Bringing global health home – Julie Chen
University students are keen to engage in service learning – going abroad to gain broader perspectives on health care and contributing to projects which can make a difference in people’s lives. Service learning supports the experiential aspect of global health: allowing students to see for themselves health issues that transcend boundaries, the determinants such as education and income that underlie these issues, the means, and the solutions, which aspire to achieve equity in health. But does the experience of global health require globetrotting? Do students necessarily need to go abroad to achieve the same outcomes given that there are vulnerable populations here at home? Medical students at The University of Hong Kong (HKU) and the University of British Columbia (UBC) have engaged in local service opportunities that gave them valuable real life insight into the impact of socioeconomic factors on health and access to health care while providing additional impetus to being part of the solution.
At the Li Ka Shing Faculty of Medicine, students at the end of their 3rd year select 4- to 8-week elective opportunities as part of the MBBS curriculum. Two options offered by the Department of Family Medicine and Primary Care involved active engagement with non-governmental organizations (NGO) that work closely with the poorest of the poor in Shamshuipo (Missionaries of Charity (MOC)) and with female sex workers (Action for Reach Out (AFRO)). Students come face to face with the realities of the socially marginalized and gradually learn the stories of individuals by meeting them through community outreach, helping in the clinic or kitchen, or discussing health and preventive care advice. They are supported by front-line NGO staff and outreach workers on an ongoing basis and also by academic staff who provide briefing and debriefing sessions.
On the other side of the world, triggered by the Syrian refugee crisis that dominated the news in the past year, medical students at the University of British Columbia were motivated to start the ‘Refugee Health Initiative (RHI).’ This voluntary, self-initiated project aimed to ease refugees’ transition to life in Canada especially with navigating the healthcare system and accessing community resources. Medical students are paired with refugee families in a personal mentorship-like relationship for a year and are supported closely by clinical staff, government agencies, interpreters as well as a faculty mentor.
These experiences made an impression on students who completed written reflections on their involvement. Students expressed their understanding of social disparity and social determinants of health in both these endeavours:
HKU medical student:
The residents taught us a lot in other areas. For example, how government policies impact them. I couldn’t imagine how great the impacts are on this group of people. This kind of experience can enrich my understanding towards how social inequity actually has impact on people [and how it] also complicates health problems…
UBC medical student:
…able to personally engage with these social determinants of health (housing, education, income) and witness how they play a role in the lives of the individuals in my partnered refugee family. In particular, I have seen how seemingly simply aspects of our day to day life such as transportation, language and culture have produced barriers for my partnered family in accessing available resources and amenities that could greatly facilitate their resettlement in Canada. I can also see how in the long term these barriers may eventually snowball in to long term effects on their health and wellbeing…
These two initiatives take contrasting approaches to global/local programmes but both manifest many of the essential components that make such projects successful. Rowthorn (2015) has suggested seven components as follows:
- Establishing community engagement as the central tenet, to identify needs and approaches to meet needs
- Using universally recognized health frameworks (such as social determinants of health, cultural competence etc.) to scaffold the learning and to apply to a local context
- Having a focus on health disparities and social justice
- Sharing local strategies and experience
- Encouraging experiential learning with appropriate supervision
- Adopting an interprofessional approach that emphasizes multidisciplinary methods and diverse modalities
- Incorporating reflection to augment the learning process and personal growth
A stay-at-home service initiative in the local community has the potential to help students learn the lessons of global health while simultaneously allowing them to contribute to the betterment of health.
Dr Esther Yu and Dr William Wong of the Department of Family Medicine and Primary Care, HKU were the academic leads of the MBBS electives to MOC and AFRO, respectively. Dr Videsh Kapoor was the faculty mentor for the UBC initiative.
- Rowthorn V. (2015). Global/Local: What does it mean for global health educators and how do we do it? Annals of Global Health, 81(5), 593-601.
The overseas experience of the author mentioned in this article was supported by the Teaching Exchange Fellowship Scheme. For details of the TEFS, please refer to http://tl.hku.hk/staff/tefs/