Christian Journal for Global Health
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Open Access journal
ISSN (Online) 2167-2415
Published by Center for Health in Mission [1 journal]
- Educating globally for health
Authors: H Elliott Larson
Pages: 1 - 2
Abstract: A survey of articles in Christian Journal for Global Health, Volume 3, Issue 2, November 2016
- "Exporting" medical education
Authors: Vinod Shah, H Elliott Larson, Nathan Grills, Michael Soderling, Daniel O'Neill
Pages: 3 - 5
Abstract: A commentary on four reports of the pre-conference on medical education in low and middle income countries and efforts by mainly North American physicians to provide assistance held November, 2015. The authors address issues of participatory learning and developing critical thinking; mutual learning and leadership; and professionalism and ethics in medical education.
- Health and wholeness undergraduate course in Uganda: potential public
health impact and transferability
Authors: Douglas L Fountain, Edward Mukooza, Edward Kanyesigye
Pages: 6 - 17
Abstract: Over 26,000 students at a major Christian University in Uganda have completed a single semester course on Health and Wholeness. While common in other higher education contexts, general education courses and health education courses in particular are uncommon in the Africa higher education context. This course therefore is a bold initiative by Uganda Christian University. The course is designed to help students in a wide range of programs understand how to promote and improve health in their own lives as well as their homes, communities, workplace and society. Students learn about the definitions of health and wholeness. They discuss hygiene; nutrition; sanitation, water and land use; common occurring health problems, HIV/AIDS and sexually transmitted infections; sexuality; first aid and early intervention; family health, dependence, fitness and life skills and leadership for a healthy society. Through discussion, students are expected to identify factors that hinder or enhance health. Challenges and lessons learned in the course include confronting cultural practices, improving critical analysis skills, addressing information at the right technical level, and improving behavior change. Because graduates come from, and move on to, virtually all facets of economic, civil and social life in Uganda and beyond, this course could carry tremendous potential to improve the public’s health.
- Evaluation of community health worker training course effectiveness in
Authors: Nicole Butcher, Adeline Sitther, Jachin Velavan, Elizabeth John, Mary Chandra Thomas, Nathan Grills
Pages: 18 - 26
Abstract: Community health workers (CHWs) have long played a key role in delivering healthcare in rural and remote populations, through primary care, prevention and education. Numerous mechanisms of training and supporting CHWs have been implemented, and the WHO has outlined recommendations for the programmatic and financial aspects of CHW programs. This study evaluated the outcomes of a CHW training program in India whereby community development workers from faith-based organisations have been trained since 2011 to extend health prevention, promotion, education and basic services to rural, remote and poor communities across the country. Triangulation of quantitative and qualitative data and course information was conducted, and analysis pointed to the effectiveness of the trainees in their respective work locations. Outcomes were noted in the areas of first aid and primary care, health promotion and education, the breadth of beneficiaries, and spiritual health. The consistency of the data across these areas suggests that the training course is effective in its delivery, its contribution to the expansion of healthcare coverage and its potential for impact across India.
- Continuing medical and dental education on the global stage: The nexus of
supporting international Christian healthcare workers and developing
Authors: Lyubov D Slashcheva, Mark A Strand, Ruth E VanReken, Collin Sanford, J Dwight Phillips, Gloria Halverson
Pages: 27 - 37
Abstract: One of the challenges facing international healthcare missionaries is that of maintaining up-to-date knowledge and staying current with professional certification. Since 1978, annual programs by the Christian Medical and Dental Associations have offered professional continuing education to thousands of US healthcare professionals serving as missionaries in the regions of Africa, Asia, and, in more recent years, globally. In addition, conference programming is designed to prepare, train, and support healthcare missionaries to, in turn, serve as educators in their places of ministry. The program is designed for both professional education and personal encouragement. Utilizing historical documents from program facilitation and interviews from those involved with its implementation, this paper describes the history, vision, and favorable quantitative growth and qualitative impact on participants. The program continues to grow as healthcare missionaries are educated near their places of service, while reinforcing their own roles as educators.
- Outcomes of a faculty development conference in Mongolia
Authors: Deborah A Kroeker, Anne Walling
Pages: 38 - 48
Abstract: Background: Medical Education International (MEI), an organization that provides faculty development to medical educators in developing countries, wanted information on the program effectiveness of its faculty development conferences.Objectives: To assess the outcomes of an MEI faculty development conference in Mongolia on the knowledge, confidence in applying new skills, and attitudes of participants.Methods: A retrospective pretest survey of participants was used to assess the outcomes of a 3-day faculty development conference given twice at the Mongolian National University of Medical Sciences. The survey assessed participant views on their ability to meet the objectives of the conference, the perceived overall value of the conference, and their suggestions for improvements in future MEI conferences.Results: Twenty participants (65%) completed surveys. Participants reported significant changes in agreement with their ability to meet the objectives of the conference in all of the pre-post measures (pre-post p<0.001). The value of attending the conference was ranked at a mean score of 4.05 on a Likert scale from 1 to 5, with 1 indicating “Strongly Disagree” and 5 “Strongly Agree.” Conference attendees indicated interest in additional training on more advanced topics. Conclusion: Overall, the findings indicate that conference attendees gained knowledge and confidence in applying new skills and valued the training received from a faculty development conference led by physicians from the USA. Further research is needed to determine long-term impact on residency education in Mongolia.
- Developing and measuring healthcare capacity and quality in Burundi:
LifeNet International’s horizontal conversion franchise model
Authors: Michael F Brooks, Maggie Ehrenfried
Pages: 49 - 59
Abstract: In a departure from traditional “vertical” healthcare interventions in low-resource settings that work to combat a single specific health issue, LifeNet International (LN) uses a horizontal conversion franchise to develop and measure healthcare capacity and quality in primarily faith-based health centers in East Africa. Through a comprehensive franchise package of Medical Training, Management Training, Pharmaceutical Supply, and Growth Financing, LN is able to leverage existing resources and respond to a greater number of the obstacles preventing facilities from providing quality care. Through its Quality Score Card, LN measures improvements in quality of care within its network. This tool has measured consistent and significant improvements in quality of care following LN partnership. Together, these services improve quality of care at East African primary care facilities in ways that issue-specific, “vertical” interventions cannot.
- A qualitative study on provider perspectives on the barriers to
contraceptive use in Kaliro and Iganga districts, Eastern Central Uganda
Authors: Constance Sibongile Shumba, Jonathan Miyonga, Judith Kiconco, Patrick Kerchan, Tonny Tumwesigye
Pages: 60 - 71
Abstract: Background: Family planning confers unique benefits including preventing unintended pregnancies, improved maternal and child health outcomes and increased women’s access to education and economic opportunities.However, Uganda has a low contraceptive prevalence rate of only 30% and progress in improving maternal and child health outcomes is therefore slow.Objective: This assessment explored health providers’ qualitative perspectives on the uptake of contraceptives in Iganga and Kaliro districts in Eastern central Uganda.Methods: This baseline assessment used a qualitative approach with purposively selected respondents aged 20-60 years. A total of two focus group discussions with Community Health Workers and four key informant interviews with facility-based health workers and were conducted. Thematic content analysis was done manually.Results: The main factors influencing contraceptive uptake in these communities were preference for large families; myths and misconceptions; fear of side effects; spousal and family support; male domination and risk of violence, divorce and polygamy; inadequate human resource capacity and availability; limited community mobilization; and user fees.Conclusion: The study findings suggest that there is low community knowledge on family planning. A strong focus is also required in building the capacities of health providers to offer long-term and permanent methods in order to increase the availability of family planning options. Family planning interventions should increase the availability of contraceptive methods using gender-sensitive strategies including community mobilization.
- A realist evaluation of the formation of groups of people with
disabilities in northern India
Authors: Rebekah Young, Matthew Reeve, Alex Devine, Lawrence Singh, Nathan Grills
Pages: 72 - 90
Abstract: Background: Disabled Peoples’ Organisations (DPOs) are organisations established by and for people with disabilities. Formation of DPOs in low- and middle-income countries is a key component of disability-inclusive development strategies. In some contexts, organisations involved in disability-inclusive development work in partnership with people with disabilities to bring together groups of people with disabilities (DPGs) that may go on to become DPOs. While there is evidence that such groups can achieve beneficial outcomes for people with disabilities, they seem to form and function differently in different settings and little is understood about why this is the case. This study aimed to explore how and why different factors affect the development and operation of DPGs by investigating the contextual factors and mechanisms that enabled and hindered the formation and functioning of DPGs in north India.Methods: This study adopted a realist approach to evaluation. Preliminary context-mechanism-outcome configurations were developed, tested empirically and refined by undertaking five case studies in Uttarakhand state, India.Results: Results from this study were grouped under the broad, emergent themes of factors related to: 1) external supports; 2) community and physical environment; and 3) group composition. It was found that external entities could support the development of DPGs by advocating for the rights of people with disabilities and providing information, knowledge and funding to groups. Support from local village leadership was central to facilitating group formation and functioning, but the benefit of this support was amplified when DPGs formed strong networks with other, similar groups. DPGs displayed a capacity for stimulating positive societal changes in regard to disability through influencing societal understandings of disability and improving inclusion and participation of people with disabilities.Conclusion: While the results of this study are specific to the context in which it was undertaken, many findings were consistent with those in the literature, suggesting that there may be common principles which can be applied to other contexts. By providing insight into the contextual factors that affected DPG formation and function, the findings of this study may assist those involved in DPG formation to adapt models and methods to better suit specific contexts.
- Maternal and child health from a human rights perspective: the Indian
scenario and nuns as community health enablers
Authors: Dr. Tomi Thomas, Dr. Anto Maliekal
Pages: 91 - 106
Abstract: All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. This discussion tries to look into the life context of maternal and child health and the health scenario for women/girl children in general in India from the perspective of Human Rights. Currently, most of the public and private health experts and organizations do not talk and act on the human rights perspective of health service delivery. Reversely, only a very few rights-based organizations advocate directly the right to health of the marginalized. Within the framework of a rights-based approach, the right to (Maternal) Health on practical terms means Availability, Accessibility, Acceptability and Quality. Concluding, in the background of the Catholic Health Association of India (CHAI), the discussion also focuses on how the nun nurses play their role as “Community Health Enablers” to improve the situation.
- An educational model for preparing Christian nurses and church
congregations to offer local whole-person health programmes
Authors: Helen Anne Wordsworth
Pages: 107 - 112
Abstract: The implications of the Tübingen declarations for congregational involvement in health provide the setting for this commentary. Using an example from the United Kingdom, where government health provision has become economically challenging and largely disease focused, the author demonstrates how it is possible to introduce the kind of education for nurses and congregations that will lead to them becoming important sources of whole-person health promotion. In this way, parish nurses and church congregations may make a distinctive contribution that will complement state and private health provision. This model has relevance across all Christian denominations. It is already being followed in 28 different countries, and with appropriate respect to culture, language and health policy, could be globally transferable.
- The emerging health paradigm in the 21st century: the formative first 1000
days of life
Authors: Jose Miguel De Angulo, Luz Stella Losada
Pages: 113 - 128
Abstract: During the 20th Century Western society's thinking regarding health and wellbeing underwent profound and rapid changes. Towards the end of the century, a health paradigm based on social health determinants emerged, providing a strong foundation for influencing priorities in global health. In this paper we will present evidence that supports a new paradigm. It avers that human health and development is founded on infants’ brain architecture and their capacity to transform the brains and lives of adults. Neuroscience now shows how the brain architecture of the person becomes established during the intrauterine period and the first two to three years of life. This brain architecture determines the capacity of the organism to self-regulate its biological, emotional, cognitive, and interactional processes with the environment. The more robust this brain architecture, the more potential and capability that individual has to enjoy physical, emotional, and mental health as well as his/her capacity to contribute to the health and wellbeing of others. We hold that the transformative value of infants to society is biblical. This new understanding can generate a shift towards a focus on early infancy as the best strategy to foster development of healthy and sustainable societies.
- Equipping healthcare professionals to care for the whole person
Authors: Sharon Ann Falkenheimer
Pages: 129 - 133
Abstract: Western medical education has only recently sought to attend to the spiritual aspects of the patient. The overwhelming evidence of the role the spiritual plays in health and disease has led to movement to adopt a bio-psycho-social-spiritual model of care. However, these efforts often lack wholistic integration. The purpose of this article is to describe a program and international network helping to address the need for curricula and methods to educate healthcare professionals in whole person care wholistically and to make the availability of these resources more widely known to those likely to benefit from and use them. The UK Christian charity PRIME: Partnerships in International Medical Education provides a free curriculum and training opportunities for this purpose. PRIME’s approach and course have been widely sought and accepted by professionals from different cultures and faith groups and has developed into an international network.
- PRIME Partnerships in International Medical Education - Restoring a
Christian ethos to medical education worldwide
Authors: Huw Morgan
Pages: 134 - 139
Abstract: Modern medicine has developed from an essentially Christian world-view and in Western countries has been greatly influenced by the Christian tradition of hospitality and caring for the sick. However during the 20th century medical education became increasingly secularised and focussed on the bio-physical model of disease, losing sight of a holistic view of the person that includes awareness of a spiritual dimension. Former Communist countries in particular have little recent tradition of caring and medical education there tends to be characterised by poor role-models and out-dated didactic teaching. In the resource poor countries of the global South there are many Christian hospitals and clinics but often a lack of experienced medical teachers. Partnerships in International Medical Education (PRIME)’s vision and mission is to support health-care education worldwide to restore a Christian based holistic approach to patients and act as a resource where needed, tailoring medical educational programmes to meet the needs of overseas partners (or colleagues in the NHS). Using interactive leaner-centred and problem based educational methods PRIME tutors (all experienced and qualified Christian medical educators) seek to model patient centred care by using learner centred teaching, valuing each person as a bearer of the image of God. Most of PRIME’s teaching involves the doctor-patient relationship, communication skills, compassion, ethics and professionalism, often based around particular clinical scenarios to suit the learners. Small teams of voluntary tutors visiting partner institutions and colleagues for a few weeks a year can have a surprisingly large impact, as those grasping the vision become advocates for positive change in their own situations. Training of trainers and teachers in learner centred, androgogic methodology to build capacity and sustainability is also a major part of the work.
- Modern medicine failed me in Kenya
Authors: Kathryn L Butler
Pages: 140 - 142
Abstract: An account of the limitations of a purely medical approach to cross-cultural service, and the leaarning that occurs by listening to what care recipients have to speak into care-giver's lives.
- Fostering international undergraduate medical education
Authors: James D Smith, Dan Poenaru, J Dwight Phillips
Pages: 143 - 150
Abstract: The severe lack of human resources in the health care field in many countries has resulted in avid interest in global undergraduate medical education. Christian medical missionaries have, thus, a unique opportunity to contribute to transformative, holistic development through the training of future physicians for resource-limited settings. Starting a new medical school is, however, a complex process which requires significant resources and intellectual investment. This paper outlines some of the challenges encountered in faith-based individuals’ engagement in undergraduate medical education, as well as suggesting some practical solutions and recommendations.
- Starting and resourcing family and internal medicine residency programs as
Authors: Stephen Paul Merry, Bruce Dahlman, Adam Sawatsky, Dennis Palmer, Kevin C. Shannon, Thomas D. Thacher
Pages: 151 - 159
Abstract: Graduate medical education is an excellent means of building the capacity of health care systems in low and middle Income Countries (LMIC) and a growing way for physicians in the U.S to get involved in integral mission – the proclamation and demonstration of the Gospel. This white paper purposes to provide a “best practices” recommendations on family and internal medicine (“medical”) residency program development in majority world settings. An expert panel of residency educators convened in November 2015 at the Global Missions Health Conference (GMHC) in Louisville, Kentucky and through an iterative process identified themes that were then further defined and clarified by medical residency faculty unable to be present. Participants largely agreed that integration and cooperation with the country’s Ministry of Health (MOH) is essential for sustainable residency development. Recognition of family medicine as a specialty will enable graduates to succeed in the country’s physician job market and health systems leadership. Recognition by the national church of the unique needs of their mission hospitals’ educational programs to control their revenue in order to fund their programs’ growth and development exemplifies the common wisdom to provide authority and resources where responsibility for good outcomes is expected. Co-training of general surgeons and medical residents who can provide essential surgical call coverage may lead to on-going synergies. Teaching by medical and surgical subspecialists is essential in medical residencies to provide the depth of instruction residents need to develop as excellent clinicians. Dependable scheduling of their specialty instruction allows residency program directors to assure inclusion of their content in the residency curriculum. In summary, participants agreed that teaching in medical residency programs in LMIC present excellent opportunities for national and expat Christian physician educators interested in integral mission.
- Surgical residency training in the mission setting: current status and
Authors: James D Smith, Dan Poenaru, David Thompson, J Dwight Phillips
Pages: 160 - 167
Abstract: Surgery has traditionally been an important aspect of services offered by mission hospitals, but only in the last 20 years has surgical residency training been incorporated into the mission hospital setting. A working group of surgical educators met in conjunction with the Global Missions Health Conference in November 2015 and discussed the current status of surgical training in the mission setting. This paper outlines the current status and makes recommendations for mission groups who are contemplating starting a residency training program. Potential difficulties and the importance of regional recognition of the program are discussed. The work group felt that it was important to include a strong spiritual emphasis as part of the training. Future directions and the concern about employment opportunities are explored.
- Mobilizing and training academic faculty for medical mission: current
status and future directions
Authors: James D Smith, Roger P Holland, J Dwight Phillips, Sharon A Falkenheimer
Pages: 168 - 175
Abstract: As more mission groups become involved with health care education, by starting medical and nursing schools, postgraduate training programs and paramedical professional training, there is a need to recruit expatriate faculty from high income countries to help start programs as there are few national health care education professionals available in the mission setting in most low- and middle-income countries. This paper outlines the current status and needs for academic faculty in health care education mission settings. A working group of medical educators met in conjunction with the Global Missions Health Conference in November 2015 and discussed the motivational factors which lead Christian academics to volunteer, both short- and long-term in mission settings. The group then looked at barriers to volunteering and made suggestions for future directions and best practices when mobilizing academics from high income countries.