International Health for the Pediatrician

International Child Health for the Practicing Pediatrician

Section on International Child HealthNovember 3, 2003David P. Norton, MD FAAP

International Child Health

Why get involved?Where to find opportunitiesPreparing for doing medical work abroadChallengesReturning Home

Why get involved?

Children and Health CareWhere are most of the world’s children?Child health issues – US vs. GlobalDisparities– developed world vs. developing

Population Comparisons

World US Per cent

Total 6,228,348,730 287,675,526 4.6%

0-19 years

2,389,021,046 81,069,249 3.4%

Under-five mortality rate trends

(per 1,000 live births)

Region 196

0

1970 198

0

199

0

199

5

2000

Industrialize

d

37 26 14 9 8 7

Developing 223 166 132 103 96 90

Least dev. 278 244 208 180 170 159

World 197 147 117 93 87 82Source: UNICEF

Child Mortality

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

Total Number of Immigrant Visas Issued to Internationally Adopted Children by

Year

0

5000

10000

15000

20000

25000

1992 1994 1996 1998 2000 2002

Source: US Dept State

“Why we do it”– UNICEF –for the Children

Children have rightsThe world has set goals for childrenChildren 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

Why get involved-- other reasons

Moral/ ethical– personal need to give backSense of AdventureLanguage skills, interest in other lands and culturesPrevious international experience – personal/ family ties Broaden one’s educational horizons

Requirements

Idealism and a sense of hope! ResilienceFlexibilityOpen MindCultural Sensitivity and AwarenessSense of humor

Other Factors to ConsiderThe home scene / family life

Family– bring them or leave them?Involve them!

Job – Who’s covering and how happy are they?

MoneyAccess to support for your workLoss of income

Time off– vacation/ CME/ leave of absence Personal Health

How to get involved -- abroad

Short term work with volunteer organizationsLonger term– with NGO’s, governmental agencies, universitiesTypes of work-

Clinical Care / ServiceMedical EducationResearch

How to get involved– at home

Donation programs-Books and JournalsRecycling Medical Supplies –”REMEDY”

International Adoption and Caring for Immigrant PopulationsTravel Clinics

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 ChildWhere your tax dollars goOther issues– land mines, child labor

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

Volunteer Opportunities– Resources

SINCH WebsiteSINCH list serveIHMECIMVAReligious OrganizationsJournal Articles- JAMAWord of mouth/ Network with colleaguesMake contacts while traveling

Things to consider-

ContextAlone or with a team/groupSecular or religious NGO

Type of workEducation, service, combinedPhysically demandingPersonal experience/ training

Things to consider– cont’d

SafetyLogistics

TravelClimateAltitude

Local medical communityHow welcoming?Teaching opportunitiesPediatric colleagues

Challenges

Overwhelming Need– How can I possibly make a difference?Lack of ResourcesLanguage Cultural DifferencesFood, HousingHealth of the VolunteerEmotional Challenges

Preparation– What to learn

Job Description– figure out what you will be expected to do!

Specific tasks expected– patient care, teaching, procedures, administrativeUpdate PALS, NALSRange of medical problemsWork hours and time off.Who are your colleagues?Connect with previous volunteers

Preparation– What to learn-

Language – even a little bit helps, and is appreciatedResearch the area– geography, culture, ethnic groupsHealth information – what kinds of health problems are you likely to see?

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Preparation – What to do

Medical – for the volunteerTravel ImmunizationsMalaria prophylaxisHigh Altitude meds

SuppliesMedical Equipment/ ToolsMedicationsBooksTeaching – slides, teaching kits (PALS)

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…

Preparing -- teaching

What kind of teaching– lectures, rounds, discussion groupsWhat tools can you use?

SlidesHandoutsOverheads

Language issues with teaching

Packing

Traveling Alone or with a group?Personal Items

Documents—passports, visa, copies of everything!Personal MedicationsSunscreen, insect repellentAppropriate Clothing – acceptable in the local hospital or clinic

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.

Packing – Medical Supplies

Containers– zip lock bags, small plastic bottlesDisposable gloves, masks, gowns, eye protection.Antiseptic hand wash/ consider n-95 masksHIV prophylaxisElectrical equipment- may need transformer if electricity is different voltage.

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.

Medications– what to bring

Antibiotics – stick to the basics.Analgesics and AntipyreticsAvoid–

Meds that don’t actually do much– cough/cold prepsNew meds unfamiliar to local docs, especially if there are any significant side effects or risks.

Cultural Issues

Beliefs, customs related to health, disease and the medical community – where does your work fit in?

Level of educationRole of physicians vs traditional medicineMedical advise vs. what really happensIntegrating your work with local colleagues

Cultural Issues, cont’d

Language and Translation– Getting your message across….

Use of appropriate terminologyTalking to the right person!Use of translatorsLiteracy issues/ use of pictograms

Make an effort to speak – a few words go a long way!

Cultural Issues, cont’d

Other important issues—Local dress- what is appropriate for physicians?Local hospital political sceneInteractions outside the medical setting

Returning Home

Cultural re-entry can be challengingReturn to “opulence” of our health careRelative lack of medical need here vs. therePatients/ parents here may seem demanding.

Volunteer may be physically and emotionally drained upon return.

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.

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.

Returning Home– the gains

You’ve learned a lot!Flexibility- new definitionIngenuity & InnovationAppreciation of the resources at homeCharged batteries– remembering why you became a pediatrician! You had the opportunity to just practice medicine.

The Pediatrician’s Gift

--- To touch the life of a

child…