Think Global, Learn Local: The Importance of Global Health Education

Rosalyn E. Plotzker, MD


January 09, 2017

In 2008, I worked with the Kenya Medical Education Trust's (KMET) home-based care program. It was just after the Kenyan crisis. Interethnic violence erupted in response to electoral manipulation in the 2007 presidential race. The riots were over when I arrived, but husks of burnt storefronts still lined the main road, which was luxuriously paved in concrete. The home-based-care patients lived in one of three areas in the Kisumu District: Manyatta, Nyalenda, or Nyamasaria. Their homes were primarily single-room or double-room structures with mud walls, connected by a network of muddy footpaths. KMET trained local leaders to be community health workers (CHWs). They were tasked with wound care, pain relief, recognition of opportunistic infection, malnutrition management, and monitoring adherence to HIV and tuberculosis medications. They visited their sick neighbors at least once a week. For many people, the CHWs were a crucial link to medical care and, thus, survival.

When a CHW's skills were not enough, a visit to the clinic was a full-day ordeal. Typically, two men carried a frail patient across a mile of footpaths to the drier, wider dirt road at the slum's edge. We picked up the patient with KMET's vehicle. From there, the drive was 20 minutes over unpaved roads to the clinic. The concrete building was furnished with two exam rooms, an infant scale, a microscope, a refrigerator stocked with vaccines, various antivirals and antibiotics, and a cabinet of nonalphabetized patient medical records. I was not a doctor yet. I had not learned to rely on the ease with which laboratory results are reported via electronic records or the granularity of information those results could provide. Urinalysis and serology were only possible if a patient made the arduous journey to our clinic. In those cases, blood and urine seemed incredibly precious; not a drop was to be wasted.

These healthcare experiences in the developing world are not unique to young doctors in training. Today, interest in global health among trainees is evident. Medical schools organize international missions during their vacation times. Many students opt to take an away-year between their third and fourth years of medical school to do an international fellowship, such as the Fogerty, Fulbright, or the Luce Scholar Program. Others choose to do an international elective. When these globally inclined students graduate from residency, many seek out deeper work abroad in lieu of joining a practice at home. They are bright young physicians, already accomplished and passionate. They have to be.

International work is a competitive gig. For example, selection to volunteer with Doctors Without Borders is now statistically more difficult than admission to Harvard's undergraduate program. Others might apply for USAID's Global Health Fellows Program or the CDC's Allan Rosenfield Global Health Fellowship Program. Once thought of as an off-the-beaten-career-path for doctors, jobs in the global health sector are becoming more sought-after and more necessary. Thus, a natural question emerges: How should the next generation of doctors be trained to take on the health of the world?


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