Colonization and decolonization of global health: which way forward?

Despite taking on several forms throughout history such as colonial medicine, tropical medicine, and international health, the field of global health continues to uphold colonialist structures. History demonstrates that acts of colonialism inevitably lead to negative health outcomes. Colonial powers promoted medical advancements when diseases affected their own people, and only did so for locals when in the colonies' best interests. Numerous medical advancements in the United States also relied on the exploitation of vulnerable populations. This history is critical in evaluating the actions of the United States as a proclaimed leader in global health. A significant barrier to progress in the field of global health is that most leaders and leading institutions are located in high-income countries, thereby defining the global standard. This standard fails to meet the needs of most of the world. In times of crisis, such as the COVID-19 pandemic, colonial mentalities may be more evident. In fact, global health partnerships themselves are often ingrained in colonialism and may be counterproductive. Strategies for change have been called into question by the recent Black Lives Matter movement, particularly in evaluating the role that less privileged communities should have in their own fate. Globally, we can commit to evaluating our own biases and learning from one another.

Transforming Global Health Communications During the COVID-19 Pandemic: International Partner Perspectives.

Background: With the COVID-19 pandemic restricting travel, global health programs are faced with the challenge of bidirectionally supporting students, partners, and communities in new ways. Though other global health programs have-to the best of our knowledge-temporarily frozen, we at the Nuvance Health/University of Vermont Larner College of Medicine Global Health Program have carried forward by transforming our communications through launching a COVID-19 Resources Page with bi-weekly article summaries, redirecting our monthly eMagazine and weekly blog to pandemic themes, and staying in constant communication with our partners around the world. Objective: To investigate the extent to which our program's published content shifted in sync with the COVID-19 pandemic, as well as our international partners' perception of the COVID-19 resource center, eMagazine, and blog in terms of relevance, representation, and utility. Methods: A survey consisting of quantitative questions and open-ended response questions was allocated along the following themes: (1) eMagazine; (2) Global Health Diaries blog; (3) COVID-19 Resource Center including article summaries; and (4) communications. It was sent to 34 leaders in our partner sites across nine countries-Botswana, China, the Dominican Republic, India, Thailand, Russia, Uganda, Vietnam, and Zimbabwe-and filled out by 31. Findings: Survey results revealed overwhelmingly positive feedback from our global health partners who reported frequently using our COVID-19 resources, often as first-line information about the pandemic; feeling emotional support through our communications; enjoying content in our eMagazine and blog; and finding fair representation in our published content. Our global health program is more deeply connected than ever. Conclusions: Though global health programs seemingly have their hands tied, we are only beginning to imagine the breadth of new avenues for connectivity, learning, and sharing. We must all be creative about staying connected. There are avenues for global health advocacy yet to be discovered.

Developing medical education capacity in Russia: twenty years of experience.

BACKGROUND: The partnership between Yale University (USA) and Kazan State Medical University (KSMU, Russia) was established in 1996 and transitioned to Western Connecticut Health Network (WCHN)/University of Vermont Robert Larner, M.D. College of Medicine (USA) in 2012 with the goal of modernizing medical education at KSMU primarily through introduction of the American medical education structure, role modeling, and educational capacity building. It was centered on the formation of a select group of Russian junior faculty members familiar with American medical education who would then initiate a gradual change in medical education at KSMU. Here we describe the 20 year partnership, rooted in local capacity building, through which a sustainable, mutually rewarding international collaboration was established. In addition, we evaluate the program's outcomes and impact on medical education at Kazan State Medical University, and assess its influence on Russian program participants. METHODS: Senior residents and faculty were sent to KSMU to conduct teaching sessions with local faculty and trainees. Their responsibilities included familiarizing Russian colleagues with specific topics in clinical medicine, importing knowledge about the basics of teaching, clinical epidemiology and evidence based medicine, and creating, in consistency with the American model, a "Clinical Teaching Team Structure" that integrates patient care with clinical education. Furthermore, 44 of selected KSMU members, including 13 junior faculty (29.5%), 14 clinical PhD students (31.8%), 12 interns/residents (27.3%), and five medical students (11.4%), were trained at Yale/WCHN or one of their major affiliated community hospitals for a period of 1 to 12 months for a total of 844 participant-weeks of training. RESULTS: Thirty (68.2%) individuals who were trained in the U.S. are currently working in Kazan primarily as faculty at KSMU. Among them, three trainees (10%) have become heads of their department, eight (26.7%) hold senior faculty positions, and two (6.7%) have clinical and educational administrative leadership positions. Two major clinical departments have adopted the "Clinical Teaching Team Structure." As a result of the collaboration, three teaching courses - Evidence-Based Medicine, Tropical Medicine, and HIV/AIDS Medicine - have been designed and incorporated into the curriculum. CONCLUSION: This partnership has been instrumental in introducing the American medical education model and expanding the medical knowledge of faculty, residents, and students of KSMU on infectious diseases, HIV/AIDS, tropical medicine, renal diseases, and global health topics. Capacity building through the Yale/WCHN-KSMU exchange program has greatly contributed to the quality of medical education at Kazan State Medical University.

Access, attitudes and training in information technologies and evidence-based medicine among medical students at University of Zimbabwe College of Health Sciences.

BACKGROUND: The Medical Education Partnership Initiative, has helped to mitigate the digital divide in Africa. The aim of the study was to assess the level of access, attitude, and training concerning meaningful use of electronic resources and EBM among medical students at an African medical school. METHODS: The study involved medical students at the University of Zimbabwe College of Health Sciences, Harare. The needs assessment tool consisted of a 21-question, paper-based, voluntary and anonymous survey. RESULTS: A total of 61/67 (91%), responded to the survey. 60% of the medical students were 'third-year medical students'. Among medical students, 85% of responders had access to digital medical resources, but 54% still preferred printed medical textbooks. Although 25% of responders had received training in EBM, but only 7% found it adequate. 98% of the participants did not receive formal training in journal club presentation or analytical reading of medical literature, but 77 % of them showed interest in learning these skills. CONCLUSION: Lack of training in EBM, journal club presentation and analytical reading skills have limited the impact of upgraded technology in enhancing the level of knowledge. This impact can be boosted by developing a curriculum with skills necessary in using EBM.

The Economic and Social Impact of Informal Caregivers at Mulago National Referral Hospital, Kampala, Uganda.

BACKGROUND: The severe deficit of health care workers in Uganda necessitates hospitalized patients to be cared for by a relative. These informal caregivers constitute a crucial component of patient care. Mulago Hospital in Kampala, Uganda, is one of the nation's national referral hospitals, receiving very sick patients. Although studies have been conducted on challenges facing informal caregivers in the home setting, no study has addressed the caregiver burden in the hospital setting. METHODS: A survey of 100 randomly selected informal caregivers was conducted in Mulago Hospital's internal medicine wards to evaluate informal caregivers' demographics, impact on patient care, and challenges. RESULTS: Challenges include emotional burdens, lack of sanitation, accommodation, sufficient health workers, finances, and recognition. Recommendations were given to ensure improve informal caregivers' situations. CONCLUSIONS: Despite hardships, informal caregivers recognize the importance of familial presence, thereby setting a new standard for patient care by recreating the comfort of home care in the hospital. Studying the characteristics of these care givers and more fully delineating the sacrifices they make and the challenges they faced provides the basis for a series of recommendations to hospital management aimed both at improved patient care and care of the informal caregiver.

Training Young Russian Physicians in Uganda: A Unique Program for Introducing Global Health Education in Russia.

BACKGROUND: Global health is a new concept in Russia. There has been an ongoing academic collaboration between the Yale School of Medicine in the United States and Makerere University College of Health Sciences in Uganda since 2010, and the US Western Connecticut Health Network/University of Vermont College of Medicine since 2012, to introduce global health concepts to Kazan State Medical University (KSMU) in Russia. The purpose was to educate Russian physicians and medical trainees about the practice of clinical medicine and medical education, as well as the general practice of global health in culturally diverse, resource-limited settings. OBJECTIVES: The aim of this study was to evaluate the initial outcomes of this multi-institutional partnership and to assess the impact of the global health elective on the participants and on KSMU. METHODS: Participants were selected to attend a 6-week elective in global health at Mulago Hospital in Kampala, Uganda. The elective consisted of clinical experience, education about Uganda's common diseases, and region-specific sociocultural classes. It included a predeparture orientation and, upon return, completion of a standard questionnaire to assess the program's impact. RESULTS: Since 2010, there have been 20 KSMU members (4 medical students, 4 interns, 9 residents, 2 fellows, and 1 faculty member) who have participated in the program. As a result of the elective, the participants reported increased knowledge of tropical medicine (70%) and HIV/AIDS (75%), and 95% reported increased cultural sensitivity and desire to work with the underserved. The majority noted a very positive impact of their careers (90%) and personal life (80%). KSMU established the first successful collaborative program in global health education in Russia, leading to the integration of tropical medicine and global health courses in medical school curriculum. CONCLUSION: This elective has proven highly effective in introducing the concept of global health to faculty, fellows, residents, and medical students at KSMU. It trained these participants to address the challenges faced by physicians in culturally diverse and resource-limited countries.

Adherence to standard of care in the diagnosis and treatment of suspected bacterial meningitis.

Acute bacterial meningitis (ABM) is a rare but deadly neurological emergency. Accordingly, Infectious Diseases Society of America (IDSA) guidelines summarize current evidence into a straightforward algorithm for its management. The goal of this study is to evaluate the overall compliance with these guidelines in patients with suspected ABM. A retrospective cross-sectional study was conducted of adult patients who underwent lumbar puncture for suspected ABM to ascertain local adherence patterns to IDSA guidelines for bacterial meningitis. Primary outcomes included appropriate utilization of neuroimaging, blood cultures, antibiotics, corticosteroids, and lumbar puncture. In all, 160 patients were included in the study. Overall IDSA compliance was only 0.6%. Neuroimaging and blood cultures were appropriately utilized in 54.3% and 47.5% of patients, respectively. Steroids and antibiotics were appropriately administered in only 7.5% and 5.6% of patients, respectively. Adherence to IDSA guidelines is poor. Antibiotic choice is often incorrect, corticosteroids are rarely administered, and there is an overutilization of neuroimaging.

A depiction of imported malaria in Connecticut.

In 2010, there were roughly 219 million cases of malaria reported worldwide resulting in an estimated 660,600 deaths [1]. In contrast, the total number of cases according to the Centers for Disease Control and Prevention (CDC) in the United States (USA) was only 1691 [2]. Of those, 1688 were cases of imported malaria [2]. This is the highest number of cases reported in U.S. since 1980 [2]. Here, we describe a case of imported malaria and conduct a retrospective case series at four Connecticut (CT) hospitals in order to describe the demographics of imported malaria and to identify potential barriers to timely diagnosis and treatment.

Severe acute respiratory syndrome.

Severe acute respiratory syndrome (SARS) is a new respiratory illness due to a novel coronavirus called SARS-CoV. Cases of SARS were first identified from Guangdong Province in southern China in November 2002. Over the next several months, international travel allowed for the rapid spread of >8,000 cases over three continents. The economic and psychological impact of this mysterious illness was profound. In order to better educate the public about this emerging infectious disease, we describe the characteristics of SARS-CoV and review the epidemiology, clinical presentation, laboratory, radiographic and histopathological features, diagnosis, treatment, prevention and infection control issues pertaining to SARS. While a significant amount of information about this disease has been gained in a brief period of time, details regarding the origin of SARS-CoV, its stability in the environment and in human body fluids, and whether it has become established in humans remain unknown.

Cardiac manifestations of HIV.

Cardiac disease in the setting of HIV/AIDS has only recently been appreciated. The pathogenesis is multifactorial including direct toxic effects, viruses, autoimmunity, nutritional deficiencies and drugs. The clinical manifestations include pericardial, myocardial and valvular heart disease. Lipodystrophy, caused by anti-retroviral therapy is common and may be a risk factor in ischemic heart disease. The treatment of lipodystrophy is reviewed in detail.

Implementation of a cross-cultural evidence-based medicine curriculum.

While principles of evidence-based medicine (EBM) are increasingly prevalent in medical education curricula in Europe and North America, medical educators elsewhere face formidable barriers to its implementation. We sought to determine the feasibility of implementing a learner-centered, case-based EBM curriculum among academic physicians in Kazan, Russia, facilitated by residents participating in an international health elective. This article reports that implementation of an EBM curriculum is feasible during a resident international health elective and that mutually beneficial educational exchanges represent an opportunity for teaching the tenets of EBM abroad.