When I was in medical school, we often saw the term international health in the context of faraway villages, where issues like access to clean water, sanitation, and a basic understanding of the spread of disease were at the heart of figuring out how to improve a community’s well-being. As medical students, we saw short-term medical mission trips as our way of getting a glimpse of the world outside our environment and gaining exposure to not just tropical diseases that we would never see at home, but also to the ways that healthcare providers in these settings coped in order to care for their patients.
Things changed somewhere along the way, and what we used to call international health became global health, the term much more indicative of a connected world where diseases – and physicians – crossed borders. A decade ago it was SARS and later the avian flu. More recently, we have seen chikungunya make its first appearance in the western hemisphere and a nurse in Dallas contract the Ebola virus.

International health, it seems, has come home.
The October 2014 issue of Family Medicine includes several articles on global health themes. In the lead editorial, “Global Health as a Frame of Mind,” Dr. John Frey, III of the University of Wisconsin notes that in the two decades between 1993 and 2013, Medline references to the term “global health” increased from 480 to 8,662. The term means different things to different people, still inclusive of intermittent clinical service, provision of supplies, and short-term public health interventions, but now also encompassing exchanges of educational experiences that benefit both sides.

Frey points out that “global health can be a treatment for [US] medical myopia,” referring to a seeming inability for the US clinical and educational systems to learn from other cultures and systems. “At its best,” he writes in his closing statement, “global health offers a perspective based on humility rather than arrogance and on an openness and generosity of thought that changes thinking and practice in all directions.”

Well said, Dr. Frey.
US medical schools have worked for years to respond to medical students’ growing interest in global health programs. Many have developed elective courses that enable students to spend time in another country to observe and learn about healthcare delivery.  At AUC we have never referred to any sort of global health initiatives, because it's just what we do. It is part of our culture. 

Here are what I see as the key elements of the AUC global health experience:

  • Immersion experience: AUC students live in St. Maarten for almost two years. During that time period, students are required to have local health insurance and many students have a need to access the local health care system. 

  • Insight into governments’ role in population health: Under the guidance of a full-time director of service learning and community engagement, AUC students have the opportunity to collaborate with the Ministry of Health on initiatives to improve the health of citizens through many types of initiatives: research, clinical care/screening, public health interventions, and education. 

  • Front lines of global infections: St. Maarten was the first non-African location to see cases of chikungunya. AUC students learned firsthand about responding to this type of infection and were able to participate in community-based research programs designed to determine the prevalence of sero-conversion and rates of symptomatic infection.

  • Health and illness in a non-US environment: AUC students engaged in research are learning that type 2 diabetes mellitus (DM) in St. Maarten does not have the same risk factors as type 2 DM in the United States. Being able to discover that a US-centric view of a common disease may lead you down the wrong path if you deliver care to people who have not grown up in the US is a critical understanding.

  • Required rotations in another country: Global health experiences in many medical schools are elective. Any AUC student can complete 6 to 42 weeks of required clinical clerkships in the United Kingdom, experiencing and contributing to healthcare delivery in a very different healthcare system.

  • And yes, our students can take short trips as well. In fact, a group just returned from Guatemala, and their comments about their reflections on this experience demonstrated their personal growth.

US medical schools are looking for ways to enhance their global health initiatives, which is commendable. However, I believe most US medical schools are a long way from being able to offer the following package: immersion experiences in two different countries in addition to clinical training in the United States, ability to engage with government officials on public health initiatives, and opportunities to advance research on global health topics. I truly believe this gives AUC students an advantage in our increasingly globalized world. 

Dr. Heidi Chumley

Posted October 17, 2014 10:40 AM

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