Residents are allowed two electives away from Altoona.
Wilderness Medicine in Yosemite
White Rim Trail,
"Polypharmacy" in an 84 year old in Honduras: five medications.
Goal: To expand the resident’s worldview and skills to effectively evaluate and impact the needs of a community, by a supervised experience in cross-cultural medicine in the US or abroad.
Objectives: By the end of the experience abroad, the resident will:
· Be more sensitive to the needs of patients of different backgrounds, both abroad and at home (P,SBP,PC)
· Be able to work effectively in teams (P, C, SBP, PC)
· Understand the role of primary-care based systems for better health outcomes (SBP,PC)
· Understand culture and how to cross cultures for effective care (MK,P,C,SBP,PC)
· Be able to evaluate the complex factors that contribute to the unmet medical needs of a community (MK,PB,SBP,PC)
· Better use appropriate levels of technology (MK,PI B,SBP,PC)
Outcomes and evaluation
The resident’s performance will be evaluated by the on-site supervisor using the standard evaluation form. Satisfactory completion of other objectives will be evaluated by the project mentor based on debriefing discussions and by evaluation of the presentation.
Format: 2-4 weeks (additional vacation up to one week may be taken for travel time) service abroad under the supervision of qualified professionals. The resident will prepare for the experience through readings, research and meeting with a faculty advisor. The experience abroad can be arranged by the resident or through the Institute for International Medicine. The setting must include supervision by a professional who agrees to adequately supervise and provide an evaluation. Upon return the resident will meet with the faculty mentor, and give a structured noon conference on his/her experience.
Choosing where to go
Anywhere in the world is possible, but there are a number of issues to consider when selecting a site for a Global/International Elective.
· Adequate supervision – there must be a professional there to supervise and evaluate you
· Safety – check the US State Department site (www.state.gov) to see current warnings about countries. You are responsible for your own safety on your trip
· Know yourself – What kind of experience do you want? Do you want to do procedures or surgeries? Do you want work in a hospital or help in rural underserved areas? Do you want to go alone or with a group? Do you want to observe or be hands-on? Are you able to be flexible? What kind of living conditions are you willing to live with?
· Stretch yourself – Don’t avoid things that may make you uncomfortable. However, if you decompensate when your hands get dirty, maybe you shouldn’t choose a jungle location.
· Cross cultures – It is possible to travel a long ways, but only interact with people like yourself. Try to find a place where you will actually experience another culture. Don’t be a tourist; get involved with the people.
· Cost – International travel is expensive (often several thousand dollars). Count the cost before you commit.
· Impact – You want your trip to make a lasting difference, not just in your life, but in the people you go to serve. Curing their parasites for a month doesn’t help them in the long-tem. Sustainability is often assured by partnering with people with a long-term commitment to the area. They don’t go once a year with band-aids, but they have a more comprehensive strategy. The best projects partner with local people and meet the “felt needs” of the people. Good projects do not promote dependency, but leave the people better able to care for themselves.
· There are opportunities for cross-cultural medicine without leaving the US. Consider serving in an urban area or community health site.
Discuss your options with you faculty mentor. Start to research options. If you don’t have personal connections, you might try these:
· Local connections. Some local groups do regular trips and are glad to have you join them
o Lean Dereus – Penn State – Altoona Campus – Dominican Republic – March
o Henry Thurston-Griswold, Juniata College, Thurston@juniata.edu
o St. Johns – Lakemont – Haiti
o Carmelite Nuns – Haiti
o Dave Brock, MD – South America
· Institute for International Medicine (www.inmed.us) This non-profit group will match you with one of 45 mission hospitals and clinics in economically developing nations of the world. They will arrange travel, visas, and insurance.
· CareerNet (http://jamacareernet.ama-assn.org/misc/volunteer.dtl) has a listing of organizations who are requesting volunteers. The site is sponsored by the AMA.
· International Health Volunteers (www.internationalhealthvolunteers.org) – Clearinghouse of projects with a calendar of trips
· Mission-finder (www.missionfinder.org/medical.htm) – list of faith-based organizations doing international trips
Adequate preparation is key to a successful elective. You wouldn’t walk in to do a procedure without reading about it and having adequate training and supervision. You will be required to choose several methods of systematic preparation, discuss them with your mentor and document their completion for your file.
· Read INMED International Medicine – Advanced Preparation for Health Professionals and take the internet post-test.
o This reference or one of similar breadth is required
o Your overview reference (if not this one) must include
§ Discussion of international health
§ Underlying issues in healthcare for the disadvantaged
§ Survey of medical issues found predominantly in the economically disadvantaged areas
§ Cross-cultural skills
§ Health systems and health leadership
· Other possible sources for training
o Health Volunteers Overseas (www.hvousa.org) Sponsored by the ACP. Extensive training materials and guidebook.
o Global Health Education Consortium (http://globalhealthedu.org) – extensive training materials
· Attend conferences
o Wonca World conferences or regional conferences (www.globalfamilydoctor.com/conferences)
o Global Health Education Consortium (http://globalhealthedu.org), many opportunities
o Global Health Council conferences (www.globalhealth.org) – many conferences available
o INMED conference (www.inmed.us) – offers two day conference in May in Kansas City about international medical issues
o AAFP Global Health Workshop (www.aafp.org)
· Investigate the country you are going to
o World Health Organization (www.who.kint/countries/en) – country specific health information
o Local library, internet sources
Resources on Global/International Health
· Wonca (www.globalfamilydoctor.com) The World Organization of Family Doctors.
· Wonca Member Organizations (http://globalfamilydoctor.com/MO/MO.asp?refurl=aw). Find the equivalent organizations to the AAFP for each country
· World Medical Association members (www.wma.net). Find the national equivalents of the AMA
· World Health Organization (www.who.int/en/) Reports, statistics, health topics
· AAFP International Affairs Office (www.aafp.org/international) – information and links from the AAFP about international health
· CIA Factbook (www.cia.gov/library/publications/the-world-factbook/) Especially good for maps
How to pay for your trip
International trips can be quite expensive. There are a number of possibilities for help.
· AFP CME funds can be spent on your trip
· Community organizations are sometimes willing to support international aid trips, especially if you are willing to give them a presentation when you return
· If you are connected with a church or religious organization, they may be willing to sponsor your trip
· Friends and family may wish to contribute to your trip
· We will work to see if the ARHS foundation will be able to accept tax-deductible contributions on your behalf
· Creative Funding for International Electives (www.amsa.org/program/ih/creative.htm)
· MAP International Medical Fellowship (www.map.org) – Christian-based organization providing airfare for trips
· Christian Medical and Dental Association (www.cmda.org) – scholarships
· More fund-raising strategies ( )
There are many logistical issues regarding international trips. Planning must start many months before the planned trip date. Many popular training sites are scheduled months to years in advance.
Travel risks and precautions, immunization advice
· WHO (http://www.who.int/ith/en/)
· US State Department site (www.state.gov)
· CDC travel site (http://www.cdc.gov/travel/)
Getting sick (or even dying) in a foreign country can be inconvenient and expensive. Travel insurance can give you experienced people to call. Traditional medical insurance may not cover you in another country. A number of companies offer travelers insurance that can cover anything from cancellations to finding a doctor for you in country. They cost $3-10/day and are highly recommended. Here are some choices. Compare coverage carefully, not just price.
· Adams and Associates International www.aaintl.com
Don’t forget your passport, visas, local and national permissions. Check out any licensure issues in your destination.
Some travel agencies specialize in international travel and can get you good deals. Here are some possibilities:
Get all the necessary coverages for your home responsibilities.
How you pack depends on where you are going and what you are doing. Generally, the less you pack the better.
Ask for guidelines. Your dress will reflect on your hosts and your witness. It is easy to alienate just by what you wear. For example, in many areas, shorts are only worn by children. Women should ask whether pants are acceptable and if there are any modesty issues. Bring comfortable shoes that are broken in.
Take traveler’s checks and credit cards. Don’t flash your money. It confirms the stereotype of the rich Westerner. Never carry money or passport in a wallet, purse, fanny pack or back pack. Wear it under your clothes.
Bring some nutritious snacks (granola bars, peanuts). You won’t always be near food around meal time. Always use bottled water (readily available) or boiled water. Watch the ice cubes! Be careful with uncooked foods. Get a full set of guidelines at www.cdc.gov/travel/foodwatr.htm. With that said, don’t hesitate to eat and drink things put before you in someone’s home. If you get sick, you will recover; if you disgrace your host, you may not be able to reconcile the relationship.
Certainly take all the medicines you routinely take in their containers. You may wish to bring some special things to have with you:
Medicines for traveler’s diarrhea (Bactrim, Floxin, Cipro, Immodium)
A clean syringe, in case you need an injection.
Antibacterial cream (eg, Bactroban, Bacitracin) and bandages
Take toilet paper - not always available, always appreciated
Don’t bring: More than you can carry, by yourself, several blocks, up stairs
· Don’t go out alone. When you go out, make sure someone knows where you are going.
· Carry a copy of your passport and all important information (phone numbers, visa, address you are going to) in every bag and with you.
· Don’t carry all your cash in one place.
· Never carry important documents or cash on the outside of your clothes. Shoulder bags, backpacks and belt bags can be easily cut off in a crowd. Use a neck bag or belt pouch that goes inside your clothes.
· When sleeping in a non-secure place, sleep with your documents and money under your pillow.
· Avoid drunks. Avoid dogs.
· Never ask someone on the street for directions, only a person in a shop or a policeman.
While in country
Please realize that you are representing the US, Family Medicine, and AFP. You are responsible for consistent professional behavior, even when tired, sick, and culture-shocked. Be sure to ask knowledgeable people about appropriate dress, greetings, gestures and language. You can avoid being the stereotypical “ugly American” through preparation and commitment. Be a learner. Avoid comparing everything to “the right way to do it” (your way of course) and look at life from the people’s standpoint. Be flexible – things often don’t go as planned. Don’t let that ruin your trip.
While true culture shock may take several weeks to start, you may find yourself feeling overwhelmed by the new sounds, sights and smells. Don’t withdraw! Continue your activities and avoid comparing everything to what you are used to. Attitude is everything. Early culture shock can manifest with fatigue and depression.
Nip culture shock in the bud. Don’t complain. It will rob your joy and color your trip, and it’s very contagious. It starts with harmless comments: “This place…, that smell…, this food…, these people…, that bathroom…, etc. Agree as a team ahead of time to avoid complaining. Be an encourager.
If you don’t speak the language or have a translator, gestures and a phrase book can go a long way. Often there are people around, eager to practice their English on you, but don’t count on it. Don’t assume the interpreters are accurate. Instead of speaking louder, speak slowly, distinctly, with simple words. Repeat a lot. If you aren’t getting through, rephrase it, rather than saying it louder.
Responsibilities on return
Within one week of your return, you will have a debriefing with your project mentor.
You are responsible to share a presentation about your trip. This cannot be simply a “travelogue” or chronological tale of your trip. Include episodes that illustrate important principles about international medicine or cross-cultural interactions. What are the unmet needs of the community you worked with? How can these needs be met? Discuss the technology that was available to you and what additional technology might be appropriate. Tell how you trip has changed you and how you will practice medicine differently.
You are responsible to apply what you have learned to your community and your practice