International Health for the Pediatrician

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  • 1. International Child Health for the Practicing Pediatrician Section on International Child Health November 3, 2003 David P. Norton, MD FAAP
  • 2. International Child Health
    • Why get involved?
    • Where to find opportunities
    • Preparing for doing medical work abroad
    • Challenges
    • Returning Home
  • 3.  
  • 4. Why get involved?
    • Children and Health Care
      • Where are most of the world’s children?
      • Child health issues – US vs. Global
      • Disparities– developed world vs. developing
  • 5. Population Comparisons 0-19 years Total 4.6% 287,675,526 6,228,348,730 3.4% 81,069,249 2,389,021,046 Per cent US World
  • 6. Under-five mortality rate trends (per 1,000 live births) Source: UNICEF 2000 1995 1990 1980 1970 1960 Region 82 87 93 117 147 197 World 159 170 180 208 244 278 Least dev. 90 96 103 132 166 223 Developing 7 8 9 14 26 37 Industrialized
  • 7. Child Mortality                                                                                            
  • 8. Child Mortality, US
    • Leading causes of Death in Children, ages 1-4 years.
    • 1 Accidents (unintentional injuries)
    • 2 Congenital malformations
    • 3 Malignant neoplasms
    • 4 Assault (homicide)
    • 5 Diseases of heart
  • 9. Total Number of Immigrant Visas Issued to Internationally Adopted Children by Year Source: US Dept State
  • 10. “Why we do it”– UNICEF –for the Children
    • Children have rights
    • The world has set goals for children
    • Children demand a voice
    • Poverty reduction starts with children
    • The people of the world say 'Yes' for children
    • Children should not be dying from preventable causes
  • 11. Why get involved-- other reasons
    • Moral/ ethical– personal need to give back
    • Sense of Adventure
    • Language skills, interest in other lands and cultures
    • Previous international experience – personal/ family ties
    • Broaden one’s educational horizons
  • 12. Requirements
    • Idealism and a sense of hope!
    • Resilience
    • Flexibility
    • Open Mind
    • Cultural Sensitivity and Awareness
    • Sense of humor
  • 13. Other Factors to Consider
    • The home scene / family life
      • Family– bring them or leave them?
      • Involve them!
    • Job –
      • Who’s covering and how happy are they?
    • Money
      • Access to support for your work
      • Loss of income
    • Time off– vacation/ CME/ leave of absence
    • Personal Health
  • 14. How to get involved -- abroad
    • Short term work with volunteer organizations
    • Longer term– with NGO’s, governmental agencies, universities
    • Types of work-
      • Clinical Care / Service
      • Medical Education
      • Research
  • 15. How to get involved– at home
    • Donation programs-
      • Books and Journals
      • Recycling Medical Supplies –”REMEDY”
    • International Adoption and Caring for Immigrant Populations
    • Travel Clinics
  • 16. How to get involved– at home
    • Sponsoring/ working with visiting physicians, nurses here for education
    • Political Action– advocate for children!
      • UN Convention of the Rights of the Child
      • Where your tax dollars go
      • Other issues– land mines, child labor
  • 17. International Child Health-- on the Net
    • Consulting from afar- “e-mentoring”
      • Doctors of the World-USA
    • Foster knowledge access and exchange with colleagues across the globe.
    • List serves– method to collaborate on international projects–
      • Yahoo group– Honduras Hospitals
    • International Pediatric Chat
  • 18. Volunteer Opportunities– Resources
    • SINCH Website
    • SINCH list serve
    • IHMEC
    • IMVA
    • Religious Organizations
    • Journal Articles- JAMA
    • Word of mouth/ Network with colleagues
    • Make contacts while traveling
  • 19. Things to consider-
    • Context
      • Alone or with a team/group
      • Secular or religious NGO
    • Type of work
      • Education, service, combined
      • Physically demanding
      • Personal experience/ training
  • 20. Things to consider– cont’d
    • Safety
    • Logistics
      • Travel
      • Climate
      • Altitude
    • Local medical community
      • How welcoming?
      • Teaching opportunities
      • Pediatric colleagues
  • 21. Challenges
    • Overwhelming Need– How can I possibly make a difference?
    • Lack of Resources
    • Language
    • Cultural Differences
    • Food, Housing
    • Health of the Volunteer
    • Emotional Challenges
  • 22. Preparation– What to learn
    • Job Description– figure out what you will be expected to do!
      • Specific tasks expected– patient care, teaching, procedures, administrative
      • Update PALS, NALS
      • Range of medical problems
      • Work hours and time off.
      • Who are your colleagues?
      • Connect with previous volunteers
  • 23. Preparation– What to learn-
    • Language – even a little bit helps, and is appreciated
    • Research the area– geography, culture, ethnic groups
    • Health information – what kinds of health problems are you likely to see?
  • 24.                            
  • 25.                          
  • 26. Preparation – What to do
    • Medical – for the volunteer
      • Travel Immunizations
      • Malaria prophylaxis
      • High Altitude meds
    • Supplies
      • Medical Equipment/ Tools
      • Medications
      • Books
      • Teaching – slides, teaching kits (PALS)
  • 27. Preparation-- teaching
    • Consider topics-
      • What may be interesting or useful for your professional colleagues?
      • What are you comfortable teaching/ what can you prepare for?
    • Who will you be teaching? – physicians, students, residents, nurses, lay health care workers…
  • 28. Preparing -- teaching
    • What kind of teaching– lectures, rounds, discussion groups
    • What tools can you use?
      • Slides
      • Handouts
      • Overheads
    • Language issues with teaching
  • 29. Packing
    • Traveling Alone or with a group?
    • Personal Items
      • Documents—passports, visa, copies of everything!
      • Personal Medications
      • Sunscreen, insect repellent
      • Appropriate Clothing – acceptable in the local hospital or clinic
  • 30. Packing – Medical Supplies
    • Really depends on what you will really be doing!
    • Tools you need to do your job.
    • Bring only supplies that are useful and can be maintained, not dependent on advanced technology.
    • Heed customs regulations– vary from country to country.
  • 31. Packing – Medical Supplies
    • Containers– zip lock bags, small plastic bottles
    • Disposable gloves, masks, gowns, eye protection.
    • Antiseptic hand wash/ consider n-95 masks
    • HIV prophylaxis
    • Electrical equipment- may need transformer if electricity is different voltage.
  • 32. Medications– what to bring
    • Never bring expired meds.
    • Be selective – what is really needed?
    • Obtaining meds-
      • Samples– sometimes useful, but often lots of package for not much med.
      • Many pharmaceutical companies have donation programs– will donate larger amounts of medications to volunteers.
  • 33. Medications– what to bring
    • Antibiotics – stick to the basics.
    • Analgesics and Antipyretics
    • Avoid–
      • Meds that don’t actually do much– cough/cold preps
      • New meds unfamiliar to local docs, especially if there are any significant side effects or risks.
  • 34. Cultural Issues
    • Beliefs, customs related to health, disease and the medical community – where does your work fit in?
      • Level of education
      • Role of physicians vs traditional medicine
      • Medical advise vs. what really happens
      • Integrating your work with local colleagues
  • 35. Cultural Issues, cont’d
    • Language and Translation– Getting your message across….
      • Use of appropriate terminology
      • Talking to the right person!
      • Use of translators
      • Literacy issues/ use of pictograms
    • Make an effort to speak – a few words go a long way!
  • 36.  
  • 37. Cultural Issues, cont’d
    • Other important issues—
      • Local dress- what is appropriate for physicians?
      • Local hospital political scene
      • Interactions outside the medical setting
  • 38. Returning Home
    • Cultural re-entry can be challenging
      • Return to “opulence” of our health care
      • Relative lack of medical need here vs. there
      • Patients/ parents here may seem demanding.
    • Volunteer may be physically and emotionally drained upon return.
  • 39. Returning Home- cont’d
    • Sharing your experience may not be easy--
      • Most people don’t really want to know much.
      • Hard to communicate your experience.
      • Criticism of the home scene may not be well-received.
  • 40. Returning Home– Integrating the Experience
    • It may be easier to share with colleagues with similar experiences.
    • Direct your enthusiasm about a trip into talks or slide shows– for interested audiences.
    • Become active in the planning and administration of the organization that sent you.
  • 41. Returning Home– the gains
    • You’ve learned a lot!
    • Flexibility- new definition
    • Ingenuity & Innovation
    • Appreciation of the resources at home
    • Charged batteries– remembering why you became a pediatrician!
    • You had the opportunity to just practice medicine.
  • 42. The Pediatrician’s Gift
    • --- To touch the life of a child…