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