1. Health Care of the Under-Served at Home and Abroad
Leto Quarles MD
Clinica Family Health Services
AAFP Global Health Workshop
September 2009

2. Health Care of the Under-Served at Home and Abroad
Medically Under-Served Populations
Barriers to Providing Health Care
Shortage of Healthcare Providers
Insufficient Social Infrastructure
Barriers to Receiving Health Care
Economic Barriers
Geographic Barriers
Cultural or Linguistic Barriers

3. Health Care of the Under-Served at Home and Abroad
The Medically Under-Served in the US
60 Million men, women and children
1 in 5 people in the US
The Medically Under-Served Globally
2.5 Billion men, women and children
1 in 3 people in the world

4. Health Care of the Under-Served at Home and Abroad
Sources of Care for the Under-Served
Community Health Centers
Charity Care & Free Clinics
Public Health Departments
Emergency Rooms
Folk and Traditional Healers
Unlicensed / Unregulated Sources
None: Going Without Care

5. Health Care of the Under-Served at Home and Abroad
In the US, 93% of care to under-served populations is in the US is provided by Primary Care providers (includes MD, DO, NP, PA, CNM):
47% Family Medicine
19% Internal Medicine
19% Pediatrics
9% OB/GYN & Women’s Health

6. Health Care of the Under-Served at Home and Abroad
Many who do this work within the US also seek to do so internationally
Many physicians working in Community Health Centers in the US have also worked abroad
Many more express interest
Many non-physicians have interest and/or experience
Skill sets, knowledge and expertise are transferrable and relevant across borders

7. Health Care of the Under-Served at Home and Abroad
How People who work with the Medically Under-Served in the US also Participate in Global Health Activities:
Short-Term Projects / Travel
Longitudinal Relationships between Sites
Academic & Policy Work
Hosting International Students
Past and Future Full-Time Work

8. Health Care of the Under-Served at Home and Abroad
How to better harness these resources
Interested personnel
Relevant parallel experience & knowledge
Commitment to type & intensity of work
Necessary to understand
Motivations
Rewards
Challenges
In Order to Design Future Opportunities

9. Health Care of the Under-Served at Home and Abroad
Survey
May – September 2009
Online via
Open to “everyone who works in any capacity with healthcare of the under-served in the US and has an interest in global health”
230 respondents

10. Health Care of the Under-Served at Home and Abroad
Respondents main role in providing care to the under-served

11. Health Care of the Under-Served at Home and Abroad
Experience of Respondents:
24.9% working 0-2 years
28.4% working 3-5 yrs
19.7% working 6-10 yrs
27.1% working >10 yrs
28.8% managers
25.9% <30 years old
47.8% years old
26.3% >50 years old

12. Health Care of the Under-Served at Home and Abroad
How do respondents get their information?

13. Health Care of the Under-Served at Home and Abroad
Respondents Global Health experience:

14. Health Care of the Under-Served at Home and Abroad
Motivations – All Respondents

15. Health Care of the Under-Served at Home and Abroad
Motivations – w/ International Experience

16. Health Care of the Under-Served at Home and Abroad
Motivations – All Healthcare Providers

17. Health Care of the Under-Served at Home and Abroad
Motivations – Providers w/ Intl Experience

18. Health Care of the Under-Served at Home and Abroad
Comments: Motivations
Feel good about helping patients who are underserved
The chance to help my hispanic community in any way possible or available
All the minor reasons add up to a major reason for my interest. Also, I had a parent and several cousins that have worked outside the U.S. which has influenced me
I would like to help in whatever way I can to bridge the gap of economic inequality
Desire to help train healthcare providers in "developing" countries

19. Health Care of the Under-Served at Home and Abroad
Comments: Motivations (cont’d)
The country I come from, is no more. Now I go back to do what I can for the families who could not leave.
Worked as a nurse in Chiapas MEXICO in the 80's before I got my NP
I was a medic in Desert Storm 1. It changed my life, I went to PA school.
When I came from my country I thought it was for a better life just for me, but now I know I can make a better life for the other people also

20. Health Care of the Under-Served at Home and Abroad
Challenges – All Respondents

21. Health Care of the Under-Served at Home and Abroad
Challenges – w/ International Experience

22. Health Care of the Under-Served at Home and Abroad
Challenges – All Healthcare Providers

23. Health Care of the Under-Served at Home and Abroad
Challenges – Providers w/ Intl Experience

24. Health Care of the Under-Served at Home and Abroad
Comments: Challenges
As an administrator I am not sure what role I would have that would be helpful.
I have found it difficult to find a way to balance a workable lifestyle in which I can also particpate in international humanitarian programs
I would love to participate in this type of work, however due to terrorism I couldn't.

25. Health Care of the Under-Served at Home and Abroad
Rewards – All Respondents

26. Health Care of the Under-Served at Home and Abroad
Rewards – w/ International Experience

27. Health Care of the Under-Served at Home and Abroad
Rewards – All Healthcare Providers

28. Health Care of the Under-Served at Home and Abroad
Rewards – Providers w/ Intl Experience

29. Health Care of the Under-Served at Home and Abroad
Comments: Rewards
the work I did abroad changed my perspective on life/world; I think everyone should be required to participate in one international relief program
Since my Christian faith in Jesus Christ is my major motivation for my international medical educaiton work, the major benefit is the preparation and empowerment of national physicians to carryout their call and vision.
The foreign work I do is my atonement for the reprehensible foreign policies of my government.
To do the healign work of Jesus Christ our Savuior but some of them were not True Christians
It is a blessing and honor to serve my brothers & sisters anywere

30. Health Care of the Under-Served at Home and Abroad
Discussion:
There exists in the US a pool of motivated healthcare professionals with expertise in care of under-served populations, who are already interested in and committed to global heath.
How can we make best use of this resource?
How can we solicit, support and sustain their involvement?