Global Health: Why direct patient care is NOT the answer

Transcription

1 Global Health: Why direct patient care is NOT the answer Michelle Holm, PharmD, BCPS Medical Director of Global Health Education 2015 MFMER slide-1

2 Conflict of Interest No financial or other relationship conflicts to disclose 2015 MFMER slide-2

3 Objectives Identify the principles and methods necessary for successful implementation of a global health initiative in developing countries. Summarize the unique opportunities and barriers typically encountered while serving in developing countries. Describe best practices for creating and maintaining a longterm global health partnership with the collaborating country MFMER slide-3

4 Doctors without Licenses Pharmacists without Licenses Provide Incompetent Medical Care in Developing Countries Provides Incompetent Medical Care in Developing Countries New Doctors without Licenses Program Provides Incompetent Medical Care to Refugees Courtesy of theonion.com

5 Perceived Weaknesses Domestic Health Professionals entering Global Health practices Cross cultural Communication Understanding context & realities Cultural Sensitivity Flexibility, adaptability, & creativity Rudy, S USAID conference findings. Presented at CUGH 2015

6 Understanding Cultural Differences Toxic Charity The Bottom Billion Sun City Picture House Half the Sky Poverty, Inc. Sugarprep.org Preceptor/ Mentor Relationship

7 Poverty, Inc. Trailer

8 PRINCIPLES OF SERVANT LEADERSHIP Awareness Listening Foresight Empathy Conceptualization Greenleaf, et al. Servant Leadership (2002)

9 Needs Assessment Observe Plan Report Assess Improve Most importantly, collaborate and ask questions! Wright, et al. BMJ (1998)

10 Which misstep do global medical mission teams often make? Providing education to healthcare staff Forming partnerships with in country non profit organizations Failing to perform an adequate needs assessment Waiting to make improvement recommendations until arrival in the developing country

11 GLOBAL HEALTH GUIDELINES (WEIGHT) FOR EDUCATIONAL TRAINING 1. Develop well structured programs and discuss expectations and responsibilities 2. Consider local needs and priorities 3. Recognize the true cost of your recommended implementations 4. Aspire to maintain long term partnerships 5. Clarify goals, expectations, and responsibilities through agreements 6. Develop, implement, and update formal training 7. Encourage non threatening communication Crump, et al. American Journal of Trop Med Hygiene (2010)

12 Global Health guidelines (WEIGHT) for educational training recommend which of the following: Development of an educational curriculum based on your previous pharmacy experiences Clarify goals, expectations, and responsibilities through agreements Prepare for visits by reviewing gold standard medications and the newest FDA approved drugs Serve on several short term trips in several countries to increase your global health presence and discuss expectations well structured programs and discuss expectations and responsibilities

13 EVIDENCE BASED EDUCATIONAL APPROACH Targeted Education Stroke Diabetic Ketoacidosis Case Based Learning Clinical vignettes Multimodal teaching techniques Hand hygiene Aseptic technique Peabody, et al. Disease control priorities in developing countries (2006)

14 Which of the following global educational approaches is evidencebased in nature? Memorization of medical guidelines Providing patient counseling Broad scope educational focus Multimodal teaching techniques

15 Opportunities

16 Volunteer Opportunities Mayo Clinic Abroad Haiti trip Trip Dates: November 6 12 th Application Due Date: July 8 th Contact: Michelle Holm, RPh for application Dominican Republic Faculty Member trip (Non Mayo Sponsored) Trip Dates: February 18 th 26 th Estimated Cost: $1400 Contact person: Julie Cunningham, RPh MIHP International Residency Rotation Deadline:? Scholarship: $2,500 Contact: Garrett Schramm Good Samaritan Clinic Clinic days: Monday and Wednesday evenings Contact: Kathleen Hannon Hawthorne Education Center Provide education to members of our community to promote employment opportunities Contact:

17 the Western observers habitually point out developing countries spend lavishly and cannot afford such expenditures. In purely economic terms this may be true. Men, however, do not live by bread alone especially not in situations of desperate need and urgent hope. In such situations men at least also live on dreams. Conrad and Gallagher Conrad and Gallagher. Health and Health Care in Developing Countries Gallagher EB, et al. Health and Healthcare in Dev Countries (1993)

18 Force Multiplier effect

19 Phased Educational Approach Direct Patient Care Providing Education Train the Trainer Holm, et al. Global Health Action (2015)

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21 Pharmacy Computerized Inventory Program (PCIP) Monitors medication purchases, usage, and inventory levels Eliminates drug shortages Education and training provided for all users Picture courtesy of St Damiens Hospital The single most important contribution from Mayo Clinic has been the pharmacy computerized inventory system. Father Rick Frechette, CEO, St. Luke Hospital

22 PCIP Medication Requests Holm, M, et al. Global Health Action (2015)

23 What are your End Goals? People reached Improvements made Visits Completed Better test scores

24 Barriers

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26 Which of the following describes a common barrier for pharmacists serving in a developing country? Time Vitamin D deficiency Unfamiliar with advance technology present Minimal patient admits per shift

27 Organizations caught in a reactionary cycle are incapable of operating on a theory of knowledge; a reactionary cycle is shortterm and usually occurs without opportunity to check the effect of that action on other components of the system. W. Edwards Deming

28 Long Term Partnerships

29 Sustainability Education Partnerships Accountability

30 Which of these tasks ensure longterm sustainability when working in a developing country? Performing direct patient care Organizing their pharmacy Dispensing medications to patients Train the Trainer

31 Difficult to embrace Happens slowly Sustainable when it comes from within and is owned by the beneficiaries If you want to go fast, go alone. If you want to go far, go together. African Proverb

32 Culture Shock Process Honeymoon The Fall Bottom Out Refractory Period Xia, Junzi. Intl Journal of Psych Studies (2009)

33 Take Home Points Review Principles of Servant Leadership and Global Health Training Guidelines (WEIGHT) before serving as part of a long term initiative. Perform an adequate needs assessment and embrace available opportunities to help overcome the barriers present when serving. Improvements happen slowly through sustainable measures rather than direct patient care initiatives. Verify your initiative includes measured, sustainable outcomes MFMER slide-33