Global Health Reflections


About 37 years ago a devastating earthquake killed thousands as they slept in their homes in the highlands of Guatemala. International groups of volunteers including physicians and nurses responded to the devastation and human need almost immediately. I was among the volunteers, having recently graduated from medical school. I arrived at a makeshift clinic without laboratory or x-ray equipment and with limited medications in one of the only buildings still standing. Since I had arrived several weeks after the earthquake, one of my jobs was to sort out the various patients in casts that had been applied by volunteer orthopedists now gone, to decide what further treatments would be needed. There were descriptions of diagnoses jotted on 3 by 5 cards, but the names were all out of order. Who knew what lay under the white plaster? Should I ask who had the femur fracture the way I might ask customers at a restaurant who ordered the scrambled eggs and bacon? Meanwhile a line of patients in brightly colored huipiles awaited the beginning of the consultations for various ailments like diarrhea, cough or back pain which I was supposed to treat. As I contemplated what to do first, the ground began to shake and everyone ran for shelter, except me because I was still trying to figure out what was happening. A small boy in a cast grabbed my hand and walked me out of the building as the aftershock continued, and we were the last two out of the building.

This was global health in 1976, and many might say that those of us who volunteered relieved much suffering and provided some comfort to the survivors. But there were also many things that happened that left me wondering about our impact. There were the temporary liaisons between volunteers and local villagers, the misdiagnoses by under trained medical personnel, and the competition between aid groups representing different countries who did not want to share resources. Disasters are one of the most extreme situations for participation in global health. But many of the same motivations, opportunities and risks also exist in numerous other global health situations, and students are increasingly attracted to international medical experience to help those in need and to learn about health care in less technologically dominated environments. Students struggle to find meaningful experiences and medical schools attempt to guide the students while defining the field and the learning goals.

In the January Issue there are two articles that discuss global health.  Pfeiffer and colleagues from the University of Washington identify competencies of global health that would be helpful in the development of a curriculum in global health. In another article Peluso and colleagues from Yale searched web sites for descriptions of global health programs and found them in about a quarter of medical schools.  However, there was great variability in what the programs required, leading to a recommendation for greater standardization of programs.

I believe  we need to define the core knowledge base and experiences that our students should seek in global health education. We need to do this so that our students understand what will be expected of them should they volunteer as I did or otherwise serve in global health, and we need to do this to provide assurance to our international partners that our students’ involvement in their countries will be respectful of their culture and will protect the safety of the populations who interact with our students. Additionally, as faculty and administrators we have a responsibility to protect the safety of our students. By defining the competencies and standardizing our programs we may be able to improve educational experiences, provide humanitarian assistance and assure the safety of those who participate in global health educational experiences. An international experience can be life changing for the student, opening up possibilities never before imagined, and it can also begin  a lifetime of service to those most in need of medical care in this country and the world. I encourage our readers  to share their ideas about how we can continue to support our students’ interests in global health and do so safely, respectfully and in a way that builds new knowledge for future global health activities.

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