International Child Health for the Practicing Pediatrician

1. International Child Health for the Practicing Pediatrician Section on International Child Health November 3, 2003 David P. Norton, MD FAAP

2. International Child Health • Why get involved? • Where to find opportunities • Preparing for doing medical work abroad • Challenges • Returning Home

4. Why get involved? • Children and Health Care • Where are most of the world’s children? • Child health issues – US vs. Global • Disparities– developed world vs. developing

5. Population Comparisons

6. Under-five mortality rate trends (per 1,000 live births) Source: UNICEF

7. Child Mortality

8. Child Mortality, US Leading causes of Death in Children, ages 1-4 years. • 1 Accidents (unintentional injuries) • 2 Congenital malformations • 3 Malignant neoplasms • 4 Assault (homicide) • 5 Diseases of heart

9. Total Number of Immigrant Visas Issued to Internationally Adopted Children by Year Source: US Dept State

10. “Why we do it”– UNICEF –for the Children • Children have rights • The world has set goals for children • Children demand a voice • Poverty reduction starts with children • The people of the world say 'Yes' for children • Children should not be dying from preventable causes

11. Why get involved-- other reasons • Moral/ ethical– personal need to give back • Sense of Adventure • Language skills, interest in other lands and cultures • Previous international experience – personal/ family ties • Broaden one’s educational horizons

12. Requirements • Idealism and a sense of hope! • Resilience • Flexibility • Open Mind • Cultural Sensitivity and Awareness • Sense of humor

13. Other Factors to Consider • The home scene / family life • Family– bring them or leave them? • Involve them! • Job – Who’s covering and how happy are they? • Money • Access to support for your work • Loss of income • Time off– vacation/ CME/ leave of absence • Personal Health

14. How to get involved -- abroad • Short term work with volunteer organizations • Longer term– with NGO’s, governmental agencies, universities • Types of work- • Clinical Care / Service • Medical Education • Research

15. How to get involved– at home • Donation programs- • Books and Journals • Recycling Medical Supplies –”REMEDY” • International Adoption and Caring for Immigrant Populations • Travel Clinics

16. How to get involved– at home • Sponsoring/ working with visiting physicians, nurses here for education • Political Action– advocate for children! • UN Convention of the Rights of the Child • Where your tax dollars go • Other issues– land mines, child labor

17. International Child Health-- on the Net • Consulting from afar- “e-mentoring” • Doctors of the World-USA • Foster knowledge access and exchange with colleagues across the globe. • List serves– method to collaborate on international projects– • Yahoo group– Honduras Hospitals • International Pediatric Chat

18. Volunteer Opportunities– Resources • SINCH Website • SINCH list serve • IHMEC • IMVA • Religious Organizations • Journal Articles- JAMA • Word of mouth/ Network with colleagues • Make contacts while traveling

19. Things to consider- • Context • Alone or with a team/group • Secular or religious NGO • Type of work • Education, service, combined • Physically demanding • Personal experience/ training

20. Things to consider– cont’d • Safety • Logistics • Travel • Climate • Altitude • Local medical community • How welcoming? • Teaching opportunities • Pediatric colleagues

21. Challenges • Overwhelming Need– How can I possibly make a difference? • Lack of Resources • Language • Cultural Differences • Food, Housing • Health of the Volunteer • Emotional Challenges

22. Preparation– What to learn • Job Description– figure out what you will be expected to do! • Specific tasks expected– patient care, teaching, procedures, administrative • Update PALS, NALS • Range of medical problems • Work hours and time off. • Who are your colleagues? • Connect with previous volunteers

23. Preparation– What to learn- • Language – even a little bit helps, and is appreciated • Research the area– geography, culture, ethnic groups • Health information – what kinds of health problems are you likely to see?

26. Preparation – What to do • Medical – for the volunteer • Travel Immunizations • Malaria prophylaxis • High Altitude meds • Supplies • Medical Equipment/ Tools • Medications • Books • Teaching – slides, teaching kits (PALS)

27. Preparation-- teaching • Consider topics- • What may be interesting or useful for your professional colleagues? • What are you comfortable teaching/ what can you prepare for? • Who will you be teaching? – physicians, students, residents, nurses, lay health care workers…

28. Preparing -- teaching • What kind of teaching– lectures, rounds, discussion groups • What tools can you use? • Slides • Handouts • Overheads • Language issues with teaching

29. Packing • Traveling Alone or with a group? • Personal Items • Documents—passports, visa, copies of everything! • Personal Medications • Sunscreen, insect repellent • Appropriate Clothing – acceptable in the local hospital or clinic

30. Packing – Medical Supplies • Really depends on what you will really be doing! • Tools you need to do your job. • Bring only supplies that are useful and can be maintained, not dependent on advanced technology. • Heed customs regulations– vary from country to country.

31. Packing – Medical Supplies • Containers– zip lock bags, small plastic bottles • Disposable gloves, masks, gowns, eye protection. • Antiseptic hand wash/ consider n-95 masks • HIV prophylaxis • Electrical equipment- may need transformer if electricity is different voltage.

32. Medications– what to bring • Never bring expired meds. • Be selective – what is really needed? • Obtaining meds- • Samples– sometimes useful, but often lots of package for not much med. • Many pharmaceutical companies have donation programs– will donate larger amounts of medications to volunteers.

33. Medications– what to bring • Antibiotics – stick to the basics. • Analgesics and Antipyretics • Avoid– • Meds that don’t actually do much– cough/cold preps • New meds unfamiliar to local docs, especially if there are any significant side effects or risks.

34. Cultural Issues • Beliefs, customs related to health, disease and the medical community – where does your work fit in? • Level of education • Role of physicians vs traditional medicine • Medical advise vs. what really happens • Integrating your work with local colleagues

35. Cultural Issues, cont’d • Language and Translation– Getting your message across…. • Use of appropriate terminology • Talking to the right person! • Use of translators • Literacy issues/ use of pictograms • Make an effort to speak – a few words go a long way!

37. Cultural Issues, cont’d • Other important issues— • Local dress- what is appropriate for physicians? • Local hospital political scene • Interactions outside the medical setting

38. Returning Home • Cultural re-entry can be challenging • Return to “opulence” of our health care • Relative lack of medical need here vs. there • Patients/ parents here may seem demanding. • Volunteer may be physically and emotionally drained upon return.

39. Returning Home- cont’d • Sharing your experience may not be easy-- • Most people don’t really want to know much. • Hard to communicate your experience. • Criticism of the home scene may not be well-received.

40. Returning Home– Integrating the Experience • It may be easier to share with colleagues with similar experiences. • Direct your enthusiasm about a trip into talks or slide shows– for interested audiences. • Become active in the planning and administration of the organization that sent you.

41. Returning Home– the gains • You’ve learned a lot! • Flexibility- new definition • Ingenuity & Innovation • Appreciation of the resources at home • Charged batteries– remembering why you became a pediatrician! • You had the opportunity to just practice medicine.

42. The Pediatrician’s Gift --- To touch the life of a child…