1. Involvement in Global Health as a Family Physician
Calvin Wilson MD

2. Objectives
Provide a general framework for consideration of global health involvement
Discuss possible options for involvement in global health activities

3. Why?? Why do you want to do this?
Be clear on motives and objectives for Global Health involvement
“Adventure and tax write-off”
“Join colleagues on a fun excursion”
“Learn about another part of the world”
“Help those less blessed”
“Make a difference in the world”

4. Timeframe Short term – 1-3 weeks Medium term – 1-6 months
Long term - >6 months
Repeating commitment – repeated (annual or biannual) short or medium term visits to same place

5. Range of Involvement √ Activity Short Term Medium Term Long Term
Repeating
Tourism -Exploration √
Medical Services
Teaching
Program Development
Faculty Development
Program Leadership

6. Preparation and Orientation
Always necessary
Degree of preparation/orientation depends on:
Timeframe of visit (short, medium, long term)
Degree of westernization (vs. eastern/traditional orientation)
Degree of clinical sophistication and infrastructure
Setting of visit (village, urban, university)
Clinical problems anticipated (tropical, poverty-related, social, war/violence)

7. Preparation and Orientation
Where to find mentors/orientors
FMG or internationals from same area
Returned long-term workers in same area – missionaries, NGO workers, professional consultants
Experienced long term workers in same region with some overlap to area of interest
Fact-based resources – guidebooks (Fodors, Lonely Planet, etc.), CDC, WHO, Dept. of State, CIA

8. Short Term Options (<3 weeks)
Ad hoc groups
Church related, faith-based organizations
Almost every denomination represented
Mission-based groups (orphans, disability specific)
Hospital-based groups (ie, Catholic or Adventist hospitals)
Established groups
Physicians with Heart
Medical Missions International
Project CURE (Denver)
Child Family Health International (students)

9. Short Term Options Profit-based groups Personal arrangements
Based in specific country or region
Have often agreed to provide specific services with intermittent short term groups
May be effective, but need to investigate agenda
Charges often far in excess of normal travel costs
Personal arrangements
Local contact willing to help arrange a short-term trip
Requires planning, flexibility, and sense of adventure!
Better for more experienced international travelers

10. Medium Term Options (1-6 months)
Faith-based or mission based organizations and hospitals
Personal arrangements with national FM program
Short-term teaching contract – paid or unpaid
Faculty development
Program development
“Beltway Bandit” program managers - PHC development consultation

11. The “Beltway Bandits”
Eg., Johns Hopkins, Abt Associates, Family Health International, University Research Corp., Engender Health, John Snow Inc.
Compete for and manage large government international development contracts
Focus on family planning, maternal/child health, HIV/AIDS/TB, malaria control, institutional capacity building
Administer USAID, PEPFAR, Global Fund funding
Recruit experienced consultants for specific tasks
Requires persistence and flexibility

12. Long Term Options (>6 months)
Faith-based or mission based organizations and hospitals
Doctors without Borders
Mercy Ships, Project Hope
“Beltway Bandits” – long term assignment
Personal arrangements with national FM program or University
Teaching
Faculty development
Program development

13. Long Term Options Special consideration
Dept. of State physician (attached to embassy)
Fulbright Grant (negotiated with local Fulbright Commission in country of interest)
Military physician
Peace Corps (maximum 3 years)
Volunteers of America
Telemedicine conferencing and teaching with specific program or hospital

14. Repeating Commitment Deserves strong consideration with:
Desire to make a sustainable impact on health and national health workers - BUT
Currently available only for short term visits
Build trust and confidence by focus on one place and limited objectives over multiple visits
Mentoring small group of doctors or healthcare providers
Introducing a few new skills or concepts
Continued involvement between visits via , phone conversations, telemedicine link
Possibly sponsoring visit to U.S. for specific training or skill development

15. Repeating Commitment
Responsibility for development and maintenance of relationship depends on US
Requires persistence, faithfulness, keeping one’s promises, caution with perceived expectations
Based on development of personal relationships, not on gifts of equipment and supplies
Teaching and training should be mutual and bilateral, and maintain the dignity of national colleague

16. Other Options for Global Health/ Cross-Cultural Involvement
U.S. Indian Health Service
Federally Funded Health Center for minority groups/immigrants
Refugee resettlement programs
Practice outreach to specific local immigrant groups