In addition, hospitalist Deepak Asudani, MD, MPH, FHM, health sciences assistant clinical professor at the University of California San Diego, reports that his department is interested in organizing a global health fellowship program. A firm believer in the distinction between global health and international health, Dr. Asudani explains that the UCSD program will be geared to teach U.S.-trained physicians how to practice medicine in resource-limited countries. It will have a track for physicians from other countries to study hospital medicine here.
Sustainable Care
During their rotations in Haiti, Dr. Le says the UCSF clinical fellows’ mission is capacity building, meaning they usually do not deliver care as primary physicians but rather engage in what he calls “clinical accompaniment.” They assist with care delivery and teach clinical skills to Haitian trainees.
“We do not want to be a substitute for doctors who are there,” he says. “We want to support Haitian residents and give consultative advice on difficult cases. We do not want to go, provide care, and leave. We are moving toward long-term relationships that foster systemic change.”
Clinical fellows teach quality improvement methods, and then the local partners, whether in Liberia or Haiti, generate ideas for QI projects around their most pressing needs. The fellows then offer support in the development and implementation of those projects.
Dr. Le and Dr. Pierre at St. Thérèse Hospital in Hinche, Haiti.
Congruent Practice
The global health program at the University of Minnesota, led by Patricia Walker, MD, DTM&H, has established a medical teaching collaboration with Selian Lutheran Hospital in Arusha, Tanzania. Its name, Tufundishane, is a Swahili word meaning “let us all teach one another” and points out one of the many benefits for hospitalists who pursue this type of work. They report that the work changes the way they practice when they resume clinical duties back home.
Dr. Verma, a UCSF clinical fellow, can attest to those changes. After a three-month stint at St. Thérèse Hospital in Hinche, Dr. Verma says he intended to challenge his residents on the teaching service to “think about every single test they’re ordering.” That resolve was just one consequence of working in a resource-challenged hospital environment.
Speaking from Hinche in December, Dr. Verma says that in the U.S., “you can order a complete blood count and electrolytes for your patients every day they’re in the hospital. But here, if I want to get a renal test on a patient, I have to find the lab manager and find out if we have the reagents for those tests. It makes me question whether I really need that test or whether I am ordering it to make myself feel better.”
Dr. Verma views the workaround challenges as a net positive.
“Many times, you can do a lot of good for patients with an incomplete picture,” he says. It’s a view shared by other hospitalists who incorporate global health work into their clinical duties back in the U.S.
Dr. Hendel-Paterson has a wealth of global health experience: He worked in India and Zimbabwe during medical school, conducted research in Uganda, volunteered in Haiti, and has taught a tropical medicine course in Thailand. He says hospitalists can benefit from knowledge about global health when treating their own patients. For example, seeing patients with malaria or dengue fever during volunteer or service work can help providers recognize, diagnose, and treat those diseases in returning U.S. travelers. It also can help hospitalists avoid causing iatrogenic disease, as in the case of disseminated strongyloidiasis, which can result when people who have lived in or visited endemic areas are treated with immunosuppressants like corticosteroids.