Dr. DeGennaro consults with a patient at Hospital Bernard Mevs/Project Medishare’s women’s cancer clinic in Port au Prince, Haiti.
Western medicine has a long tradition of humanitarian service in developing countries. But, over the past two decades, the manner in which medical services are provided to under-resourced nations has evolved. Rather than volunteering to deliver acute care through humanitarian missions, a new generation of global health physicians aims to become dispensable. Through new nonprofit and collaborative models, they are establishing ongoing relationships with medical professionals in host countries to actively promote capacity building, from construction of new facilities to medical education and training.
“Global health work needs to be collaborative and bilateral, not just an export of our Western medical model to a low-resource setting,” says HealthPartners hospitalist Brett R. Hendel-Paterson, MD, an assistant professor of medicine at the University of Minnesota who also practices in HealthPartners’ Travel and Tropical Medicine Center in St. Paul, Minn., and is co-director of the UM/CDC online global health course.
Sriram Shamasunder, MD, DTM&H, hospitalist, health sciences assistant clinical professor, and co-director of the University of California San Francisco (UCSF) Global Health-Hospital Medicine Fellowship, agrees. “Mission medicine has incredibly well-meaning and committed people, but to address the upstream problems that bring people to the hospital, there need to be systems-based solutions,” he says.
And that is where hospitalists come in.
Growing numbers of hospitalists are joining in global health efforts, as Marwa Shoeb, MD, MS, and Phuoc Le, MD, MPH, DTM&H, discovered when they surveyed SHM members about participation in global health activities. Drs. Shoeb and Le are assistant clinical professors in the division of hospital medicine at UCSF. The survey (J Hosp Med. 2013;8(13):162-163) revealed that 51% of 232 respondents had done global health work prior to becoming a hospitalist; another third continued global health work after they began their HM careers.
Many believe hospitalists are uniquely qualified for global health initiatives. HM’s emphasis on systems of care delivery and quality improvement can supply much-needed knowledge as under-resourced countries strive to increase access to health care, says Michelle Morse, MD, MPH, an instructor in medicine at Harvard Medical School in Boston and deputy chief medical officer of Partners in Health (PIH) in Haiti (www.pih.org).
“Being a hospitalist is incredibly complementary to doing global health work,” Dr. Morse says. PIH has maintained a presence in Haiti for more than two decades and just recently celebrated a milestone with the Haitian medical community: establishment of the country’s newest medical residency training at University Hospital in Mirebalais.
Embrace Challenges
In early December, a group of UCSF hospitalists visited another PIH site, a Haitian Ministry of Health hospital in Hinche, located in the central plateau region of the country. Robin Tittle, MD, and Varun Verma, MD, were nearing the end of their first three-month rotation in the country as clinical fellows in the two-year-old Global Health-Hospital Medicine Fellowship.