To Improve Health at Home, Look Abroad
As Americans confront a growing array of hard problems here at home, there is a natural tendency to turn inward for solutions. This makes for the potential to miss insights we might gain from abroad.
Our health-care system seems particularly conducive to such inward-looking thinking. Rising costs, reform, barriers to access, and the growing rural-urban divide are just a few of the challenges that bedevil our field.
In this environment, it might make sense to say “let’s fix our own problems first.” But his would be a mistake. Foreign engagement is one of the most effective tools we have to produce better doctors and to deliver better care at home.
This is why many leading medical schools and teaching hospitals are committed to strengthening their programs abroad. My own institution, the University of Michigan, now has formal agreements with partners in 12 countries, including India, Taiwan, and Brazil, Ghana, Uganda and Ethiopia.
Through these programs, we send our medical school faculty and students abroad to train caregivers and to care for patients. And we welcome students, scholars and caregivers from around the world to build their skills in our state-of-the-art facilities.
Those participants report a host of benefits. First, engagement in health care abroad helps students and faculty recognize and address the tension between newfangled machines and traditional caregiving.
In the United States, medical technology is putting a premium on cold analytic skills, especially the ability to interpret machine generated data. The widespread use of electronic health records means that physicians spend more time with documentation than with patients. And yet, our nation’s increasingly diverse demographics along with our growing awareness of disparities in delivery of care, make it even more important for caregivers to bring a “human touch” to heath care — an ability to communicate with, listen to, and understand patients who bring different experiences and assumptions to the examination room.
While it is relatively easy to overlook or ignore these issues at home, it is impossible abroad. Students and faculty working in far-flung places know from the get-go that they are outsiders who must figure out how to adapt to their new environment. Such cultural humility is equally important at home, especially as we become aware of the myriad lifestyle and cultural factors that influence patient outcomes.
By necessity, global health programs based in developing nations require students and faculty to learn important details about those they treat, their families, their environment and potential responses to therapy — in contrast to relying on technology and data. These programs also push caregivers to become more innovative.
One Michigan student, Steven John, was frustrated by the absence in Nepal of a common but expensive piece of equipment — a positive pressure ventilation system — that helps babies breathe. (Respiratory issues are a leading cause of deaths in premature infants.) In response, he devised a substitute that serves the same function but costs only $10, instead of $1,000. Maybe this technology will replace the more “connected” data-intensive approaches used here.
In many foreign countries, access to care is a profound issue. Two-thirds of mothers in Uganda, for example, do not receive any post-natal care. In Ghana, there were only 18 psychiatrists in the country’s system in 2017 – and just 11 in 2011 – for a nation of almost 30 million people.
Students and faculty who experience these conditions abroad often more clearly see these issues at home. It attunes them to the fact that prenatal care is often not available or not utilized in vulnerable populations in the U.S. Likewise for lack of mental health resources impacts underserved populations in the U.S. more than any other demographic. That helps explain why students with international medical experience are more likely to enter primary care careers focused on underserved communities in the U.S.
These disparities also suggest a moral dimension of global health outreach. Billions of people do not enjoy anything close to the standard of care we take for granted. Family planning services, for example, cannot meet the demand in many African nations, including Rwanda and Ghana. Hospice care is almost nonexistent in Brazil. While we will never solve all of these problems, it is imperative that we help where we can.
In addition, cures and preventive strategies based on global needs often form the foundation of approaches used in the U.S. The Ebola outbreak in Western Africa was only the most recent of many instances where the very strategies developed in Africa are easily translatable to the U.S., should such an outbreak occur here. There are only so many NIH/CDC level treatment rooms available to treat Americans infected by Ebola, but isolation of pathogens, vaccine development and other approaches will work just as well here as in Africa.
Global outreach is an essential component of medical training at the University of Michigan and at many other medical schools. The benefits that result from our presence across the world are profound, for those countries as well as the U.S. A robust presence in health care in underserved countries will continue to provide rewards near and far.
Marschall S. Runge, MD, PhD, is Executive Vice President for Medical Affairs and Dean of the Medical School for the University of Michigan.