Best Practices for Global Health Programs

Identifying interesting approaches to global health education

Innovation

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Identify those programs that in your opinion exhibit an enthusiasm for high-impact and distinctive initiatives.

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In general IGOT is innovative in its academic approach to global orthoapedics & trauma. Specifically IGOT’s SMART Course is an example of cross training orthopaedic surgeons “plastic surgery” limb salvaging principles. This model has expanded to in-country courses which are more costs effective & yield a higher impact reaching >100 regional attendees annually as opposed to 2-3 per region at our local SF course. The SMART Course is scalable yet defined in its scope. IGOT’s “Bay Area Global Health Film Festival” is an advocacy & awareness program that has potential to be expanded across the UCSF campus to highlight our efforts.

IGOT's ability to focus on specific training applicable to resource constrained settings allows it to work at the forefront of its field in GH. The program has been innovative in its fundraising and outreach, the integrated approach to surgical and research training, and now in how it is "flipping" its class to be taught abroad.

Having participated in a Global Health rotation during my pharmacy residency year at UCSF, I was able to further enhance my skills and knowledge on barriers to medication supply chain management. The project looked at identifying these barriers to medication supply chain management at a Public Hospital in Roatan, Honduras in collaboration with UCSF SOM, SOP, & SON. Future innovative projects may include developing rotation sites for multidisciplinary students/residents to round with physicians, prepare medications, and counsel patients on high risk medications; assisting with developing and revising a medication administration record (MAR) for nurses; and creating standard treatment guidelines (i.e. adapted algorithms based on available medications, video prompts with smartphones - Medic Mobile).

The island of Roatan, Honduras, has a population of >>60,000, with a diverse race/ethnic mix (African, Garifuna, Latino) and dual languages (English and Spanish) matching well with our learners.  Taken together with geographic isolation, a resource-limited public health capacity (one public hospital/birthing center, four public health clinics, and no EMS system), and a high burden of disease (dengue/HIV/ malaria; trauma and infant mortality; early childhood caries and malnutrition), Roatan itself is a microcosm of developing world challenges.  This locale provides an ideal model for the development and vetting of scalable global health solutions. 

We piloted a novel immunization clinic-based early childhood fluoride varnish program, which appears to have reduced childhood caries, as measured on preliminary assessment by investigators from UCSF SOD.  As the project paired with one of Hondura’s strengths (immunization), the MoH has considered nationalization.  Roatan has strong cellular network and many staff have smart phones.  SON is pursuing “microlearning” video training for local staff.  SOM and SON are partnering in SMS-based maternal education/tracking to enhance breast-feeding compliance.  SOM, GHS, BSRI, UCSB and UCB are exploring dengue epidemiology and extending a rapid-diagnostic developed in collaboration with Nicaragua.  All projects have a goal of ultimate implementation throughout Mesoamerica and beyond.

The program has already received wide interest from across UC given the ability to harness the collective cross-campus expertise in one manageable location. This would prove innovative in global health education whereby seemingly disparate disciplines (e.g. geography and medicine) can develop joint studies, thereby tackling health needs in a multifaceted way (e.g. mapping breeding sites to target malaria and arbovirus [Dengue and Chikungunya] infection).  In short this holds enormous promise for both faculty and students alike, who can participate in transdisciplinary initiatives in a real world “global health laboratory”.

As a pharmacy student at UCSF who is also interested in becoming involved in Global Health, I think that having the opportunities to build upon my skills and knowledge on medication supply chain management and its barriers through innovative rotation sites would be very valuable. With a dense curriculum, pharmacy students do not get very many opportunities to learn about these crucial topics that are important for Global Health involvements. With this basic knowledge and skill set, Global Health students can perform studies and projects to break down the barriers to medication supply chain management.

Early childhood caries (ECC) is the most prevalent and neglected chronic diseases worldwide. In addition to its common negative consequences, including higher risk of caries in subsequent permanent teeth, pain, chronic infections, inability to eat, and impaired growth/development and education potential, ECC share defiencient dietary habits that are associated with future non-infectious disease such as diabetes, obesity and cadiovascular diseases. ECC is preventable by early  intervention—beginning by 1 year of age—with oral health and nutrition education and fluoride varnish application. However,  worldwide shortages of dental services have prevented the optimum oral health promotion for young children.

In contrast, medical care and vaccination clinics worldwide have excellent population-wide coverage of children from birth to 5 years of age even in developing countries. Over the years, the Roatan project has been well integrated into local health care and established trusting relationships with the island community (patients, families, providers and national medical/political/business leaders). The UCSF director initiated a novel project to include oral health education and FV application for 18 to 60 month old children to improve early childhood oral health at four public health vaccination clinics in Roatan in 2009. With the collective effort of the students and faculty from all 4 schools of UCSF, the public health department of UC Berkely and local health community of Roatan island, we will able to conduct research projects on the severity of ECC, the effectiveness,  feasibility, coverage, best practices, and implementation barriers of oral health program; and make scientific-based recommendations for program improvement.We hope that

understanding the strength and obstacles of this new approach in a full study of its implementation, outcome effectiveness and attitudes and opinion towards the program from key stakeholders (administrator’s providers and parents) would provide critical information needed to build strong, efficient, and sustainable oral health education and prevention programs that can be expended to other regions in the future. This appoach has recently been put as a potential model by WHO to improve oral health globally.


"Because of it's relatively small size and complex healthcare challenges, Roatán is ripe to use innovative geospatial research methods to understand the socioeconomic, demographic, and environmental  determents of the burden of disease on the island. The initiatives spearheaded by UCSF and Global Healing in Roatán to integrate truly interdisciplinary  researchers from across the UC system provides an excellent opportunity to continue to improve healthcare outcomes for Hondurans and people living throughout the developing world. As a PhD student researching the spatiotemporal  relationship of health and environment in Roatán, I am excited for the opportunity to contribute to such a fantastic project." - Cascade Tuholske 

Cascade Tuholske, commenting above, is a PhD student in the Dept of Geography at UCSB, under the mentorship of David López-Carr, Director, Latin American and Iberian Studies, and Professor, Department of Geography.  His work in Roatan collaborates with both UCSF and UC Berkeley.

Center for Global Surgical Studies (CGSS, global.surgery.ucsf.edu)

As low- and middle-income countries move through the epidemiological transition, surgical disease and injury have become a leading cause of morbidity and mortality. As a result, initiatives working in the area of prevention of surgical disease and injury have the potential to make significant impact.

Our projects to establish surgical and trauma surveillance systems in Cameroon and Uganda lay the groundwork for such efforts, allowing us to understand the burden of disease and injury, and to highlight optimal resource allocation as well as map problem areas in communities with respect to disease onset and injury location and mechanism. These efforts have been shown to have local, regional, and national impact in the formation of specialized task forces and through policy development and implementation.