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Abstract

Dr. Hauswald provides an excellent perspective about clinical practice in resource-limited settings. Although American physicians are trained in a technologically advanced environment with unlimited access to specialized services, the appeal of global health and international emergency medicine fellowships is that they do offer opportunities for American physicians to learn how to work and improve their diagnostic skills in resource-limited environments. Most (if not all) opportunities offered by international emergency medicine and global health fellowships cover aspects of local accreditation and licensing; in regard to more independent endeavors, providers should indeed be mindful of ensuring accreditation in the local environment. However, our experience is that on the receiving end, organizations are more than happy to facilitate these types of administrative tasks in exchange for the health care expertise that visiting physicians provide. The Diploma of Tropical Medicine and Hygiene programs he mentions are available not only at the London School of Tropical Medicine and Hygiene, at which he trained, but also at several universities in the United States. These programs' duration ranges from 13 weeks to 3 years, with various types of certification involved (more information is available at http://www.astmh.org). However, it is doubtful that the 3-month course mentioned is likely to give emergency providers mastery of such complex techniques as the use of forceps for obstructed labor. Reading and interpreting one's own laboratory tests is also a standard part of educational experiences in many international emergency medicine fellowships and other overseas practice opportunities. However, additional exposure to these techniques in the form of a Diploma of Tropical Medicine and Hygiene program can certainly be of assistance for those practicing in resource-limited environments. We also agree with Dr. Hauswald's comment that the visiting physician often is the student, rather than the teacher, in their overseas clinical work experience. Aspects of the Diploma of Tropical Medicine and Hygiene curriculum are covered in a number of wilderness medicine and austere medicine courses and fellowships offered through programs such as those at Stanford University and the University of Utah.1Advanced wilderness life support.http://www.awls.orgGoogle Scholar, 2Stanford University Department of Emergency Medicine: wilderness medicine fellowship.http://emed.stanford.edu/fellowships/wilderness.htmlGoogle Scholar These courses focus on the practice of medicine in any type of low-resource environment (whether in the United States or abroad). Further, the combined wilderness, austere, and international emergency medicine fellowship is of course available at Dr. Hauswald's institution, the University of New Mexico.3University of New Mexico Department of Emergency Medicine: wilderness, austere, and international emergency medicine fellowship.http://hsc.unm.edu/emermed/Fellowships/WAIEMFellowship/WAIEMFellowship.shtmlGoogle Scholar International Emergency Medicine and Global Health: Training and Career Paths for Emergency Medicine ResidentsAnnals of Emergency MedicineVol. 57Issue 5Preview[Ann Emerg Med. 2011;57:520-525.] Full-Text PDF International Emergency Medicine and Global Health: Training and Career Paths for Emergency Medicine ResidentsAnnals of Emergency MedicineVol. 58Issue 6PreviewI share the enthusiasm of Morton and Vu1 for global medicine but wish to add a few cautionary notes. American physicians are trained in an environment that is uniquely technologic in focus and resistant to economic limitations. We train and practice, at least in urban areas, with essentially unlimited access to tests, consultants, and specialists. Access to a modern laboratory and radiology suite, the availability of orthopedic and other specialty surgeons, and the ability to triage pregnant patients directly to labor and delivery is certainly good for patients. Full-Text PDF