Friday, November 16, 2012

Ethical Issues in Global Health Outreach Work: A Call for Formalized Medical Student Education

VCU Medical Students Assessing a Patient in Coyoles, Honduras
This is an interesting article published earlier this year by Timothy Lahey in the journal Academic Medicine. In this perspective piece Lahey discusses some of the ethical issues associated with short-term global health outreach work, especially as faced by medical students. He outlines the key components of a medical school curriculum in global health, noting this is important for all learners as "global rightly includes local because healing the sick has the same worth in inner-city Detroit as it does on the outskirts of Dar es Salaam, even if geography and culture alter the manifestations of illness and need."

Lahey notes that the principles of biomedical research should can be applied to global health outreach work: nonmaleficence, beneficence, patient autonomy and justice. Short-term medical trips are rife with pitfalls in all of these areas, as providers often provide sub-standard care without understanding the health needs of the population they are serving, or the greater context of the health pressures faced by these communities or the health disparities that drive illness.

Lahey notes a medical curriculum for global health must include an exploration of health disparities, and notes that faculty mentorship and post-trip debriefing are important components of medical student education in global health.

Over the past 6 years working on short-term medical relief missions in Honduras I personally have struggled with many of the issues Lahey brings up, and have watched many medical students and residents struggle with these issues, as well. Our group has worked to address these issues via close community partnerships, an emphasis on high-yield public health interventions, and providing logistical support to help bolster the longitudinal health efforts of the local ministry of health (find out more about the evolution of our program here).

 In terms of working with students, we have found the following:

1) Pre-trip counseling/ education of learners is essential
2) Providing learners a context for their work (e.g., how their work contributes to the longitudinal/ overall health work performed by the group) is critical
3) Continuous 'checking in' with learners/ helping learners process their experience before, during and after the brigades is very important

As "global health" truly includes addressing health issues/ disparities both internationally and domestically, Lahey's call for integration of global health education into medical school curricula is an excellent one. This 'call' should be extended to residents' curricula, as well.

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