International Health Electives: "A Delicate Balance"

Today I had lunch with Paul Drain, physician and lead author of a new guidebook to working in global health, called “Caring for the World.”  The book is aimed primarily at medical students and residents who want to gain global health experience (“Like a guidebook for those visiting a city, especially for the first time,” said a review of the book in last week’s JAMA, “it should help those contemplating work in the field of global health avoid the pitfalls and make the best of the experience.”)

“I got the idea for the book at medical school,” Dr Drain told me.

Before becoming a medical student, he’d gained a microbiology degree, worked in sanitation and health as a Peace Corps Volunteer in the High Atlas Mountains of Morocco,  completed a Masters of Public Health (involving research in Madagascar), and worked on vaccine development and delivery at PATH, a global health NGO in Seattle.

That’s a pretty unusual resume for a medical student.  It meant that his fellow medical school students at the University of Washington would often ask him “how to get into global health.”

The book is a detailed answer to their query, compiling opportunities for medical electives, and laying out the specifics of planning a trip (there are chapters on “understanding the landscape and identifying your goals,” and “funding for global health opportunities.”)  The final chapter has advice from some big names in global health: Allan Rosenfield, Jim Kim, Richard Feachem, Evaleen Jones, and Keith Brown.

I did a medical elective in rural Guatemala in my last year at medical school, and I feel sure it sensitized me to many of the issues in global health.  At the same time, I’ve often worried about the imbalance involved in Western students gaining experience in poor countries (after all, what, if anything, does the host country gain?).

I asked Paul what he thought.

“There’s a delicate balance in these rotations,” he said.

“You want to expose students to global health–then they become engaged in the issues.  The problem comes when they want too much autonomy.”  Dr Drain believes it’s problematic when a student or resident arrives in a developing country and  immediately wants to take over on day one, operating on patients, or running clinics.

Another source of difficulty is when the elective is short-term, such as four weeks.  “That’s just enough time to get bitter and frustrated about the system, ” he said, leading students to cut short their elective and “go on safari.”

There’s also the potential for medical electives to be a burden on the host country’s health system, by taking away time from professors, teachers, and admin staff.

Dr Drain thinks the answer to these problems lies in having Northern and Southern institutions enter into twinning arrangements (e.g. Massachusetts General Hospital, where Dr Drain is heading this year for a fellowship in infectious diseases, is twinned with a hospital in South Africa).  Twinning, he feels, sets up a more “cooperative” relationship, allowing bilateral student exchanges  (North to South and South to North) as well as collaborative research arrangements.

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