Raising Voices for Health – A Social Medicine Educational Collaborative

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Raising Voices for Health – A Social Medicine Educational Collaborative

Uganda
Budget: 
$1,000 - $10,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Empowering patients in resource-poor settings requires partnership with healthcare workers who are attentive to local and global context. We have developed an immersion curriculum in social medicine and global health for medical students from around the world that merges clinical teaching with socioeconomic, cultural, political, and historical understandings of illness.

About Project

Problem: What problem is this project trying to address?

In resource-poor settings, patients face not only a tremendous burden of disease but also gender inequality, racism, political violence, broken educational systems, and lack of clean water and sanitation. Each factor obstructs patients from accessing needed preventative and curative medical care. Empowering patients to successfully confront disease requires partnership with healthcare workers who view the physician-patient relationship as a collaborative effort to marshal the biomedical, psychosocial, and community resources necessary for healing. Currently, medical education neglects such training. Ugandan medical students report no exposure to social medicine. Current community health rotations demoralize Ugandan students and drive them into specialized careers. International medical students, who are venturing abroad in unprecedented numbers for global health rotations, regularly participate in unstructured and unsupervised experiences that fail to adequately attend to the local context. Our innovation aims to fill these gaps and build a movement of healthcare workers committed to empowering patients through primary care systems.

Solution: What is the proposed solution? Please be specific!

Our four-week curriculum aims to empower patients by training healthcare workers in three innovative ways. First, our course merges immersive clinical training in diseases affecting the poor with simultaneous training in social medicine. Social medicine topics, such as the political and economic determinants of health, globalization, human rights advocacy, and community-based healthcare, are often taught either thousands of miles or years away from clinical training. Through a combination of patient care integrating narrative medicine, interactive lectures, films, and community field visits, course participants develop an understanding of the connections between social context and clinical disease. Second, our classroom integrates local medical students (Ugandan) with visiting medical students from international locales. This collaborative model brings together Ugandans who likely will act as direct patient care providers and international students who will more distally provide patient care in resource-poor settings as policymakers, program managers, and project designers. Partnerships between these proximal and distal sources of care are essential to deliver care that maximally enhances patient empowerment. Finally, at a time when the WHO calls for primary care “now more than ever” and acknowledges that past failures to achieve health for all were due to vague, ill-defined strategies for the comprehensive provision of primary care, our course provides an innovative and concrete step to train healthcare workers in the spirit of primary care. Providing primary care that incorporates community participation and empowerment requires training healthcare workers to listen to and understand the social lives of their patients, something our course aims to do.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

During the inaugural course held in 2010, twenty-one medical students from Uganda, the United States, and Holland participated in the course. Instructors from Uganda and the US co-developed and taught the course. Based on course evaluations and classroom observation, it was evident that students gained a deep appreciation of social understandings of disease and new conceptualizations of health interventions that incorporate community participation and social justice. Students demonstrated how to integrate narrative medicine, which involves gathering patient illness narratives in order to develop therapeutic responses appropriate to social context, into their clinical work. Through attentiveness to economic and power inequities amongst the students, an equitable classroom burgeoned in which engagement with global health was made deeply personal, thereby leading students to build strong peer relationships ready to catalyze change through collaboration. The students spontaneously formed working groups to address medication and equipment shortages and malnutrition in Northern Uganda through community-based research and advocacy. Articulating this energy for social change, one student noted, “I feel my eyes are open, my muscles are contracted, and the hand and body is ready to start acting against problems,” and another shared, “working with the community requires a lifelong commitment and also involving the community at every single step of the program.” The curriculum literally reshaped the trajectory of future careers prompting one student to share that the course, “will forever change how I view and practice medicine.” Such impacts are essential for building primary care systems in which health workers and patients can empower one another and achieve health for all in their communities.
About You
Organization:
Uganda Health and Social Justice Fund
Section 1: You
First Name

Michael

Last Name

Westerhaus

Website URL

http://None (Being Developed Now)

Organization

Uganda Health and Social Justice Fund

Country

, MA, Suffolk County

Section 2: Your Organization
Organization Name

Uganda Health and Social Justice Fund

Organization Phone

617-869-2908

Organization Address

36 Prince St., #1; Jamaica Plain, MA 02130

Organization Country
Your idea
Country and state your work focuses on

, GUL

Website URL

http://None (Being Developed now)

Innovation
Do you have a patent for this idea?

Impact
Actions

In order to achieve success, we are enhancing our public outreach, strengthening our curriculum, and building opportunities that bridge the course experience with clinical opportunities. Through dissemination of our course video and model through conference presentations and blogs alongside building relationships with US medical schools, we have generated immense global student and faculty interest in this year’s course. In order to strengthen our curriculum, we are extensively evaluating last year’s course to address weaknesses and developing a formal research project to quantitatively and qualitatively evaluate the impact of this year’s course. Course interns are enhancing content and presentation of the curriculum through literature searches, multimedia expansion, and website development. Finally, we are working with our partner Ugandan medical school to create opportunities for course graduates to work in well-resourced community health centers where together with patients they can combine clinical and social medicine to address health disparities.

Results

Through these actions, we will generate support to form an NGO focused on delivering the course curriculum and supporting graduates to work with communities in resource-poor settings to provide high-quality, primary healthcare. In Uganda, community health rotations for medical students will be created at well-functioning health centers to demonstrate the transformative power of primary healthcare and patient empowerment, thereby leading to physician retention in rural areas and stemming brain drain. International student participants will incorporate social medicine understandings into global health careers as program managers, funders, academics, and activists, helping to potentiate optimal conditions for implementing patient-centered comprehensive primary healthcare. Through strengthened networks and visibility, this model of education and community-based healthcare will be expanded to numerous locations throughout the world in concert with our partners.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

Achieving these successes in the next three years will require intensive investment in programming, fundraising, and publicity to support concrete movement forward. In the first year, we will set up a formal NGO under which to conduct our work, thereby serving to enhance our visibility and fundraising capabilities. In addition to continual provision of the course for thirty (15 local, 15 international) students, the NGO will focus initially on building a network of community health centers in Northern Uganda in partnership with the Ugandan government that provide high-quality primary care through community participation and patient empowerment. In addition, a scholarship program will be developed for students who desire to participate in the course but are inhibited by financial constraints. In the second year, we will begin to offer, in partnership with Gulu University School of Medicine, structured community health rotations within the network of supported community health centers for Ugandan medical students that are course graduates. In the third year, well-funded clinical and programmatic opportunities for medical school graduates who participated in the course will open at the community health centers. Through our network of international student graduates, extensive financial and programmatic support will be provided to support community- and patient-led health improvement initiatives at these sites. Our model of social medicine education will be shared and adopted by others in the world through our established network of groups interested in medical education and community health care provision. Together we believe these initiatives will maximize the patient-physician interface in a manner that yields mutual respect and empowerment, long-term commitments to community health, and expanded access to high-quality primary care in resource-poor settings.

What would prevent your project from being a success?

Our primary obstacles to achieving success involve ensuring sustainable funding and building strong institutional and partner support. In terms of funding, we generate financial support for the course through a course fee paid by international students. However, this revenue fails to cover the full cost of the course and the balance is secured through an unreliable stream of private donations and institutional support. Community health center support in Northern Uganda has been achieved through private donations and foundation support. To ensure increased and reliable financial support, we plan to continue building partnerships with US medical schools who will contribute financially in order to have their medical students participate, to raise the course fee, and to generate funds by sharing our innovative curriculum through publishing a text in social medicine, making videos of the course available to facilitate distance learning, and providing consultations for others wishing to implement a similar program. Further, student graduates who have completed their medical training will be asked to contribute to the ongoing sustainability of the project.

How many people will your project serve annually?

101‐1000

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your project seek to have an impact on public policy?

Sustainability
What stage is your project in?

Operating for less than a year

In what country?
Is your initiative connected to an established organization?

Yes

If yes, provide organization name.

Students for Equality in Healthcare; Gulu University Faculty of Medicine; St. Mary's Hospital Lacor; Partners in Health

How long has this organization been operating?

More than 5 years

Does your organization have a Board of Directors or an Advisory Board?

Does your organization have any non-monetary partnerships with NGOs?

Yes

Does your organization have any non-monetary partnerships with businesses?

No

Does your organization have any non-monetary partnerships with government?

Yes

Please tell us more about how these partnerships are critical to the success of your innovation.

Building partnerships with NGOs, local government, and academic medical centers allows for us to integrate individuals from these bodies into our course as instructors in order to provide a multidisciplinary, immersive education. These partnerships have also given rise to classroom space, sites for field visits, and access to patients for students to learn and practice the application of combined clinical and social medicine. These partnerships will be critical as we work with the local government to strengthen the system of community health centers in order to provide transformative experiences for medical students and patients. Finally, these partners, as central members in current healthcare provision in Northern Uganda, will be central to developing a sustainable and attractive primary healthcare system for providers and patients alike.

What are the three most important actions needed to grow your initiative or organization?

The three most important actions needed to grow our initiative are increasing our revenue, developing a concrete strategic plan for a strengthened system of community health centers in Northern Uganda, and sharing our model with other sites. First, increasing our revenue will ensure the overall sustainability of our project, allow us to offer scholarships to prospective student participants, and ensure that we move into the next phase of our initiative involving the creation of a well-funded system of community health centers at which graduates of our course can study and practice collaborative medicine with patients. Second, utilizing relationships with our partners in Northern Uganda, our project needs to develop a realistic strategy for strengthening community based healthcare delivery that tackles the challenges of chronic understaffing, unreliable medication supply chains, and dilapidated physical structures that currently confront patients and health workers. Incorporating patient, NGO, government, and health worker perspectives into this strategic plan will be central to its success and growing this component of our initiative. Finally, believing in the potential for our educational model to transform healthcare provision in many resource-poor settings of the world, we will utilize our global network of academic and NGO relationships to adapt and implement our initiative in numerous settings. Together these actions will grow our initiative in order to enhance healthcare provider education and commitment to social medicine and primary care, ultimately creating healthcare systems in which patients can advocate for their health needs and participate more fully in healthcare delivery.

The Story
What was the defining moment that led you to this innovation?

Our defining moment was not one occasion, but rather a collection of experiences over years of working in resource-poor settings, including India, the Dominican Republic, Haiti, Guatemala, Lesotho, Rwanda, Eritrea, the United States, and Uganda. On numerous occasions, we’d find ourselves amidst a cluster of health professionals attempting to engage and address the extremely difficult challenges facing the population. Despite the health workers’ (who came from both local and international destinations) best intentions to serve those in need, they’d make unsettling comments about the patients they served: “they just don’t listen;” “he never asked me any questions when I was going over treatment protocol, I think he may just not be intelligent enough to get it;” and “I don’t think she really wants to get better.” As we listened, we heard the health workers’ frustration from working in challenging situations alongside a piercing ignorance of the social, economic, and political context in which they were operating. Once at a rural community health center in northern Uganda, an adolescent of 14 years presented with severe malnutrition and advanced HIV/AIDS. Without the will to advocate for himself, many of the health workers at the clinic felt that the adolescent should be sent home for palliative care since his disease was so advanced and he was unlikely to survive. Critical reflection inspired us to envision the potential impact that comprehensive social medicine education could have made for the health workers in that case. Furthermore, a strengthened and well-resourced clinic would have also ensured that health workers had some concrete options beyond offering palliative care for the young man. Through these conversations, experiences, and reflections, the innovation for our immersive social medicine course coupled with strengthening community health centers emerged. We realized that a large part of the solution to empowering patients so that they could better advocate for themselves involved training health workers to be more holistic in their understandings and treatment of various ailments. As we shared the idea with our networks, we found that many health workers, particularly those in their formative years of training, also noticed patient disempowerment and were actually searching for structured opportunities to explore how to more effectively meet the needs of their patients.

Tell us about the social innovator behind this idea.

The social innovators behind this idea are 3 young people—a Ugandan physician, a US sociologist, and a US physician – friends and colleagues who brought extensive experience traversing the challenges of providing and advocating for global health, specifically in the context of Northern Uganda. Each of the three brings a diverse set of skills and experience; from public health training at Harvard to grassroots human rights work in the context of war to clinical work in both resource-poor and resource-rich contexts to extensive teaching experience with undergraduates, medical students, and mid-career professionals. As these 3 innovators brainstormed and discussed the ideas for the course and the subsequent strengthened community health centers, they each brought their own set of resources, literature, and case studies from which to draw. But perhaps most importantly, the three innovators who became the lead course instructors also modeled the partnership that became such a critical component of the innovation. This began through extensive consultation as the course was being formed – they utilized the input of other Ugandan physicians with experience in Northern Uganda, a Ugandan medical anthropologist, Ugandan medical students, U.S. medical educators, and U.S. based health activists to create the specific course content and teaching methodologies. The collaborative partnership between the innovators continued as the innovators made the most significant decision involving the creation of the course—the inclusion of medical students from abroad alongside medical students from Uganda as the participants. This decision was made based on observations that the 3 innovators had made while working in Northern Uganda as well as through noting the general trend of global health education, which focuses on North American and European students studying problems in resource poor contexts. The innovators felt that the current model of global healthcare education that focused primarily on teaching North Americans and Europeans missed critical opportunities for both learning and partnership-building. They strove to create a collaborative learning space that undid some of the power and resource inequities, which are too easily replicated when only “outsiders” are seen as healthcare providers in resource-poor settings. Thus, the collaborative partnership that became a central aspect of the course was only possible because the instructors and the students hailed equally from the region as well as from abroad. They each brought individual strengths, but realized that more was possible for patient empowerment when voices were heard from multiple regions and backgrounds.

How did you first hear about Changemakers?

Friend or family member

If through another, please provide the name of the organization or company

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