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Canadian Students’ Involvement in International Health

Canadian Students’ Involvement in International Health. Alexandra Martiniuk MSc Community Health & Epidemiology PhD candidate Epidemiology and Biostatistics University of Western Ontario, Canada SUNSIH President 1999-2000 and 2000-2001 ( www.csih.org ) Contact: alexmartiniuk@hotmail.com. 1.

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Canadian Students’ Involvement in International Health

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  1. Canadian Students’ Involvement in International Health Alexandra Martiniuk MSc Community Health & Epidemiology PhD candidate Epidemiology and Biostatistics University of Western Ontario, Canada SUNSIH President 1999-2000 and 2000-2001 (www.csih.org) Contact: alexmartiniuk@hotmail.com 1

  2. WHAT TO EXPECT IN THIS PRESENTATION • Why topic important • Students involved in international health important for global community + Canadian one • Students already involved • Students need to improve communication to each other, their universities/faculty + overseas 2

  3. BACKGROUND “A resurgence of interest and activity in international health [is] strong but unorganized”(Stuck et al., 1995) International health care/aid is provided through multiple channels (both local and international) resulting in duplication and waste, fragmentation of care and poor coordination of services Most believe that health faculties have an important role in this struggle (Ulmer, D.D., 1995) 3

  4. RATIONALE • HOW MANY STUDENTS ARE INVOLVED? • 1989 annual AAMC (American Association of Medical Colleges) graduating medical student survey - 15.3% had done an overseas elective (Imperato, 1996.) 4

  5. BELIEF THAT INTERNATIONAL ROTATIONS/ELECTIVES ARE POSITIVE: • confidence in knowledge, history and physical exam • skills in diagnosis • appreciation of economic (costs) and political policy effects on health • understanding of cultural factors in Dx/assessment and Tx (Bissonette, R.P. and Alvarez, C.A.,1991)

  6. Benefits of International Work to Home Community CANADIAN LACK OF RURAL HEALTH CARE PROVIDERS: “Undergraduate international experiences may preserve desire to work in under-served communities” (Chiller, et al., 1995) “Links seen between developing world and under-served populations in North America” (Stuck, C. et al, 1995.) CANADIAN HEALTH CARE SYSTEM IN FINANCIAL CRISIS: International health work can de-emphasize the use of expensive technology. Health care costs may be reduced. (Chiller et al., 1995) 5

  7. PUBLISHED LITERATURE ON THIS TOPIC • Canadian contribution (Head, I.L. “Canadian Contributions to Health in the Developing World” Canadian Journal of Public Health. Vol. 74, July/august 1983) + (McGill paper, 1993) • 1945 - 96% of US medical schools taught tropical medicine/international health • 1954 - 7% were offering such courses while the number of students performing electives overseas has increased (Imperato et al., 1996.) 6

  8. Literature Cont’d Do international health rotations increase interest in resource-poor areas back at home? • international health rotations “increase the number of physicians entering careers in under-serviced areas and improve the health systems in resource-poor regions” (Pust, R.E., & Moher, S.P., 1995.) • STUDY (Chiller, T.M. et al., 1995) • questionnaires to 142 graduates (1993) • 23.1% who attended international rotations intended to work in resource poor areas of the US • compared to 5.6% of those who did not do an international rotation • note: follow-up poor (76 students) ALSO self-selected, no argument for causality) 7

  9. Literature Cont’d Are international health rotations meeting their objectives? • Current objectives include: • develop professional linkages in international health work • increase training (+ international health courses) • expand multi-disciplinary research in global health issues (Torjesen, H.,1995) • STUDY: • questionnaires to 30 medical students (international rotations since 1984) • improvements in communication, role of religion and disease concepts on management of illness (Bissonette, R.P. & Alvarez, C.A., 1991) 8

  10. FUTURE DIRECTIONS • More research into international health rotations/electives • “a paucity of articles on consequences of international rotations”, studies into effects of student international experiences encouraged (Chiller, TM et al., 1995) • systematic survey of alumni who participated in overseas electives re: their subsequent careers would be useful (Imperato, P.J., 1996.) • “US medical schools have provided medical student experiences overseas for 40 years but no systematic documentation of educational consequences” (Bissonette, R.P. & Alvarez, C.A., 1991) 9

  11. INTERNATIONAL HEALTH STUDENT GROUPS IN CANADA • Dalhousie University (DIMS) McGill University (OMAF) (SAMA) • McMaster University (SIHI) Queen’s University (QMO) • Universite de Leval (Sante Universite de Montreal Tiers-Monde) (CINESIUM), (CASI) • University of Alberta (SIHA) University of British Columbia (GOSA) • University of Calgary (GHIG) University of Manitoba (MSAID) • University of Ottawa (OSHI) University of Saskatchewan (Health Everywhere) • University of Toronto (UTIHP) University of Western Ontario (MedOutreach, WIHN) 10

  12. SCHOOL (year) LOCATION (last is current location) 1. Dalhousie (99) Gambia, Cuba 2. McGill (84) Cameroon, Kenya, Haiti, Croatia, Armenia 3. McMaster (?) Malawi, Cambridge Bay (Nunavut) 4. Queen’s (84) Guyana, Belize, Northern ON., Kingston 5. U of Alberta (90) Guyana, Tanzania, Edmonton 6. UBC (93) Guatemala, Vancouver 7. U of Calgary (?) developing project in Bangladesh 8. U of Manitoba (96) Haiti, Northern Manitoba 9. U of Ottawa (88) Zaire, Rwanda, Burundi, Guyana, Malaysia, Vietnam, Malawi 10. U of T (95?) Toronto, developing project in Ethiopia 11. UWO (86 + 98) Nigeria, Tanzania 11

  13. WHAT ARE THESE STUDENTS DOING OVERSEAS? 1. Dalhousie medical students observe Cuban health care system 2. McGill work with disabled children in orphanages, health education, refugee supplies, mental health survey, photo journalism, funds for wells in Haiti 3. McMaster curriculum development “Peace through Health”, fundraising, journal club 4. Queen’s rehabilitation in Guyana, program evaluation in Belize, immunization, health education schools + village workers, northern ON continuing education, Camp Trillium, CNIB 5. U of Alberta hypertension/diabetes study in Guyana, primary health care + education, hook worm Dx/Tx in Tanzania, AIDS education, FAS edu in Edmonton, Operation Eyesight, text collection 12

  14. 6. UBC health/SES survey Guatemala, pediatric safety, immunizations, Vancouver Boys and Girls club nutrition classes, Health + Safety Fair, aboriginal health 7. U of Calgary international health resource center 8. U of Manitoba malaria program (bednets), TB/CHF clinics, physio at orphanage (Haiti) 9. U of Ottawa public health edu, English/Chitambukan medical dictionary, Child to Child 10. U of T immigrant health in Toronto, pen pal to health professionals in Ethiopia 11. UWO speaker series (WIHN), protocol dev in Tanzania (eg. Antibiotic use), parasitology research, neonatal respiratory physio, physical exam + diagnosis with rural health care workers 13

  15. ISSUES AND INSIGHT • Growing student base, a need to collaborate and create (eg. U of Arizona offers an international health course for students from any university) • Need for Canadian knowledge base (better record keeping, sustainability + communication) • Roles & Responsibilities of the University need to be discussed such as: supervision of student, protection of student from illness and injury • Risks to student + university (20’s developmental stage, risks worth gains?) 14

  16. ISSUES AND INSIGHT CONT’D • Ethics • working in another culture/country (clean up your own backyard first vs. our global community) • meeting our needs or theirs? (a fad in North America?) • provide valuable medical assistance (now and/or later)? • Equalizing the relationship (3rd world charging tuition) 15

  17. CONCLUSIONS • Topic is important • Students in international health relevant to our global community + our Canadian one • Students involved • Need to improve communication between students, universities/faculty + overseas 16

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