international health for the pediatrician
TRANSCRIPT
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International Child Health for the Practicing Pediatrician
Section on International Child HealthNovember 3, 2003David P. Norton, MD FAAP
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International Child Health
Why get involved?Where to find opportunitiesPreparing for doing medical work abroadChallengesReturning Home
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Why get involved?
Children and Health CareWhere are most of the world’s children?Child health issues – US vs. GlobalDisparities– developed world vs. developing
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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%
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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
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Child Mortality
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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
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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
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“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
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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
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Requirements
Idealism and a sense of hope! ResilienceFlexibilityOpen MindCultural Sensitivity and AwarenessSense of humor
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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
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How to get involved -- abroad
Short term work with volunteer organizationsLonger term– with NGO’s, governmental agencies, universitiesTypes of work-
Clinical Care / ServiceMedical EducationResearch
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How to get involved– at home
Donation programs-Books and JournalsRecycling Medical Supplies –”REMEDY”
International Adoption and Caring for Immigrant PopulationsTravel Clinics
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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
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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
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Volunteer Opportunities– Resources
SINCH WebsiteSINCH list serveIHMECIMVAReligious OrganizationsJournal Articles- JAMAWord of mouth/ Network with colleaguesMake contacts while traveling
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Things to consider-
ContextAlone or with a team/groupSecular or religious NGO
Type of workEducation, service, combinedPhysically demandingPersonal experience/ training
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Things to consider– cont’d
SafetyLogistics
TravelClimateAltitude
Local medical communityHow welcoming?Teaching opportunitiesPediatric colleagues
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Challenges
Overwhelming Need– How can I possibly make a difference?Lack of ResourcesLanguage Cultural DifferencesFood, HousingHealth of the VolunteerEmotional Challenges
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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
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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)
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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…
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Preparing -- teaching
What kind of teaching– lectures, rounds, discussion groupsWhat tools can you use?
SlidesHandoutsOverheads
Language issues with teaching
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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
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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.
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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.
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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.
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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.
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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
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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!
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Cultural Issues, cont’d
Other important issues—Local dress- what is appropriate for physicians?Local hospital political sceneInteractions outside the medical setting
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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.
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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.
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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.
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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.
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The Pediatrician’s Gift
--- To touch the life of a
child…