Many students and residents choose to include a one-month international trip to a low- or middle-income country as part of their medical training. This can be an enriching, challenging, and life-changing experience. This document provides sites used by our learners in the past and/or that have solid reputations for providing excellent clinical experiences with good oversight. You are not restricted to these sites, however. For those interested in formalized training, including fellowships in global health, a listing appears at the end of this document. Typically these fellowships are completed between the third and fourth year of medical school. For further information, please see the Global Health Center website: http://www.pennstatehershey.org/web/globalhealth/ home/travel
Dr. N. Benjamin Fredrick Director, Global Health Center email@example.com
PREPARATION All medical students intending to travel abroad for credit are required by PSU-COM policy to complete the pre-trip forms and elements which are listed on the Global Health Center (GHC) website: http://www.pennstatehershey.org/web/globalhealth/ home/travel/policy
Site Selection. You should consider the following when selecting a site: 1. How much travel experience do I have with impoverished areas, or with communities very unlike what I am used to? (see Table 1) 2. Is the country on the State Department’s Travel Warning list? Or on Penn State’s list of “Dangerous” countries?
Electives. Once a site has been selected, students and residents need to contact the appropriate elective course director for approval. Travel and in-country logistics are typically arranged between the student and the host organization/entity.
3. Is the experience organized and is there proper supervision by a physician? 4. Is the location safe? What options exist for housing, food, transportation?
Levels of Experience in Under-served Settings Table 1
Your Personal Experiences in Under-served Settings
Recommended Well-Structured Semi-structured level structure for experience experience study abroad
Consider a self-tailored elective (in a safe, well-supervised setting)
Recommended study abroad activities
Look for programs with a broad range of clinical and cultural exposures in a general practice (medicine, surgery) setting.
Pay specific attention to health care system, and the logistical challenges of providing care in resource-limited settings
Same as other sections. Consider narrowing clinical focus (i.e. Public Health, Women’s or Children’s Health, HIV/TB)
Examples of study abroad programs
e.g. See Child Family Health International
e.g. See Zambia options
e.g. CMC-Vellore, India
PREPARATION Medical Students.
Supplies and Resource Center.
Medical students interested in studying or doing research abroad will need to complete the Global Health Center’s Travel Checklist and Application. This application along with all supporting documentation must be completed in its entirety before it can be submitted to the GHC for review.
The Global Health Center has gathered a number of practical resources and supplies to be used by individuals and groups on our campus for the purposes of promoting service, education, and research in global health. Some examples of items that may be borrowed from the Global Health Center include:
Study Abroad Funding. Even though trips often occur to countries where the cost of living is lower, a month-long trip can easily reach $2,500-3,000 per person. Students are responsible to obtain funding for their trips. Several scholarships are available by application through the Global Health Center and the Kienle Center for Humanistic Medicine. These can be found on our website. Please also see the Guide to Study Abroad Scholarships on our website for a list of funding opportunities. • Graham and Elizabeth Jeffries International Health Fund • James Herring Teeter and Mae McDaniel Teeter International Scholarship • Spirit of Life Foundation • The Doctors Kienle Center for Humanistic Medicine Annually the Mark J. Young International Health Policy Scholarship is made available via email in the spring. This award is to support individuals who seek educational activities related to international health care policy. The award is to be used for activities outside the United States.
• Vision screener, BP cuffs, Spirometer (PFTs), portable EKG machine, etc. • Videos with global health themes for audience discussion • Textbooks on a range of global health topics such as health systems strengthening, obstetric complications, community engagement Go to the following link to view a listing of other items available from The Global Health Center www.surveymonkey.com/s/GHCresources
HTH Insurance. Travel Insurance is required: There is no US domestic health insurance plan that will cover evacuations or repatriations for medical reasons, and not for political/security reasons or natural disasters. An evacuation or repatriation that requires an air ambulance starts at $100,000. With HTH, an evacuation such as this only costs an individual $1.12/day they pay for the policy. Most insurance companies reimburse at a specific rate (80% is pretty standard) whereas HTH reimburses at 100%. https://www.hthstudents.comge.cfm?ac=dyi-7719 Full-time residents and faculty employed by the Hershey Medical Center are provided free travel insurance. See Dr. Fredrick for further information.
WELL-STRUCTURED CLINICAL EXPERIENCES Well-structured study abroad experiences generally cost more, but they often provide highly organized curricular activities in global health. Some examples include:
Child Family Health International (CFHI) www.cfhi.org CFHI provides many country sites. Comments from medical students: “The program was very organized and a good option for those going on an abroad service trip for the first time.”
“The program is open to undergraduate, medical, and residency students and the group that goes is about 20 people.”
“This experience gave me valuable exposure to a different healthcare system, the practice of medicine in underserved populations, and the epidemic of TB, malaria, and diarrheal illnesses of third world countries.”
Foundation for International Medical Relief of Children (FIMRC). www.fimrc.org/ Offers several different country sites. These structured rotations include aspects of community health (Comparative Health Immersion Rotation Program). See the web site for further details.
Interhealth South America. www.interhealthsouthamerica.net/ Language training included. “The principal format of the program provides structured group and individual field experiences in international health, coordinated with medical language immersion study.” A number of our students have used this program.
“It was an invaluable experience that could not have been gained in Hershey. I now believe strongly in international rotations and think they can benefit any medical student at any level.”
International Health Central American Institute (IHCAI). www.ihcai.org
Institute for International Medicine (INMED).
IHCAI Foundation is a non-profit organization working for global medical education, the development of health research and for the improvement of health in the communities of Central America and the Caribbean. It aims to provide a continuous and permanent medical education for health care providers and promotes access to health information for health care consumers.
This organization provides a variety of educational experiences, both online courses and international electives.
Comments from medical students: â€œThis is a good program for medical students who wish to improve their medical spanish and learn about tropical diseases (such as malaria, leptospirosis, dengue, etc).â€?
The Comprehensive Rural Project. (http://www.jamkhed.org/) Jamkhed, India. Provides an in-depth look at providing comprehensive care to a very impoverished area. The model of care is being replicated widely. Many of our students have found this to be highly valuable.
SEMI-STRUCTURED CLINICAL EXPERIENCES More autonomy is required to participate at these sites, as well as flexibility on the part of the student.
Ecuador. Our Children’s Heart Group travels with students and a large medical group to Guayaquil, Ecuador every year. The trip occurs around November of each year, and 4th year medical students may participate as part of a pediatric cardiology elective. If interested, please email Dr. Stephen E. Cyran at firstname.lastname@example.org. Comments from medical students: “Immeasurable, it was a phenomenal experience, I have seen things that few other pediatricians in this country have ever seen, and I am not even an MD yet.”
“The fact that Guayaquil, Ecuador had such a high crime rate required us to be very careful when traveling outside the hospital. The program made great effort to ensure our utmost safety, but for this reason we could not just leave and explore whenever we wanted.” “It was a great experience to see how a hospital runs in a 3rd world country. Experiencing it first hand is more beneficial than simply reading about it. It makes me appreciate the efficiency with which things run at Hershey.”
Ghana. www.uniteforsight.org Unite For Sight is renowned as the highest quality global health immersion and volunteer abroad program worldwide. Unite For Sight prides itself on offering the best global health experience, coupled with the highest quality of health care delivery programs with our partners. Comments from medical students: “It was a great learning experience for ophthalmology. If you have the chance, ask to spend some time in the clinic with one of the ophthalmologists. They taught me how to use the indirect and the slit lamp in a low pressure environment. I could take my time and they were very good at giving tricks and tips for getting a good exam. There is also a lot of pathology that you will never see in the US.”
“The accommodations were nice, but a little pricey.”
India. CMC-Vellore www.cmch-vellore.edu A large well-established Christian-run health system. Comments from medical students: “The exposure to tropical diseases and very advanced chronic illness and malignancies is unparalleled to any offerings in Hershey. Additionally, from a public health and health systems perspective, this site has unique offerings that one would not experience back home.”
SEMI-STRUCTURED CLINICAL EXPERIENCES Zambia.
Dr. Dan and Joan Jones in Zambia with Weslyan Clinics. Christian-based primary care Danjones72@yahoo.com
http://www.uth.gov.zm/ University Teaching Hospital in Zambia
Comments from medical students: “I was exposed to conditions that I would have never been able to see in the states. I was also given responsibility beyond anything that I have ever received in medical school and a chance to be very active in surgery….The language barrier was difficult at times, but something that you have to work around in Africa.”
Provides various educational opportunities; broadly Surgery, Obstetrics and Gyn, Internal medicine and Pediatrics. Prospective students apply direct to the Assistant Dean Undergraduate or Post graduate studies via e-mail. Students have to find their own accommodation but there are several boarding houses around UTH. Comments from medical students: “Major ward rounds can take many hours as the professors ask many questions about all aspects of each patient’s disease process to ensure full understanding of pathophysiology as well as how socioeconomics come into play when dealing with medical care with limited resources. There is a wide variety of patients to see as this is the main referral hospital for the whole country. You will see things here you have only read about in textbooks. There are seminars and lectures for the medical students you can attend for additional learning experiences.”
ELECTIVE & FELLOWSHIP OPPORTUNITIES Name
Sponsoring Description organization
Epidemiology Elective Program for Senior Medical and Veterinary Students
6-8 week intro elective to applied epidemiology
March 30 for Fall semester; May 30 for Spring semester
The CDC Experience Applied Epidemiology Fellowship
1-year training program in applied epidemiology for third or fourth year medical students
CDC/CSTE Applied Epidemiology Fellowship
2-year applied epidemiology training program at a state or local health agency
http://www.cste.org/dnn/ ProgramsandActivities/FellowshipProgram/tabid/259/ Default.aspx
Emerging Leaders Program at CDC
2-year career training program in public health leadership and management
All awards are for 9 months required at the overseas site. The Fulbright Public Policy Fellowship will allow fellows to serve in professional placements in foreign government ministries or institutions and gain hands-on public sector experience in participating foreign countries while simultaneously carrying out an academic research/study project.
Fulbright-Fogarty Fellowships in Public Health
American Society of Tropical Medicine and Hygiene
Multiple fellowships and opportunities related to infectious disease
Clinical Research Fellowships for Medical Students
Doris Duke Foundation
You must be enrolled for 12 months. Typically these 12 months are consecutive but may be nonconsecutive in rare circumstances and with the permission of the Program Leader and mentor.
http://www.ddcf.org/ Medical-Research/ProgramStrategies/Clinical-Research/ Clinical-Research-Fellowship-for-Medical-Students/
CDC-Hubert Global Health Fellowship
This fellowship provides third- and fourth-year medical and veterinary students with valuable public health experience in an international setting. The main focus of the fellowship is a 6to 12-week field assignment. Fellows are mentored by experienced CDC staff and learn through hands-on experience while working on a public health project in a developing country.
Fight For Sight
Summer Student Fellowships are available to undergraduates, graduate and medical students who are interested in pursuing eye-related clinical or basic research. For most students, this is their first exposure to eye or vision research and the experience has resulted in many students choosing academic ophthalmology or eye research as a full-time career. Unrestricted awards of $2,100 are given for two to three months of full-time research, usually during June-August. Students receiving stipends from other sources are generally not eligible.
Fight For Sight Fellowship
Apply online between January 14 and February 15.