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Wintrup J. Relational Harm: On the Divisive Effects of Global Health Volunteering at a Hospital in Rural Zambia. Med Anthropol 2024; 43:189-204. [PMID: 38436972 DOI: 10.1080/01459740.2024.2322435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Drawing on ethnographic research at a hospital in rural Zambia, I show how the presence of white Christian medical volunteers from the United States damaged relations between local health workers and patients. Working from a position of economic and racial privilege, medical volunteers received praise from many patients and residents. However, these positive attitudes incited resentment among many Zambian health workers who felt that their own efforts and expertise were being undervalued or ignored. Focusing on these disrupted relationships, I argue that it is crucial to understand how global health volunteering can produce enduring forms of "relational harm".
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2
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Bloomfield LSP, Tracey C, Mbabazi E, Schultz RL, Henderson R, Bardosh K, Randolph S, Paige S. Research Participation Influences Willingness to Reduce Zoonotic Exposure in Uganda. ECOHEALTH 2022; 19:299-314. [PMID: 35674864 DOI: 10.1007/s10393-022-01589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
The majority of emerging and re-emerging infectious diseases in people are zoonotic. Despite substantial research in communities adjacent to protected areas with high levels of biodiversity, limited data exist on people's knowledge, attitudes, and practices to avoid exposure to infections from domestic and wild animals. We used a modified grounded-theory framework in QS NVivo to develop a Knowledge, Attitude, and Practices (KAP) survey administered at two time points, KAPT1 (April-July 2016) and KAPT2 (February-May 2018) to participants living at the edge of Kibale National Park, Uganda. We measured the difference in willingness to engage in protective behaviors around zoonotic exposure between an Intervention group (n = 61) and a Comparison group (n = 125). Prior to KAPT1, the Intervention group engaged in a human-centered design (HCD) activity identifying behaviors that reduce zoonotic exposure (March-May 2016). Using a difference-in-difference approach, we compared the Intervention and Comparison groups to assess sustained willingness and use of protective behaviors against domestic and wild animal exposures. At KAPT1, Comparison group participants had a significantly lower (p < 0.05) level of willingness to engage in behaviors that increase exposure to zoonoses from domestic animals; Intervention group participants had a significantly higher (p < 0.01) level of willingness to engage in behaviors that increase exposure to zoonoses from wild animals. At KAPT2, the treatment effect was significant (p < 0.01) for sustained willingness to engage in protective behaviors for domestic animal exposure in the Intervention group. There were no significant differences in practices to avoid domestic and wild animal zoonotic exposure between the Intervention and Comparison groups.
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Affiliation(s)
- Laura S P Bloomfield
- Stanford University School of Medicine, Stanford University, Stanford, CA, 94305, USA.
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, CA, 94305, USA.
| | - Christopher Tracey
- Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Edith Mbabazi
- Makerere University Biological Field Station, Kibale National Park, Kibale, Uganda
| | - Rhiannon L Schultz
- Department of Anthropology, University of Georgia, Athens, GA, 30602, USA
| | - Rebecca Henderson
- Department of Anthropology, University of Florida, Gainesville, FL, 32607, USA
| | - Kevin Bardosh
- Center for One Health Research, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Shannon Randolph
- School of Humanities and Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Sarah Paige
- Global Health Institute, University of Wisconsin-Madison, Madison, WI, 53706, USA
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3
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Bengo EMM, Muula A, Bengo JM. Sufficient informed consent to medical treatment of adults: legal and ethical perspectives from Malawi. Malawi Med J 2022; 34:143-150. [PMID: 35991823 PMCID: PMC9356522 DOI: 10.4314/mmj.v34i2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This special communication discusses the current legal and ethical requirements for informed consent to medical treatment of adults in Malawi. It analyzes the scope of the laws and code of ethics on professional discipline, including criminal privilege for surgeries and clarifies when insufficient disclosures entitle patients to compensation under civil law. Inconsistencies and uncertainties in the law are made apparent. It evaluates to which degree disclosure standards of other Commonwealth jurisdictions (e.g. the case of Montgomery) would be suitable for the health care setting of a country like Malawi that is characterized by shortages of resources, high illiteracy rates and a communitarian cultural context. Doctor-patient communication is not alien to African culture and part of sufficient informed consent. In order to balance the need for efficiency in health care delivery, accountability for quality care, fairness and effective patient-doctor communication the authors suggest to adopt the reasonable patient test only, if a defence of heavy workload on case-to-case basis is introduced at the same time. This does not dispense the need for organisational diligence on part of the institutional health care provider within its capacity.
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Biruk C. The Politics of Global Health. POLAR-POLITICAL AND LEGAL ANTHROPOLOGY REVIEW 2021. [DOI: 10.1111/plar.12431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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5
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Wintrup J. Transcending the Ethical Dilemma of Christian Humanitarianism: American Medical Missionaries at a Hospital in Rural Zambia. ETHNOS 2021. [DOI: 10.1080/00141844.2019.1696856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Closser S, Mendenhall E, Brown P, Neill R, Justice J. The anthropology of health systems: A history and review. Soc Sci Med 2021; 300:114314. [PMID: 34400012 DOI: 10.1016/j.socscimed.2021.114314] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 12/17/2022]
Abstract
Ethnographies of health systems are a theoretically rich and rapidly growing area within medical anthropology. Critical ethnographic work dating back to the 1950s has taken policymakers and health staff as points of entry into the power structures that run through the global health enterprise. In the last decade, there has been a surge of ethnographic work on health systems. We conceptualize the anthropology of health systems as a field; review the history of this body of knowledge; and outline emergent literatures on policymaking, HIV, hospitals, Community Health Workers, health markets, pharmaceuticals, and metrics. High-quality ethnographic work is an excellent way to understand the complex systems that shape health outcomes, and provides a critical vantage point for thinking about global health policy and systems. As theory in this space develops and deepens, we argue that anthropologists should look beyond the discipline to think through what their work does and why it matters.
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Affiliation(s)
- Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Rm E5545, Baltimore, MD, 21205, USA.
| | - Emily Mendenhall
- Science, Technology and International Affairs Program, Edmund A. Walsh School of Foreign Service, Georgetown University, USA
| | - Peter Brown
- Department of Anthropology, Emory University, USA
| | - Rachel Neill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Judith Justice
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, USA
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7
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Wintrup J. Who alone can ‘see’? Christian humanitarianism, aspect-perception and political critique. CRITIQUE OF ANTHROPOLOGY 2021. [DOI: 10.1177/0308275x211021658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article offers a critique of Christian humanitarianism in Zambia. But it does so by engaging with the arguments of anthropologists who have begun to question the status of political critique within the discipline. These anthropologists argue that critique often undermines ethnographic understanding because it problematically positions the anthropologist as an actor who is able to ‘uncover’ political realities that remain invisible to others. In this article, I take these concerns seriously and attempt to reconsider the practice of critique by drawing on an ethnographic description of the work of Christian medical missionaries in Zambia. Focusing on how these missionaries encouraged one another to ‘see’ their Zambian patients as ‘Christ-like’ and ‘faithful’ in moments of suffering, I argue that these practices of ‘seeing’ and ‘showing’ resemble certain forms of political critique. Rather than an exercise in ‘uncovering’ hidden realities, critique can also be understood as an act of ‘aspect-showing’ – the aim of which is to encourage others to ‘see’ the same things in a different light. The critique of Christian humanitarianism I offer here is therefore itself an act of aspect-showing that partially resembles that which missionaries themselves engaged in.
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Abstract
Anthropologists examining the relationship between physician and patient in Western biomedicine have observed an inherent power discrepancy between the physician, assumed to hold scientific knowledge, and the patient, the recipient of this knowledge. COVID-19 presents a unique challenge to that dynamic, as physicians, scientists and medical experts possess limited understanding of the pathophysiology, interventions and treatment of the disease. Drawing on my experience as a resident physician on the frontlines of the COVID-19 pandemic, I contend that the absence of knowledge surrounding COVID-19 fosters a new form of intimacy between physician and patient through greater emphasis on subjective patient experience, increased transparency between physician and patient, and an expanding physician role beyond management of the physical disease state.
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Affiliation(s)
- Kelly Colas
- Resident physician in internal medicine, Washington DC, USA
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9
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Shapiro L. Mobilizing Volume: Trauma, Surgical Skill, and Clinical Tourism in South India. Med Anthropol Q 2020; 34:324-343. [PMID: 31909509 DOI: 10.1111/maq.12562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 12/01/2022]
Abstract
This article considers the ways in which the concept of volume is deployed to create and sustain surgical expertise. Drawing on research at a large plastic and orthopedic surgery hospital in Tamil Nadu, India, I explore the ways in which a steady supply of trauma is converted into medical expertise, reputation, and care. Volume functions as a key metric by which this conversion takes place. This hospital is particularly well known for its cutting-edge treatment of severe trauma, and, while some Indian hospitals have used their combination of low cost and high expertise to attract foreign patients for medical tourism, this hospital has converted its supply of trauma patients into surgical expertise that brings foreign surgeons there to learn. This article therefore also considers the role of visiting foreign doctors in this form of clinical tourism.
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Affiliation(s)
- Lily Shapiro
- Department of Anthropology, University of Washington
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Abstract
Physician anthropologists have contributed extensively to the anthropology of biomedicine, as well as to other aspects of medical anthropology. Their use of detailed clinical case narratives allows elucidation of what is at stake for individuals and communities in the course of any given illness. Biomedically informed observations of bodies illustrate the connections between microscopic harm and macrosocial arrangements, while observations of clinical spaces and medical knowledge production contribute to current debates over evidence, metrics, migration, and humanitarianism. In moving away from culturalist explanations for illness, physician anthropologists have drawn attention to the manifold workings of structural violence—and have often sacrificed the possibility of deep epistemological challenges to biomedicine. While raising a note of caution about the moral authority of physician anthropologists, I recognize that much of this scholarship has laid the intellectual groundwork for a movement toward equity that refuses to justify poor-quality health care for poor people.
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Affiliation(s)
- Claire L. Wendland
- Department of Anthropology and Department of Obstetrics and Gynecology, University of Wisconsin–Madison, Madison, Wisconsin 53706, USA
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11
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Zhou A. Therapeutic citizens and clients: diverging healthcare practices in Malawi's prenatal clinics. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:625-642. [PMID: 30671979 DOI: 10.1111/1467-9566.12841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article examines how HIV policies and the funding priorities of global institutions affect practices in prenatal clinics and the quality of healthcare women receive. Data consist of observations at health centres in Lilongwe, Malawi and interviews with providers (N = 37). I argue that neoliberal ideology, which structures the global health field, produces a fragmented healthcare system on the ground. Findings show two kinds of healthcare practices within the same clinic: donor-funded NGOs took on HIV services while government providers focused on prenatal care. NGO practices were defined by surveillance, where providers targeted pregnant HIV-positive women and intensively monitored their adherence to drug treatment. In contrast, state-led practices were defined by rationing. Government providers worked with all pregnant women, but with staff and resource shortages, they limited time and services for each patient in order to serve everyone. This paper builds on concepts of therapeutic citizenship and clientship by exploring how global health priorities produce different conditions, practices and outcomes of NGO and state-led care.
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Affiliation(s)
- Amy Zhou
- Institute for Practical Ethics, University of California, San Diego, USA
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12
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Matthews-Trigg N, Citrin D, Halliday S, Acharya B, Maru S, Bezruchka S, Maru D. Understanding perceptions of global healthcare experiences on provider values and practices in the USA: a qualitative study among global health physicians and program directors. BMJ Open 2019; 9:e026020. [PMID: 30948593 PMCID: PMC6500299 DOI: 10.1136/bmjopen-2018-026020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The study aimed to qualitatively examine the perspectives of US-based physicians and academic global health programme leaders on how global health work shapes their viewpoints, values and healthcare practices back in the USA. DESIGN A prospective, qualitative exploratory study that employed online questionnaires and open-ended, semi-structured interviews with two participant groups: (1) global health physicians and (2) global health programme leaders affiliated with USA-based academic medical centres. Open coding procedures and thematic content analysis were used to analyse data and derive themes for discussion. PARTICIPANTS 159 global health physicians and global health programme leaders at 25 academic medical institutions were invited via email to take a survey and participate in a follow-up interview. Twelve participants completed online questionnaires (7.5% response rate) and eight participants (four survey participants and four additionally recruited participants) participated in in-depth, in-person or phone semi-structured interviews. RESULTS Five themes emerged that highlight how global health physicians and academic global health programme leaders perceive global health work abroad in shaping USA-based medical practices: (1) a sense of improved patient rapport, particularly with low-income, refugee and immigrant patients, and improved and more engaged patient care; (2) reduced spending on healthcare services; (3) greater awareness of the social determinants of health; (4) deeper understanding of the USA's healthcare system compared with systems in other countries; and (5) a reinforcement of values that initially motivated physicians to pursue work in global health. CONCLUSIONS A majority of participating global health physicians and programme leaders believed that international engagements improved patient care back in the USA. Participant responses relating to the five themes were contextualised by highlighting factors that simultaneously impinge on their ability to provide improved patient care, such as the social determinants of health, and the challenges of changing USA healthcare policy.
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Affiliation(s)
| | - David Citrin
- Department of Global Health, University of Washington, Seattle, WA, USA
- Possible, Kathmandu, Nepal
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA
- Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Scott Halliday
- Possible, Kathmandu, Nepal
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA, USA
| | - Bibhav Acharya
- Possible, Kathmandu, Nepal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Sheela Maru
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephen Bezruchka
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Duncan Maru
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Andersen SL, Andersen O, Petersen J, Wahlberg A. Traveling health-promoting infrastructures: A meta-ethnographic analysis. Health (London) 2019; 24:606-622. [PMID: 30760043 DOI: 10.1177/1363459319829195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In recent years, it has become increasingly important to understand the global circulation of healthcare innovations in nations' attempts to solve contemporary health challenges. This article is a systematic review and meta-ethnography-inspired analysis that explores the global circulation of health-related standards, protocols, procedures, and regulations, or what we term health-promoting infrastructures (HPIs). The notion of HPIs is defined as built networks that allow for the circulation of health expertise with the intention of promoting solutions that address global health problems. We conducted systematic searches in six relevant electronic databases and ended up with a set of 13 studies. The review shows that it takes arduous work to prepare and facilitate the travel of HPIs and to mold them into meaningful local forms. In conclusion, we argue that HPIs can helpfully be thought of as scripted forms, which are globally available in always sited efforts to address specific problems.
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Affiliation(s)
| | | | - Janne Petersen
- Bispebjerg and Frederiksberg Hospital, Denmark; Copenhagen University Hospital, Denmark; University of Copenhagen, Denmark
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Smith‐Oka V, Marshalla MK. Crossing Bodily, Social, and Intimate Boundaries: How Class, Ethnic, and Gender Differences Are Reproduced in Medical Training in Mexico. AMERICAN ANTHROPOLOGIST 2019. [DOI: 10.1111/aman.13174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Vania Smith‐Oka
- Department of AnthropologyUniversity of Notre Dame Notre Dame IN 46556 USA
| | - Megan K. Marshalla
- College of MedicineUniversity of Illinois at Chicago Chicago IL 60612 USA
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Roebbelen E, Dorman K, Hunter A, Kraeker C, O'Shea T, Bozinoff N. "They Will Come to Understand": Supervisor Reflections on International Medical Electives. TEACHING AND LEARNING IN MEDICINE 2018; 30:377-385. [PMID: 29565733 DOI: 10.1080/10401334.2018.1437040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Phenomenon: Increasing numbers of medical students from high-income countries are undertaking international medical electives (IMEs) during their training. Much has been written about the benefits of these experiences for the student, and concerns have been raised regarding the burden of IMEs on host communities. The voices of physicians from low- and middle-income countries who supervise IMEs have not been explored in depth. The current study sought to investigate host-physician perspectives on IMEs. Approach: Host supervisors were recruited by convenience sampling through students travelling abroad for IMEs during the summer of 2012. From 2012 through 2014, 11 semistructured interviews were conducted by telephone with host supervisors from Nepal, Uganda, Ghana, Guyana, and Kenya. Participants were invited to describe their motivations for hosting IMEs and their experiences of the benefits and harms of IMEs. Interviews were transcribed verbatim and checked for accuracy. An initial coding framework was developed and underwent multiple revisions, after which analytic categories were derived using conventional qualitative content analysis. Findings: For host supervisors, visits from international medical students provided a window into the resource-rich medical practice of high-income countries, and supervisors positioned themselves, their education, and clinical expertise against perceived standards of the international students' context. Hosting IMEs also contributed to supervisors' identities as educators connected to a global community. Supervisors described the challenge of helping students navigate their distress when confronting global health inequity. Finally, the desire for increasingly reciprocal relationships was expressed as a hope for the future. Insights: IMEs can be formative for host supervisors' identities and are used to benchmark host institutions compared with international medical standards. Reciprocity was articulated as essential for IMEs moving forward.
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Affiliation(s)
- Erica Roebbelen
- a Department of Family Medicine , McMaster University , Hamilton , Ontario , Canada
| | - Katie Dorman
- b Department of Family and Community Medicine , University of Toronto , Toronto , Ontario , Canada
- c Department of Family and Community Medicine , St. Michael's Hospital , Toronto , Ontario , Canada
| | - Andrea Hunter
- d Department of Pediatrics , McMaster University , Hamilton , Ontario , Canada
| | - Christian Kraeker
- e Department of Medicine , McMaster University , Hamilton , Ontario , Canada
| | - Tim O'Shea
- e Department of Medicine , McMaster University , Hamilton , Ontario , Canada
| | - Nikki Bozinoff
- b Department of Family and Community Medicine , University of Toronto , Toronto , Ontario , Canada
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Citrin D, Mehanni S, Acharya B, Wong L, Nirola I, Sherchan R, Gauchan B, Karki KB, Singh DR, Shamasunder S, Le P, Schwarz D, Schwarz R, Dangal B, Dhungana SK, Maru S, Mahar R, Thapa P, Raut A, Adhikari M, Basnett I, Kaluanee SP, Deukmedjian G, Halliday S, Maru D. Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal. Glob Health Action 2018; 10:1367161. [PMID: 28914185 PMCID: PMC5645653 DOI: 10.1080/16549716.2017.1367161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe. Objectives: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings. Methods: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework. Results: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships. Conclusions: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians.
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Affiliation(s)
- David Citrin
- a Possible , Kathmandu , Nepal.,b Department of Anthropology , University of Washington , Seattle , WA , USA.,c Department of Global Health , University of Washington , Seattle , WA , USA.,d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA
| | - Stephen Mehanni
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,g Gallup Indian Medical Center , Gallup , NM , USA
| | - Bibhav Acharya
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,h Department of Psychiatry , University of California, San Francisco , San Francisco , CA , USA.,i Shared Minds , Boston , MA , USA
| | - Lena Wong
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,j Tuba City Regional Health Care , Tuba City , AZ , USA
| | - Isha Nirola
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Rekha Sherchan
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Bikash Gauchan
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Khem Bahadur Karki
- k Nepal Health Research Council , Ministry of Health , Kathmandu , Nepal
| | - Dipendra Raman Singh
- l Public Health Monitoring & Evaluation Division , Ministry of Health , Kathmandu , Nepal
| | - Sriram Shamasunder
- e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Phuoc Le
- e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Dan Schwarz
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA
| | - Ryan Schwarz
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,o Department of Medicine, Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.,p Department of Medicine , Harvard Medical School , Boston , MA , USA
| | | | | | - Sheela Maru
- a Possible , Kathmandu , Nepal.,q Department of Obstetrics and Gynecology , Boston Medical Center , Boston , MA , USA.,r Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , MA , USA.,s Department Medicine, Division of Women's Health , Brigham and Women's Hospital , Boston , MA , USA
| | | | | | | | - Mukesh Adhikari
- t District Health Office, Department of Health Services , Ministry of Health , Mangalsen , Achham , Nepal
| | | | - Shankar Prasad Kaluanee
- a Possible , Kathmandu , Nepal.,u School of Leadership and Development , Eastern University , St. Davids , PA , USA
| | - Grace Deukmedjian
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,v Tséhootsooí Medical Center , Fort Defiance , AZ , USA
| | - Scott Halliday
- a Possible , Kathmandu , Nepal.,d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA
| | - Duncan Maru
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA.,p Department of Medicine , Harvard Medical School , Boston , MA , USA.,w Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA
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17
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Arora G, Esmaili E, Pitt MB, Green A, Umphrey L, Butteris SM, St Clair NE, Batra M, O'Callahan C. Pediatricians and Global Health: Opportunities and Considerations for Meaningful Engagement. Pediatrics 2018; 142:peds.2017-2964. [PMID: 30054345 DOI: 10.1542/peds.2017-2964] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 11/24/2022] Open
Abstract
Pediatric practitioners whose expertise is primarily focused on the care of children within health settings in the United States are increasingly engaged in global child health (GCH). The wide spectrum of this involvement may include incorporating short-term or longer-term GCH commitments in clinical care, teaching and training, mentoring, collaborative research, health policy, and advocacy into a pediatric career. We provide an overview of routes of engagement, identify resources, and describe important considerations for and challenges to better equipping US pediatric practitioners to participate in meaningful GCH experiences. This article is part of a series on GCH describing critical issues relevant to caring for children from an international perspective.
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Affiliation(s)
- Gitanjli Arora
- Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California;
| | - Emily Esmaili
- Department of Pediatrics, Lincoln Community Health Center, Durham, North Carolina.,Center for Health Policy and Inequalities Research and Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | - Michael B Pitt
- Department of Pediatrics, University of Minnesota and University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Andrea Green
- Departments of Pediatrics and Pediatric Primary Care, University of Vermont Children's Hospital, Burlington, Vermont
| | - Lisa Umphrey
- Doctors Without Borders/Médecins Sans Frontiéres, Sydney, Australia
| | - Sabrina M Butteris
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nicole E St Clair
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maneesh Batra
- Department of Pediatrics, University of Washington, Seattle, Washington; and
| | - Cliff O'Callahan
- Department of Pediatrics, Middlesex Hospital and University of Connecticut, Middletown, Connecticut
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Nading A. Orientation and Crafted Bureaucracy: Finding Dignity in Nicaraguan Food Safety. AMERICAN ANTHROPOLOGIST 2017. [DOI: 10.1111/aman.12844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alex Nading
- School of Social and Political Science; University of Edinburgh; Edinburgh EH8 9LD United Kingdom
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Benton A, Sangaramoorthy T, Kalofonos I. Temporality and Positive Living in the Age of HIV/AIDS--A Multi-Sited Ethnography. CURRENT ANTHROPOLOGY 2017; 58:454-476. [PMID: 29075043 DOI: 10.1086/692825] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Drawing on comparative ethnographic fieldwork conducted in urban Mozambique, United States, and Sierra Leone, the article is broadly concerned with the globalization of temporal logics and how specific ideologies of time and temporality accompany health interventions like those for HIV/AIDS. More specifically, we explore how HIV-positive individuals have been increasingly encouraged to pursue healthier and more fulfilling lives through a set of moral, physical, and social practices called "positive living" since the advent of antiretroviral therapies. We describe how positive living, a feature of HIV/AIDS programs throughout the world, has taken root across varied political, social and economic contexts and how temporal rationalities, which have largely been under-examined in the HIV/AIDS literature, shape communities' responses and interpretations of positive living. Our approach is ethnographic and comparative, with implications for how anthropologists might think about collaboration and its analytical possibilities.
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Affiliation(s)
- Adia Benton
- Department of Anthropology and Program of African Studies at Northwestern University (1810 Hinman Avenue, Evanston, llinois 60208, USA)
| | - Thurka Sangaramoorthy
- Department of Anthropology at the University of Maryland (1111 Woods Hall, 4302 Chapel Lane, College Park, Maryland 20742, USA)
| | - Ippolytos Kalofonos
- Department of Psychiatry and Behavioral Sciences and the International Institute at the University of California, Los Angeles (760 Westwood Plaza, Box #62, Los Angeles, California 90095, USA) and West Los Angeles Veterans Affairs Healthcare System (11301 Wilshire Boulevard, Los Angeles, California 90073, USA)
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Sullivan N. International clinical volunteering in Tanzania: A postcolonial analysis of a Global Health business. Glob Public Health 2017; 13:310-324. [DOI: 10.1080/17441692.2017.1346695] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Noelle Sullivan
- Department of Anthropology, Northwestern University, Evanston, IL, USA
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Global health from the outside: The promise of place-based research. Health Place 2017; 45:55-63. [DOI: 10.1016/j.healthplace.2017.03.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/28/2017] [Accepted: 03/05/2017] [Indexed: 11/19/2022]
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Rieder S. Tinkering toward departure: The limits of improvisation in rural Ethiopian biomedical practices. Soc Sci Med 2017; 179:1-8. [DOI: 10.1016/j.socscimed.2017.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
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Brada BB. The Contingency of Humanitarianism: Moral Authority in an African HIV Clinic. AMERICAN ANTHROPOLOGIST 2016. [DOI: 10.1111/aman.12692] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aellah G, Geissler PW. Seeking exposure: conversions of scientific knowledge in an African city. THE JOURNAL OF MODERN AFRICAN STUDIES 2016; 54:389-417. [PMID: 27990029 PMCID: PMC5144824 DOI: 10.1017/s0022278x16000240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Transnational medical research has become a common feature in many parts of Africa. This paper explores the contribution such activity makes to the social and economic lives of those involved, including both trial subjects and local staff. By considering the value of the 'exposure' that involvement brings to staff and research participants, we reflect on the conversion of scientific knowledge into practical knowledge and its value to sustaining precarious livelihoods in an economically fragile city. We consider the interplay between science and sociality and argue for a need to take seriously the circulation of scientific knowledge beyond the confines of expert spaces.
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Affiliation(s)
- Gemma Aellah
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom and The Royal Anthropological Institute, 50 Fitzroy Street, London W1T 5BT, United Kingdom
| | - P. Wenzel Geissler
- Department of Social Anthropology, University of Oslo, Norway and Department of Archaeology and Anthropology, University of Cambridge, Cambridge, United Kingdom
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Zdravkovic M, Chiwona-Karltun L, Zink E. Experiences and perceptions of South–South and North–South scientific collaboration of mathematicians, physicists and chemists from five southern African universities. Scientometrics 2016. [DOI: 10.1007/s11192-016-1989-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Macdonald H, Spiegel AD. ‘Distraction from the real difficulties’: ethical deliberations in international health research. ANTHROPOLOGY SOUTHERN AFRICA 2015. [DOI: 10.1080/23323256.2013.11500055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
During the past decade, donor funding for health interventions in Kenya and other African countries has risen sharply. Focused on high-profile diseases such as HIV/AIDS, these funds create islands of intervention in a sea of under-resourced public health services. This paper draws on ethnographic research conducted in HIV clinics and in a public hospital to examine how health workers experience and reflect upon the juxtaposition of ‘global’ medicine with ‘local’ medicine. We show that health workers face an uneven playing field. High-prestige jobs are available in HIV research and treatment, funded by donors, while other diseases and health issues receive less attention. Outside HIV clinics, patient's access to medicines and laboratory tests is expensive, and diagnostic equipment is unreliable. Clinicians must tailor their decisions about treatment to the available medical technologies, medicines and resources. How do health workers reflect on working in these environments and how do their experiences influence professional ambitions and commitments?
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Affiliation(s)
- Ruth J Prince
- a Department of Anthropology & Institute of Health and Society , University of Oslo , Oslo , Norway
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BROWN HANNAH. Global health partnerships, governance, and sovereign responsibility in western Kenya. AMERICAN ETHNOLOGIST 2015. [DOI: 10.1111/amet.12134] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- HANNAH BROWN
- Anthropology Department; Durham University; Dawson Building, South Road Durham DH1 3LE United Kingdom
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Berry NS. Did we do good? NGOs, conflicts of interest and the evaluation of short-term medical missions in Sololá, Guatemala. Soc Sci Med 2014; 120:344-51. [DOI: 10.1016/j.socscimed.2014.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 04/29/2014] [Accepted: 05/05/2014] [Indexed: 12/01/2022]
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Abstract
This article explores the orientations of lay people in Kenya to science—specifically to biomedical knowledge about HIV—and their struggles to convert this knowledge into meaningful futures. In Kenya, the global response to the HIV-AIDS epidemic has resulted in a highly stratified landscape of intervention. Globally-funded treatment programs and clinical trials, focusing on HIV, channel transnational resources, expertise, and knowledge into specific sites—HIV clinics, NGOs, and research stations—inscribing these spaces as ‘global’ while leaving others decidedly ‘local.’ Rolled out in the form of ‘projects,’ these interventions offer resources and opportunities for a limited time only. Based on ethnographic fieldwork in the city of Kisumu, this article follows the circulation of biomedical knowledge through such projects and its conversion in ways beyond those imagined by policy-makers, as it meets the aspirations of city-dwellers and enters into local livelihoods. Mediated by nongovernmental organizations through workshops and certificates, this knowledge is both fragmentary and ephemeral. I explore the temporal and spatial implications of such knowledge for those who seek to attach themselves to it and shape their identities and futures in relation to it.
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Affiliation(s)
- Ruth J Prince
- a Centre of African Studies , University of Cambridge , Cambridge , United Kingdom
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Kalofonos I. 'All they do is pray': community labour and the narrowing of 'care' during Mozambique's HIV scale-up. Glob Public Health 2014; 9:7-24. [PMID: 24502425 DOI: 10.1080/17441692.2014.881527] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper tracks the intertwined biographies of a community home-based care (CHBC) volunteer, Arminda, the community-based organisation she worked for, Mufudzi, and the HIV scale-up in Mozambique. The focus is on Arminda--the experiences, aspirations, skills, and values she brought to her work as a volunteer, and the ways her own life converged with the rise and fall of the organisation that pioneered CHBC in this region. CHBC began in Mozambique in the mid-1990s as a community-level response to the AIDS epidemic at a time when there were few such organised efforts. The rapid pace and technical orientation of the scale-up as well as the influx of funding altered the practice of CHBC by expanding the scope of the work to become more technically comprehensive, but at the same time more narrowly defining 'care' as clinically-oriented work. Over the course of the scale-up, Arminda and her colleagues felt exploited and ultimately abandoned, despite their work having served as the vanguard and national model for CHBC. This paper considers how this happened and raises questions about the communities constituted by global health interventions and about the role of and the voice of community health workers in large-scale interventions such as the HIV scale-up.
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Affiliation(s)
- Ippolytos Kalofonos
- a Department of Psychiatry and Behavioral Sciences , University of Washington Medical Center , Seattle , WA , USA
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McCarthy AE, Petrosoniak A, Varpio L. The complex relationships involved in global health: a qualitative description. BMC MEDICAL EDUCATION 2013; 13:136. [PMID: 24090069 PMCID: PMC3819699 DOI: 10.1186/1472-6920-13-136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 09/06/2013] [Indexed: 05/08/2023]
Abstract
BACKGROUND Growing numbers of medical trainees now participate in global health experiences (GHEs) during their training. To enhance these experiences we sought to explore expectations inherent in the relationships between GHE stakeholder groups. METHODS 20 open-ended, semi-structured interviews probed participant perceptions and assumptions embedded in GHEs. A fundamental qualitative descriptive approach was applied, with conventional content analysis and constant comparison methods, to identify and refine emerging themes. Thematic structure was finalized when saturation was achieved. Participants all had experience as global health participants (10 trainees, 10 professionals) from an urban, academic, Canadian medical centre. RESULTS We identified three stakeholder groups: participants (trainees and professionals), host communities, and sponsoring institutions. During interviews, four major themes emerged: (i) cultural challenges, (ii) expectations and perceptions, (iii) relationships and communication, and (iv) discordant objectives. Within each theme, participants recurrently described tensions existing between the three stakeholder groups. CONCLUSIONS GHE participants frequently face substantial tensions with host communities and sponsoring agencies. Trainees are particularly vulnerable as they lack experience to navigate these tensions. In the design of GHEs, the needs of each group must be considered to ensure that benefits outweigh potential harms. We propose a conceptual model for developing educational objectives that acknowledge all three GHE stakeholder groups.
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Affiliation(s)
- Anne E McCarthy
- Department of Medicine, Faculty of Medicine, University of Ottawa Ottawa Hospital General Campus, 501 Smyth Rd, K1H 8L6 Ottawa, ON, Canada
- Office of Global Health, Faculty of Medicine, University of Ottawa, 451 Smyth Road, K1H 8M5 Ottawa, ON, Canada
| | - Andrew Petrosoniak
- Emergency Medicine Residency Program, Division of Emergency Medicine, University of Toronto, 2075 Bayview Ave, M4N 3M5 Ontario, Canada
| | - Lara Varpio
- Academy for Innovation of Medical Education, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, K1H 8M5 Ottawa, ON, Canada
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Muehlebach A. On Precariousness and the Ethical Imagination: The Year 2012 in Sociocultural Anthropology. AMERICAN ANTHROPOLOGIST 2013. [DOI: 10.1111/aman.12011] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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