Transcript International Medical Rotations - Student Osteopathic Medical

International Medical Rotations
How to set up and prepare for your international experience
By Libby Windell – OMSIV
Western University of Health Sciences - COMP
What drives us to go
abroad?
Some Examples for Why We Want to Work
Abroad
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Desire to help those in need
Have family or friends there
Love to travel
Want to experience a different health care system
See and treat rare diseases
Learn a new language or improve a foreign language
skill
Broaden your knowledge about the world and about
health care
Help teach
Do Research
Get “hands-on” training without using conventional
diagnostic tools
Now that you’ve decided to
do an international rotation,
how do you decide where to
go?
Things to Consider before choosing
a site:
• Type of Experience you want:
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Research oriented
Treatment based
Clinic vs. hospital
Rural vs. urban
Teaching opportunities
Language training
Advocacy and intervention opportunities
Specialty rotation vs. general
More Things to Consider before
choosing a site:
• Language Barriers – do you speak the language or will your
preceptor speak English?
• Climate – rainy, sunny, hot, humid, cold?
• Infectious diseases – what will you be exposed to?
• Electricity and running water – is this important to you?
• Food and clean/purified water availability
• Political status – is it safe for you to go there?
• Cost of Travel – sponsors, organizations, out of pocket?
• Amount of time working – do you want free time to travel?
University Considerations
• What are Your University’s Policies on
International Rotations – What does your
school require from you to go abroad and do
they have restrictions on certain countries?
• Many schools do not allow you to do an international
rotation in a country that is on the US State
Department’s List of travel warnings. For a list of
these countries, please visit:
http://travel.state.gov/travel/cis_pa_tw/tw/tw_17
64.html
• Please contact your university’s International
Rotations Coordinator for more information.
Preparation Guides
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The Medical Student Guide to Electives Abroad:
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Hope R. The elective pack: a medical student’s guide to essential
international health and development. London: International Health and
Medical Education Centre, 2004:
• http://www.uch.edu/contentstore/MedicalStudentGuideElectives%20Abroad.d
oc
• http://www.ihmec.ucl.ac.uk/IntHealthElective/Resource_Pack/ElectivePack.p
df
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A Student’s Guide to International Health and Funding Guide:
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ToolKit for Going Abroad:
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Advising Medical Students and Residents: International Health
Experiences
• http://www.amsa.org/pdf/studguide2ih.pdf
• http://www.amsa.org/global/ih/toolkit.ctm
• http://www.globalhealthec.org/GHEC/Resources/IHMECguidebk_resources.htm.
Module 93, GHEC Teaching Modules, 2007
Who Can Help Arrange
the International
Experience?
Opportunities – Where to look
• Personal Contacts or family members
• Talk with people who live there, have traveled there, or have
worked there
• School database
• Some schools already have approved international sites
• GHEC –
• Global Health Education Consortium GHEC, together with
FAIMER and AAMC, surveyed 127 US
and Canadian medical schools to obtain information about the
international opportunities they provide for medical students,
residents and faculty. From this site you can learn about which
schools offer programs, how these are funded, and in which
geographical regions they occur. (http://www.globalhealth-ec.org/, 2007)
• IFMSA - The International Federation of Medical
Students' Associations
• Offers international exchange programs for medical students all
over the world. http://www.ifmsa.org/
Opportunities – Where to look
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SOMA
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AMSA List Serve
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NGO’s – Not-for-Profit Government Organizations
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Faith Based Groups doing Mission Work
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IHOC – International Health Care Opportunities Clearinghouse
• Database in the works!
• http://www.amsa.org/global
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Doctor’s without Borders
Liga – Flying Doctors of Mercy
Red Cross
International Medical Teams
DOCares
Etc.
• http://library.umassmed.edu/ihoc/index.cfm
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Create a New Site!
• Contact the country’s Minister of Health and see if you can set up a rotation.
You still need
to consider…
What is my tolerance level!
Can you Handle…
• Strange and sometimes uncomfortable
sleeping arrangements
• Not being able to have “normal” food
• Getting lost in a foreign country or being
stopped and searched by strange guards
• Being exposed to rare and sometimes
fatal illnesses
• Following cultural rules
• Realizing that you might have limited
ability to help
BUDGET
Funding your Trip
Where to Find Money:
• Private donations
• Send letters to friends and family
• Cut back on the home front:
• sublet your apartment while you’re gone
• Start saving/budgeting months in advance
• Cut back on unnecessary spending, aka stop buying
the Starbucks!
• Donations from Religious Affiliations
• Find a program with included amenities
• Room and board, transport, etc.
More Places for Money
• Grants:
• http://www.grants.gov/
• http://www.nmfs.noaa.gov/trade/howtodogrants.htm
• Scholarships
• Please check out the SOMA International Medicine scholarships
at www.studentdo.com
• Funding from your COM
• Ask your dean, President, Alumni Association, student clubs,
etc.
• Extra Student Loans
• Talk with Financial Aide. These trips are for educational
purposes
• Fundraising
Room & Board
How to survive while you’re away
Questions to Ask about Housing
Arrangements
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Do you have dormitories for international students?
What are the differences between the dorms specified for
international students verses those for regular students?
Are home stays available?
Are meals included in my housing options?
Is there electricity? Running water? Cooking facilities? Hot water?
How far are the dorms from the hospital/clinic?
If I have to walk to the hospital, will I feel safe walking?
If I cannot walk to the hospital, is there readily available, cost
effective, and reliable transportation?
Will I feel safe using the public transportation system?
Toolkit for going Abroad, American Medical Association, www.amsa.org
Lodging Examples
• Friend or Family in that Country
• Board with someone from the hospital or clinic
• Dorms
• Hotels, hostels
• Rent a furnished apartment
• Bring a tent
Eating in a foreign country
• Make sure there is clean water or a way
to purify water at your site
• You need to worry about your health too!
• Be prepared to possibly eat strange foods
• Bring some antacids, Imodium, etc.
• Be aware of the Cultural norms when
applied to eating
• E.g. Women may have to eat in another room,
guests of honor might have to take the 1st
bite, etc.
Other Hints and Advice
• START EARLY!!!!!
• Get a travel book and learn more about the
location you plan on going to
• Apply to many different sites/programs
• Some trips might get cancelled, so don’t put all your
eggs into one basket!
• Be flexible
• Be patient – some countries move on a much
different pace
• Contact people who have gone before
• Check what diseases or illnesses are common
• http://globalatlas.who.int/ (World Health
Organization global atlas
Documentation
&
Paperwork
Necessary Documents for Travel
• Passport
• If you don’t have one, get one!
• Obtaining a passport can take a few months, PLAN EARLY!!!!
• Make a copy, keep in a separate location from your passport (in
case it gets lost)
• Visas
• Again plan early. This process can take a very long time!
• http://travel.state.gov/visa/visa_1750.html lists which
countries you will need a visa for
• Plane Ticket
• www.whichbudget.com (great site for helping you find low cost
airfare)
• STAtravel.com
Other Important Paperwork and
Supplies
• Health Insurance:
• Contact your current insurance to see if they cover you internationally
• Purchase a local plan
• Get traveler’s insurance when purchasing your plane ticket – this often
covers health costs.
• Immunizations
• Start them now as some require a series of shots over many months
• www.cdc.gov
• www.who.org
• Medications
• Prophylactic malaria protection
• Prophylactic Antibiotics for traveler’s diarrhea
• Post-exposure HIV/AIDS prophylaxis – Only if going to an endemic
area
• Take your current meds in their original bottles along with note from
your doctor – you don’t want to get stopped at customs!
Packing
What can/should you bring?
The Bare Necessities - Clothing
• Be culturally aware! Know what the local
customs are
• Don’t think that just because it is ok to wear in the
US that you can get away with it overseas.
• Women may have to wear a head scarf or long skirts,
men might not be able to wear shorts – Be aware of
the society’s norms!
• Take clothes you would be ok with throwing out
– it’s always fun to buy some of the local attire
• Only what you need – in other words you don’t
need 12 pairs of shoes!
• Beachwear (again culturally sensitive), rain
gear, jackets
• Closed toed shoes
The Bare Necessities – Medical Kit
• Latex gloves – take your own box or make sure they have plenty at
your site
• Band-Aids
• Anti-bacterial, anti-fungal and steroid creams
• Hand-sanitizer
• Insect repellant
• Sunscreen
• H2O2
• Alcohol swabs
• Cotton balls
• Gauze
• Tape
• Epi pen (especially if you have allergies)
• Scissors, tweezers, pick-ups
• Anti-inflammatory meds (acetaminophen, ibuprophen, etc)
• Anti-diarrheals (Imodium, Pepto, etc)
• Cold Meds (take pill form, it travels better)
• Anti-histamines
Packing – other stuff
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Toiletries
Toilet paper
Plastic sacks
Phone cards (Costco sells a cheap international one)
Paper/Pen
Camera
Computer, MP3 player, cell phone
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Batteries
Money pouch
Water bottle
Laundry detergent
Flashlight
Books, travel games, deck of cards
Travel journal
Adaptors and converters
• Bring only if you truly need it
Think you’re
ready to go?
There are still a few
things to consider!
Cultural Competency!
• Culture:
• “set of beliefs, values, artistic, historical,
religious characteristics, customs, etc.
common to a community or nation.”
• Cultural Diversity:
• “the inevitable variety in customs, attitudes,
practices, and behavior that exists among
groups of individuals from different ethnic,
racial, or national backgrounds who come
into contact.”
(Definitions from Stedman's Concise Medical Dictionary, 2007)
Cultural Competency!
• You need to examine the various religious
and cultural backgrounds of the country
you are traveling to in order to gain a
better understanding of them
• You need to know the ethical issues that
may arise when modern medicine and
religion/culture collide
Examples of Some Religious/Cultural
Groups
How their customs and
health care practices
may differ
Central and South America
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Death and Illness Issues:
• Health care is often scarce
some people have little concern
for illness/death
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Communication Norms:
• Hand and finger gestures
considered rude
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Interpersonal Relationships:
• Punctuality is not considered as important
• Strong value placed on personal relationships
• Male often seen as head of family
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Traditional Medicine
• “Botanica” store selling herbs and healing oils
• “Curandero”, “Sobador”, “Horchún” Natural Healers
The Middle East
• Death and Illness Issues:
• Aligned with Muslim teachings
• Communication Norms:
• Finger signals using the left hand are particularly offensive
• Shake hands with right hand only!
• Interpersonal Relationships:
• Males are generally seen as head of family
• Women are often introduced by men and won’t shake hands
• Traditional Medical:
• Female physicians often treat women and children
• Physicians knock before entering exam room
Resources for Improving your
Cultural Competency:
• GHEC Teaching Modules:
• Hundreds of Modules created by students, doctors, professors, public
health workers, researches, etc.
• User-friendly PowerPoint presentations which can help you prepare for
various cultures and practicing health care around the world.
• Will be available Jan. 2008 at http://www.globalhealth-ec.org/
• Conferences:
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Osteopathic International Alliance - 1st – 3rd February 2008, London, England
IFMSA Annual Convention - http://www.ifmsa-usa.org/convention.htm
GHEC Annual Convention - April 3 - 5, 2008, Sacramento, CA
AOA Convention – International Health Symposium, Sunday, Sept. 30th
Check local cultural lectures in your area
• Stanford University On-Line Courses:
• Online access to interviews and lectures by nationally recognized
expects in the various fields of international health.
• http://med.stanford.edu/oih/library.html
Books, Textbooks
• Critical Issues in Global Health (Paperback)
by C. Everett, MD Koop (Editor), Clarence E. Pearson
(Editor), M. Roy Schwarz
• Understanding the Global Dimensions of Health
(Hardcover) by Anthony Piel (Adapter), A. Michael
Davies (Adapter), Bruce Sayers (Adapter), S.W.A.
Gunn (Editor), P.B. Mansourian (Editor)
• Essentials of Global Health (Essential Public Health)
(Paperback) by Richard Skolnik (Author)
• Other resources:
• http://www.globalhealthec.org/GHEC/Resources/GHonline.htm
Ready yet?
GOAL SETTING!
• Set realistic, obtainable goals!
• What impact can you really make on a 4-8 week
rotation?
• What do you personally want to gain from the
experience?
• What do you want others to gain from your
experience?
• Reflect before, during, and after your trip
• keep yourself on track with what you want to
accomplish
The more prepared you are…
• The better your experience will be
• The more help you will be able to provide
• The more rewarding the trip will be
• The better your research will be
• The bigger impact you can make
• The more you will learn
• The more FUN you will have!!!!
Questions?