The association between global health training and underserved care: early findings from two longstanding tracks.

BACKGROUND AND OBJECTIVES: Global health tracks (GHTs) improve knowledge and skills, but their impact on career plans is unclear. The objective of this analysis was to determine whether GHT participants are more likely to practice in underserved areas than nonparticipants. METHODS: In this retrospective cohort study, using the 2009 American Medical Association Masterfile, we assessed the practice location of the 480 graduates from 1980--2008 of two family medicine residencies-Residency 1 and Residency 2. The outcomes of interest were the percentage of graduates in health professional shortage areas (HPSAs), medically underserved areas (MUAs), rural areas, areas of dense poverty, or any area of underservice. RESULTS: Thirty-seven percent of Residency 1 participants and 20% of nonparticipants practiced in HPSAs; 69% of Residency 2 participants and 55.5% of nonparticipants practiced in areas of dense poverty. All other combined and within-residency differences were not statistically significant. CONCLUSIONS: These findings neither confirm nor refute the results of prior surveys suggesting that global health training is associated with increased interest in underserved care. Studies involving more GHTs and complimentary methods are needed to more precisely elucidate the impact of this training.

Effect of security threats on primary care access in Logar province, Afghanistan.

Security threats are a major concern for access to health care in many war-torn communities; however, there is little quantified data on actual access to care in rural communities during war. Kinderberg International e.V. provided primary care in rural Logar province, Afghanistan, for these three years in eight districts until they were integrated into the new health care structure led by the Ministry of Health in early 2005. We examined the number of patients visiting our clinic before and during the security threats related to the parliamentary election and subsequent national assembly in 2004. The number of patients declined in remote clinics while the number increased in central locations. This finding has an important practical implication: the monitoring of access to care should include remote clinics, otherwise it may potentially underestimate compromised access to health care due to security threats.

Need for "conflict version" of primary surgery: war surgery in the era of low-intensity conflicts.

The conventional wars between nations have widely been replaced by low-intensity conflicts within nations today, resulting in different patterns of injuries and practice of surgical care. A blurred front line, protracted durations of violence, indiscriminant fighting, and the emergence of specific surgical problems characterize low-intensity conflicts. In protracted conflicts with limited resources, surgical outcomes depend on many factors other than surgical skills, such as social/cultural values and economical feasibility. This paper examines how the characteristics of current conflicts affect surgical practice and will address key issues to evolve care to adapt to these changes. Key issues are (1) need for comprehensive surgical skills, (2) importance of improving local capacities, (3) long-term impact of trauma, and (4) limited access to information required to improve surgical skills.

Primary care training in Kosovo.

Primary care training during and after conflicts is one of the most challenging health care issues but is often neglected compared to emergency medical care. Recently, family medicine has been increasingly used as a model strategy to reconstruct primary care delivery systems in communities torn by conflicts. The lessons learned through providing primary pediatric care training in Kosovo, in two periods, both shortly before the NATO air strike and after the war in Kosovo, are shared in this paper. The training program was organized and provided in collaboration with the Kosovar nongovernmental organization, Mother Teresa Society, and Kinderberg International in support of United Nations High Commissioner for Refugees as a pilot program. This paper provides a narrative description of training experiences that focused on practical bedside training and morale support throughout these two periods. Based on our evaluation, providing morale support at the field level to encourage the health care providers' motivation for learning and collegial support while suffering physical difficulties was beneficial. International primary care organizations should maintain collegial dialogue to support indigenization of family medicine, a process that adapts the principles of family medicine into their own needs in their communities.