.

I'm sure there are other good examples.