Global Health Outreach Research Articles

The impact of global health outreach experiences on medical student burnout

BackgroundStudent burnout during medical education is a prevalent and critical problem. Burnout has reaching consequences, including negative health outcomes for students, financial loss for schools, and worsened patient care as students transition to practice. Global Health Outreach Experiences (GHOEs), known to enhance cultural awareness and clinical knowledge among medical students, are offered in most programs. Prior studies document that GHOEs benefit physicians suffering from burnout, with effects demonstrating improvement over 6 months. No study, to our knowledge, has assessed the influence GHOEs may have on medical student burnout with a comparable control group. This study examines whether participation in a GHOE, compared to a standard break from school, has a positive effect on burnout.MethodsA case control study utilizing the Copenhagen Burnout Inventory was conducted on medical students. 41 students participated in a one-week, spring break GHOE and 252 were randomly selected as non-participating students in a control group. Assessments were gathered 1 week prior, 1 week after, and 10 weeks after spring break. Response across the surveys in chronological order included 22, 20, 19 GHOE and 70, 66, 50 control participants.ResultsA significant reduction in personal burnout (PB) (P = 0.0161), studies related burnout (SRB) (P = 0.0056), and colleagues related burnout (CRB) (P = 0.0357) was found among GHOE attendees compared to control participants at 10-weeks after spring break. When modeled with potential confounders, CRB and SRB reductions remained significant.ConclusionGHOEs may be a potential tool for institutions to combat burnout rates in their students. The benefits of GHOEs appear to enhance over time.

Ailing neurosurgical services in rural Africa

Ailing neurosurgical services in rural Africa

Invited Commentary on Stoehr J et al: The Personal Impact of Involvement in International Global Health Outreach: A National Survey of Former Operation Smile Student Volunteers

During my years working in Kenya and Ethiopia, I used to warn keen short-term volunteers that, as much as they came motivated by a sincere desire to help African patients, the only real impact they could expect was on themselves - they will leave changed, and what they will receive will outweigh anything they could give. It was a tough and sobering statement, yet essential for addressing the inherent savorism that characterized - and still does - so much of global surgical care.

The Personal Impact of Involvement in International Global Health Outreach: A National Survey of Former Operation Smile Student Volunteers

BackgroundHumanitarian surgical organizations such as Operation Smile provide global health opportunities for students and medical trainees. Prior studies have shown a positive benefit for medical trainees. This study aimed to determine if the international global health experiences of young student volunteers impact their career choices as adults. MethodsA survey was sent to adults who were involved with Operation Smile as students. The survey elicited information about their mission trip experience, education, career, and current volunteer and leadership activities. Data were summarized with descriptive statistics and qualitative analysis. Results114 prior volunteers responded. The majority participated in leadership conferences (n = 110), mission trips (n = 109), and student clubs (n = 101) while in high school. Many graduated from college (n = 113, 99%) and completed post-graduate degrees (n = 47, 41%). The most highly represented occupational industry was healthcare (n = 30, 26%), including physicians and medical trainees (n = 9), dentists (n = 5), and other healthcare providers (n = 5). Three-fourths reported that their volunteer experience impacted their career choice, and half reported that their experience allowed them to connect with career mentors. Their experience was associated with the development of leadership skills, including public speaking, self-confidence, and empathy, and increased awareness of cleft conditions, health disparities, and other cultures. Ninety-six percent continued to volunteer. Narrative responses revealed that the volunteer experiences impacted their inter- and intrapersonal development into adulthood. ConclusionsParticipation in a global health organization as a student may encourage a long-term commitment to leadership and volunteerism and foster interest in a healthcare career. These opportunities also encourage development of cultural competency and interpersonal skills. Level of evidenceIII, Cross-Sectional Study.

Hands Across the Water: Global Health and International Medical Outreach

Ask the Expert| May 2022 Hands Across the Water: Global Health and International Medical Outreach Zachary Deutch, MD, FASA; Zachary Deutch, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar Sara Miller Strowd, MD, MPH Sara Miller Strowd, MD, MPH Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor May 2022, Vol. 86, 20–21. https://doi.org/10.1097/01.ASM.0000830820.18185.d9 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Zachary Deutch, Sara Miller Strowd; Hands Across the Water: Global Health and International Medical Outreach. ASA Monitor 2022; 86:20–21 doi: https://doi.org/10.1097/01.ASM.0000830820.18185.d9 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: hand, outreach, world health Welcome to the spring 2022 edition of Ask the Expert! This month, we will think outside the box of most of our collective experiences and outside the borders of our own country at the same time. We will explore international medicine and medical humanitarian outreach, a topic hugely important for reasons of conscience and ethics, especially as we are seeing the gap between the “haves” and “have nots” increase at both the individual and national levels. What, if any, moral obligations do the more fortunate have toward those who are less so? Our expert this month is Dr. Sara Strowd, from Stanford University, who will help us navigate such questions. As always, feedback, commentary, and volunteerism all are welcomed at zdeutch@yahoo.com. Thank you for co-authoring, Sara. Please describe your current position and responsibilities. Thank you for the opportunity, Zach. I'm a Clinical Assistant Professor at Stanford University.... You do not currently have access to this content.

Global health radiology planning using Geographic Information Systems to identify populations with decreased access to care.

BackgroundCommunities throughout northern Canada face significant health care disparities including decreased access to radiology. A medical hybrid airship is under development which aims to serve remote populations, requiring strategic outreach planning. This study aims to use geographic information systems (GIS) to identify (1) high risk and medically underserved patient populations in northern Canada and (2) potential landing sites for a medical airship to allow for mobile delivery of radiology services.MethodsThe northern region of Canada extending from the Rocky Mountains to the Atlantic Ocean was analyzed using multi-variable, multi-weighted GIS modeling. Based on population distance from hospitals (50% weight), health centers (eg, clinic; 30% weight), remote communities (not connected to electric grid; 10% weight), and roads (10% weight), individuals were stratified into one of five health care accessibility index (HAI) categories (ranging from very low to very high severity). HAI (80% weight) was combined with population density (20%) to create a health care access severity index (HASI). Topographic and land cover data were used to identify suitable landing sites for the medical airship. A coordinate data set was made from georeferenced health care facilities, and infrastructure data was obtained from OpenStreetMap.ResultsGIS analyzed 815 772 Canadians. Of this population, 522 094 (64%) were found to live ≥60 km from a hospital, 326 309 (40%) were ≥45 km from the nearest health center, 65 262 (8%) were within 30 km of a remote community, and 57 104 (7%) lived ≥1 km from the nearest road. Combined, the HASI identified 44% of the population as having decreased access to care (high or very high severity). Lastly, 27.5% of land analyzed was found to be suitable for airship operations.ConclusionsGIS identified medically underserved populations in northern Canada who may benefit from mobile radiology services. These techniques may help to guide future global health outreach efforts.

Clinical Implementation and Utility of Triggered kV Imaging During Spine Stereotactic Body Radiotherapy for Intrafraction Motion Management

To monitor intrafraction motion during spine stereotactic radiosurgery (SRS) treatment delivery with readily available device, we implemented triggered kV imaging using the on-board imager of the medical linear accelerator advanced imaging package.Triggered kV imaging technique was clinically implemented and applied to 32 spine SBS patients (75 fx, 20 T-spine tumors, 12 L-spine tumors) during VMAT delivery. Currently available trigger options in the medical linear accelerator software package are MU, gantry angle, time, and respiratory gating. Time trigger was selected to acquire kV images every 15 seconds, in an effort to balance temporal resolution with reasonable time for image evaluation. Upon each image acquisition, a 2D projection of the 3D image-guided radiotherapy (IGRT) structures was automatically calculated and updated at arbitrary angles as a qualitative visual guide for patient alignment during treatment delivery. For IGRT structures, patient anatomy (vertebra and spinous process) and orthopedic hardware if present were contoured, with a 1 mm expansion. As the technique depends on visual inspection, decisions could vary depending on interobserver variability. Therefore, a survey of 10 trained physicists (4) and physicians (6) was conducted to evaluate efficiency and accuracy of clinical decision with kV images collected using an anthropomorphic phantom with different CT slice thicknesses and shifts introduced. The survey consisted of 192 sample images. The participants were asked to determine if a shift requiring intervention was observed. Average time per decision was recorded.The robustness of our current patient immobilization system was validated in our clinical implementation. Based on visual inspection of projected IGRT contours on planar kV images, appreciable movement was detected in only one fraction (1.3%). However, in this instance, motion was well beyond PTV/PRV margins (2.4 mm) and treatment was stopped to take a CBCT and correct the displacement, which otherwise would have not been detected. From the survey, the average time spent per decision was 7.5 seconds. In all shift directions, detectability was proportional to the shift size and superior detectability was observed with contours drawn using CT images with 1 mm slice thickness. Shifts smaller than 1 mm are less noticeable (12.6%) compared to 2 mm shifts (42.6%). Participant detection capability was dependent on the level of training.This approach provides an effective, non-invasive intrafraction motion monitoring solution, using the built in triggered-imaging technique of the medical linear accelerator. One of the benefits this technique offers is that it can serve as a quality assurance approach to verify adequacy of a patient immobilization system. An important limitation is that the monitoring result is qualitative and depends on observer visual detection capability. Enhanced precision and utility could be achieved if an automated quantitative evaluation feature is implemented.J. Koo: None. L.Nardella: None. M.Degnan: None. J.Andreozzi: None. H.M. Yu: Honoraria; UpToDate. Speaker's Bureau; BrainLab. Advisory Board; Novocure, AbbVie. J.A.Penagaricano: None. P.A. Johnstone: None. D.E. Oliver: None. K.A. Ahmed: Research Grant; Bristol-Myers Squibb, Genentech. S.Rosenburg: Consulting; Novocure. E.J.Wuthrick: Research Grant; BMS. Honoraria; Regeneron/Sanofi, Varian. Consultant; Regeneron/Sanofi, Varian. R. Diaz: Honoraria; Zeiss; Global Health Outreach. V.Feygelman: None. E.G. Moros: Research Grant; Varian Medical Systems. Promote research in the AAPM; American Association of Physicists in Medicine. Promoting research in the AAPM; American Association of Physicists in Medicine. G.Redler: None.

The Professional and Personal Impact of Involvement in International Global Health Outreach on Student Volunteers

The Professional and Personal Impact of Involvement in International Global Health Outreach on Student Volunteers

Identifying the Knowledge Structure and Trends of Outreach in Public Health Care: A Text Network Analysis and Topic Modeling.

Outreach programs are considered a key strategy for providing services to underserved populations and play a central role in delivering health-care services. To address this challenge, knowledge relevant to global health outreach programs has recently been expanded. The aims of this study were to analyze the knowledge structure and understand the trends in aspects over time and across regions using text network analysis with NetMiner 4.0. Data analysis by frequency, time and region showed that the central keywords such as patient, care, service and community were found to be highly related to the area, target population, purpose and type of services within the knowledge structure of outreach. As a result of performing topic modeling, knowledge structure in this area consisted of five topics: patient-centered care, HIV care continuum, services related to a specific disease, community-based health-care services and research and education on health programs. Our results newly identified that patient-centered care, specific disease and population have been growing more crucial for all times and countries by the examination of major trends in health-care related outreach research. These findings help health professionals, researchers and policymakers in nursing and public health fields in understanding and developing health-care-related outreach practices and suggest future research direction.

Strategic Radiology Outreach Planning for Underserved Populations Using Geographic Information Systems.

Geographic information systems (GIS) are widely used in public health research but rarely used in radiology research. GIS can be an impactful tool in radiology global health to locate medically underserved populations and poor transportation infrastructure, characterize medical needs, and design outreach programs. Using the example of aircraft-based outreach in Alaska, we demonstrate the utility of GIS in radiological program planning for global health. Multicriteria GIS evaluations were performed to create a health severity index, using life expectancy and percentage uninsured data, and an accessibility severity index, using distance from roads and health centers or hospitals. These indices were combined with population density to create a final health access severity index (HASI). A map presenting suitable hybrid airship operating areas was produced using land cover data. Alaskan health care facilities were georeferenced to create a coordinate data set. Infrastructure was obtained from OpenStreetMap. Health data were accessed from the 2017 American Community Survey and CDC US Small-area Life Expectancy Estimates Project. GIS analyzed 738,050 Alaskans. The health severity index identified decreased health outcomes (high or very high severity) in 285,446 (39%) Alaskans, and the accessibility severity index determined decreased access to care in 218,201 (30%). Combined, the HASI established 165,108 (22%) Alaskans as underserved with high or very high overall severity. Thirty-nine percent of Alaska land area is suitable for hybrid airship operations, including 27% of HASI high and very high severity areas. GIS identified underserved populations for mobile radiology outreach in Alaska and may be useful for global health outreach planning and resource allocation.

Overcoming Challenges for Successful PACS Installation in Low-Resource Regions: Our Experience in Nigeria.

In this paper, we walk you through our challenges, successes, and experience while participating in a Global Health Outreach Project at the University College Hospital (UCH) Ibadan, Nigeria. The scope of the project was to install a Picture Archive and Communication System (PACS) to establish a centralized viewing network at UCH's Radiology Department, for each of their digital modalities. Installing a PACS requires robust servers, the ability to retrieve and archive studies, ensuring workstations can view studies, and the configuration of imaging modalities to send studies. We anticipated that we might experience hurdles for each of these requirements, due to limited resources and without the availability to make a site visit prior to the start of the project. While we ultimately experienced delays and troubleshooting was required at each turn of the install, with the help of dedicated volunteers both on and off-site and the UCH staff, our shared goal was accomplished.

Global Health Outreach by United States Ophthalmology Residency Programs: Understanding of Host Country Systems-Based Practice.

For medical residents, global health outreach is the first experience of learning how to develop partnerships with foreign medical systems. The overall objective of this project was to develop an overview of global health programs in U.S. ophthalmology residencies. The investigation focused on characterizing the goals and services offered, the didactics taught to residents, and the program director's understanding of systems-based practice gained in the host country. An online survey was sent to all U.S. ophthalmology residency program directors. The two outcome measures of the study were characterization of global health outreach and didactics completed by U.S. ophthalmology residency programs and review of program director understanding of host country systems of care. Twelve program directors of 117 (10.26%) answered the survey. 100% of programs from the Department of Defense responded. Countries served included Ecuador, Panama, Honduras, Dominican Republic, India, Tanzania, Nepal, Bhutan, Guatemala, Micronesia, Haiti, Mongolia, Bolivia. Sixty five percent worked at a free-standing public hospital. Many programs offered resident participation with only 41.87% giving residents ACGME credit. Most programs (91.67%) offered fewer than 5 hours of global health didactics. When program directors were asked about their knowledge of host country systems of care, most noted understanding of the hospital functions like the referral system, transitions of care, hospital funding, and medical supply chain, but not of the perception of patients with chronic or congenital ophthalmic diseases, host country general or ophthalmic medical education, patient research safeguards and host country malpractice system. From the small sample of program directors, Ophthalmology residency program global health outreach varies in faculty and resident participation, and in goals and services offered. In addition, there was a wide variation in ophthalmology program director understanding of host country systems of care.

Why Cuban Solidarity Was Ebola's Antidote: How Cuban Medical Internationalism is Radically Changing Health Geographies in the Global South

When the world responded to the 2014 Ebola outbreak a lot went wrong. Vaccines were promised but never delivered. Health workers were called for, but never arrived. Patients needed urgent care, but were forced into quarantine. Amid repeated calls for urgent action and increased care to the Ebola stricken countries in West Africa many nations acquiesced. Yet economically hobbled Cuba offered more health care workers, established more hospital space, and trained more people in the fight against Ebola than any other country in the world. It is a seemingly exceptional effort considering the lacking response of many nations. As this paper argues, Cuba's Ebola effort is a normative response within its broader commitment to solidarity. This paper demonstrates that Cuba employs a solidarity approach to global health that meets the health needs of some of the world's most marginalized populations, while contributing to its own economic and political goals. What is more, this approach works to further Cuba's own political interests by facilitating cooperation through health care provision. The paper explores the program design, logistical operations, and broader conceptualization of Cuba's Ebola efforts based on testimony from Cuban health workers in the field, and health officials in Havana. Cuba's solidarity approach to global health outreach stands in stark contrast to many global health efforts, and, if expanded upon, it could drastically improve global health efforts.

Establishment of a dermatology global health outreach and residency partnership program in Guatemala

Establishment of a dermatology global health outreach and residency partnership program in Guatemala

Partnerships between the faith-based and medical sectors: Implications for preventive medicine and public health.

Interconnections between the faith-based and medical sectors are multifaceted and have existed for centuries, including partnerships that have evolved over the past several decades in the U.S. This paper outlines ten points of intersection that have engaged medical and healthcare professionals and institutions across specialties, focusing especially on primary care, global health, and community-based outreach to underserved populations. In a time of healthcare resource scarcity, such partnerships—involving religious congregations, denominations, and communal and philanthropic agencies—are useful complements to the work of private-sector medical care providers and of federal, state, and local public health institutions in their efforts to protect and maintain the health of the population. At the same time, challenges and obstacles remain, mostly related to negotiating the complex and contentious relations between these two sectors. This paper identifies pressing legal/constitutional, political/policy, professional/jurisdictional, ethical, and research and evaluation issues that need to be better addressed before this work can realize its full potential.

What Are the Ethical Issues Facing Global-Health Trainees Working Overseas? A Multi-Professional Qualitative Study.

The aim of this study was to identify global health ethical issues that health professional trainees may encounter during electives or placements in resource-limited countries. We conducted a qualitative study involving focus groups and an interview at the University of California San Francisco. Participants were multi-professional from the Schools of Medicine, Nursing and Pharmacy and had experience working, or teaching, as providers in resource-limited countries. Eighteen participants provided examples of ethical dilemmas associated with global-health outreach work. Ethical dilemmas fell into four major themes relating to (1) cultural differences (informed consent, truth-telling, autonomy); (2) professional issues (power dynamics, training of local staff, corruption); (3) limited resources (scope of practice, material shortages); (4) personal moral development (dealing with moral distress, establishing a moral compass, humility and self awareness). Three themes (cultural differences, professional issues, limited resources) were grouped under the core category of “external environmental and/or situational issues” that trainees are confronted when overseas. The fourth theme, moral development, refers to the development of a moral compass and the exercise of humility and self-awareness. The study has identified case vignettes that can be used for curriculum content for global-health ethics training.

Global Speech-Language Health: Belize

This independent field experience in global health explores the application of health promotion and service delivery models from the field of public health to speech-language services through descriptive research of the case in southern Belize. This project explores first steps in global speech-language health outreach for children living in very limited resource settings. Global speech-language health outreach includes community-wide interventions, fostering collaboration in the community and internationally, health education, building on local resources to expand health services, and special education program development. This project makes the assumption that a rich language environment may be a determinant of speech-language health. Speech-language interventions that enrich the linguistic environment may be a strong starting point for regions with very limited access to speech-language services. Therefore, this project looks at targeting social and environmental factors that influence language and literacy skills. The aim is to raise awareness of pediatric speech-language disability in southern Belize, with the ultimate goal of increasing school and community participation of children with speech-language disabilities. The purpose of this project is to explore points of entry for population-wide, environment-enriching, and culturally relevant intervention targeting communication and academic growth, in a limited resource setting. Furthermore, this project describes barriers to speech-language services and interventions in southern Belize.

South Korea's Global Health Outreach through Official Development Assistance: Analysis of Aid Activities of South Korea's Leading Aid Agencies, 2008–2012

AbstractAlthough South Korea is one of the newest members to join the Organisation for Economic Co‐operation and Development's Development Assistance Committee in 2010, it has a long history of official development assistance (ODA), first as a recipient of aid (1945–1995) and later as an emerging donor (with the establishment of aid‐implementing agencies for concessional loans in 1987, and for grant aid in 1991, respectively). And, global public health has been one of the three largest outreach areas of South Korea's foreign aid programmes. This article examines the global public health outreach activities of South Korea's leading aid‐implementing agencies, namely Korea International Cooperation Agency, Korea Foundation for International Healthcare and Economic Development and Cooperation Fund, using data for the latest period, 2008–2012. South Korea's innovative global public health ODA through the Global Poverty Eradication Contribution is also examined. The analysis of global public health outreach activities has shown that South Korea has concentrated its foreign aid to Asia and Africa, and that a large share of its aid has been focused on health care services; water, sanitation and hygiene (WASH); maternal and child health (MCH); and infectious diseases. A significant regional difference was found: South Korea's aid focused on health care services and MCH in Asia, while it focused on WASH and infectious diseases in Africa. Findings have also shown that South Korea's priority countries for development cooperation have received more aid compared with non‐priority countries. In conclusion, we have found that South Korea's global health outreach activities were in line with the Millennium Development Goals (MDGs), but that they lack a clear focus and do not have globally recognised initiatives or projects compared with large and traditional donors such as the United States and Japan. Further research is needed to examine the impact of the rapidly rising aid activities of South Korea, especially in global public health.

Why Does Cuba 'Care' So Much? Understanding the Epistemology of Solidarity in Global Health Outreach

Cuba currently has more than 38,000 health workers providing emergency relief, long-term community-based care and medical education to some of the most vulnerable communities in the world. This current outreach to 76 countries positions Cuba as a leader in global health outreach. This has been well documented and praised by many scholars and policy makers alike. While many acknowledge the importance and impact of the Cuba’s global effort, there is very little understanding as to why Cuba makes such a large global health commitment in the first place. I argue that solidarity is in fact a mixture of national pride, self-interest and humanistic outreach. Ultimately, it is a calculated effort to overcome current structures of inequity and exploitation on a global scale by expanding new opportunities for health professionals dedicated to providing care in marginalized communities.

Sustainable Global Health Outreach in Haiti: Service Learning for Primary Care Nurse Practitioner Students

Sustainable academic partnerships that focus on capacity building can improve health outcomes of patients in resource-challenged international settings. The involvement of primary care nurse practitioner students and faculty in service learning can also foster cultural competency and cultural humility. This article describes program development, roles, and outcomes of 3 outreach ventures between the College of Nursing and Health Professions and a United States–based nongovernment organization at 5 different sites in Haiti. Lessons learned in conducting global health field work at the advanced practice nursing student level both inclusively and as part of an interprofessional team are shared.