Objectives and Guidelines for UWO Global Health Field Experiences The Office of Global Health is committed to effectively preparing students for participation in global health electives and activities. Our objectives for all international health electives and activities include providing students with experiential learning opportunities to: • Actively participate in the health care system of another country.
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Enhance diverse skills, learning techniques and educational experiences for students.
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Promote transformative learning processes whereby medical students will gain a broader understanding of global and EcoHealth concepts and will be able to relate them to their decisionmaking skills, practices as well as life experiences in the field.
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Increase students’ knowledge and sensitivity towards different cultures and contexts
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Develop awareness of social, economic, and political factors in health and disease.
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Expose students to a variety of international ethical issues in medicine that reflect differences in cultural practice, values, interests, standards of care, resource availability, politics and patient rights, thus leading to more culturally appropriate care methods and ethical framework development.
Important Considerations International electives often provide opportunities for personal and professional growth, exchange of information, and development of lifelong relationships. Students develop fresh insights and attitudes with exposure to a broad spectrum of health, illness, health care, and social conditions unique to regions with different ethnic groups in low resource settings. We can sharpen our clinical and language skills, refine population-based perspectives and apply these skills to resource-constrained settings in North America – from treating psychosocial or physical needs of immigrants and refugees to focusing on research and advocating for health equity. However, international electives are not for everyone as they can be challenging – physically, mentally, ethically, emotionally, spiritually and financially – so it is best to ask yourself some hard questions before you consider an elective.
Questions to ask prior to considering an international elective What are my objectives? Should I go abroad to fulfill these objectives? • • • • • •
To broaden my life experience? To test the possibilities of devoting at least part of my medical career to international health? To experience and learn from another culture? To have the opportunity to improve language skills? To serve others (or learn how to serve) with fewer resources and access to health care? To seek out information about the health and health care system of your own country of origin or ancestry?
What kind of experience do I want? • Clinical, public-health related, or research? • At what level, in what technical area, and in what type of institution? • What do I hope for in a mentor/preceptor? • Do I want to work with a group, or be integrated into ongoing care with nationals? • What geographic, linguistic, and nationality preferences do I have? • If applicable, what will my partner do, what are their views, and how will they share my experience? Will there be opportunities to travel and enjoy myself during my time off? Is the location safe and politically stable for me (given ethnicity, gender, religion, dietary/health needs)? Do I have the proper financial resources, attitude, flexibility, clinical skills, and cultural understanding at this time to benefit from this experience? • Can I afford financial or other costs? • Do I feel that the resources I will consume in flying and staying are greater than I can justify ethically in a poorly resourced world? • How will I handle sickness, instability, legal problems, crime, financial issues, and loss of identification? • Within the time-frame I've set to do my elective, will I have enough adjustment time? • Will language/culture problems arise that will keep me from interacting effectively with patients? • How will I deal with ethical issues? Ex. system not working, people not getting access to appropriate care because of resources, culture, religious attitudes, lack of education, lack of informed consent, social class, family hierarchy, and staff attitudes of indifference to things I feel are important? Have I given myself enough preparation time? Often, it may take up to a year in advance of placement to contact the supervisor, process documentation for the country of elective, obtain a visa and immunizations, secure lodging, arrange funds, approach sponsoring agencies, etc. Who is my contact person? Is there a doctor I specifically want to work with, a department chair in charge of a teaching program?
International Elective/ Activity Process 1. Meet with the Office of Global Health director/staff to discuss educational objectives, review the application process and elective guidelines, obtain contact and site information, and identify resources for supervision and orientation. Students are expected to maintain contact with the Office on a consistent basis while arranging their global health elective. 2. Gather information concerning any political problems, safety concerns, or health hazards by consulting the Government of Canada Foreign Affairs and International Trade Canada Website. 3. Confirm with your in-country supervisor the dates of elective, including a description of educational activities, on-site supervision, financial obligations, and housing arrangements. 4. Participate in a pre-departure training session or cultural orientation and prepare for the elective as directed by the Office of Global Health. Please note that it is mandatory for all SSMD students travelling abroad to participate in predeparture training. 5. Obtain medical travel advice and immunizations appropriate for host country. 6. Investigate visa and other entrance requirements that may be enforced in the host country. 7. Register with Registration of Canadians Abroad prior to departure. 8. Purchase travel insurance including reliable medical coverage for the entire duration of your time abroad. 9. Designate and identify persons both at the host site and in Canada who may be contacted in the event of an emergency. 10. Comply with the terms of the Statement of Responsibility, Release, Authorization and Acknowledgement of Risks to Participate in International Elective and Activity Programmes guidelines. 11. Adhere to laws of the host country and comply with standards of conduct set by the program site. 12. Sign and submit the specified University of Western Ontario Office of Global Health Risk Management Forms. 13. All students must submit a post-trip report to the Office of Global Health Director/staff upon return.
Language Training Students are strongly encouraged to take language training courses prior to going on their elective. In the future, the Office of Global Health will assist in organizing language training classes for our partner site languages: Guatemala (Spanish), China (Mandarin), India (Hindi), Tanzania (Swahili), and Israel/Palestine (Arabic). To sign-up for language training, please contact the administrative assistant, Shauna Solomon.
Spanish Language Classes Beginner and intermediate level Spanish classes were offered through the Office of Global Health. Please contact the GHO if you are interested in signing up for a future class. Location: Office of Global Health, HSA H041 Cost: $150 for a 12 week session Text: Spanish the Easy Way by Silvertein, Pomerantz and Heywood Mandarin Language Classes Mandarin classes were offered through the Office of Global Health from April to May, 2011 for UWO and Windsor students. Classes are currently over but please contact the GHO if you are interested in signing up for a future class. Location: UWO Cost: $75 for a 6 week session Text: Handouts and text available for purchase Swahili Language Classes If you are interested in Swahili lessons please contact the GHO and provide information about your availability and language level. Start Date: June 8, 2011 from 7:30pm-9:00pm Location: Office of Global Health, HSA H041 Cost: $75 for a 6 week session Arabic Language Classes Offered in Fall 2011 Language links Interpreters Niagara
Pre-Departure Training Courses Pre-departure training is now mandatory and should be arranged well in advance. Additional pre-departure training videos and resources are available on WebCT
The training includes core competencies recognized by current national guidelines (AFMC & CFMS, May 2008). There are three training sessions available throughout the year (in November, February, and May). Check the Office of Global Health website often for updates as the courses become available.
The University of Western Ontario
This conference is held every year in February. It covers language competency, cultural competency, personal health, travel safety and ethical considerations for those working in a resource poor setting within Canada and abroad. Please visit their website at http://www.uwomeds.com/GET_Ready/
McMaster University McMaster’s training courses are usually available in November and May. Please contact the Office of Global Health Administrative Assistant, Shauna Solomon, to register when new courses come out. For additional information on International Electives check out "The complete international electives handbook" produced by McMaster School of Medicine's 2005 International Health/Student Physicians for Global Survival Committee.
Contacting a potential elective supervisor Send an email, post letter, fax, or make a telephone call early (at least 4 months in advance). Ideally, you want establish first contact as early as possible, to give everyone plenty of notice of your arrival. It's not uncommon to find out about "last-minute" paperwork that needs to be completed by your host institution, so international delivery times need to be accounted for. Don't be surprised if you need to use all four forms of contact to finally get in touch with the person and be cognizant of whether delays on reply times will become a problem later down the road. If you need something from this person quickly, for example one week before you leave, is this going to be an issue?
In your introductory letter: • Introduce yourself, what school you're from, and all other vital information •
Provide some explanation of what your year in medical school entails – The rest of world often have quite different systems with five to seven year medical programs after high school.
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Describe previous clinical experiences, procedures etc. Be specific about your knowledge level, being conscientious of under/over-representing yourself and notifying your supervisors that you will not be doing procedures with less supervision than you would be allowed in Canada or than local trainees get.
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State your objectives very specifically. Explicitly state what you want to accomplish from your elective time, and what skills you need to acquire. If your objective is to have your own patients and present your findings to a supervisor for a quick check before discharge, then say that. If you want to be first-assist on surgeries, and learn how to do procedures independently by the end of your summer, say that too!
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Establish your contact person and determine what role(s) they will play. Find out who you can communicate with to get your questions answered, and what sorts of help that person will be able to give you in general, how you will arrange transportation, accommodations, orientation to setting, and what you have to do yourself. Who can be your "go-to" person?
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What are the administrative costs and any letters required from the university?
After Finalizing Your Location Look into airline tickets, Visa, insurance early Learn about price fluctuations, cancellation, travel medical, and personal loss insurance (ie. baggage, valuables). Find out if you need a Visa and how to get one, whether it is available at the airport and how much time it takes (may take weeks! And leave you without a passport for a while). Vaccinations and the physician's visit are not covered by OHIP and can be expensive. See if your insurance covers you. Check also the Centre for Disease Control and Prevention and other guidelines. HIV Prophylaxis Kits. We will see if UWO can do what McMaster does. Though you will have $1500 worth of medications, you are paying a deposit of $300 and will get back $250 on safe return of medications. Continue contact every two to three weeks. Finalize your accommodations. Determine modes of communication with your family (ex. stock up on phone cards), and learn the logistics hospital/clinic life, water supply, question of political instability (elections, violence, foreigners), possible advance readings, and possible local student contacts.
Risk Management Forms and Objective Approval Forms Every international elective student must be provided with a risk assessment and management package. A faculty advisor also needs to sign off on your objectives form and we must formally approve your elective after a risk assessment and management process. Visit the Global Health website for the required form, and then get this to your advisor to be signed in advance. You must sign a waiver and an agreement of responsible conduct.
Checklist and Packing Considerations Months before leaving
Basic Logistics • Canadian passport – Proper validity for some countries is six months. • Visas for countries such as India and Russia must be obtained weeks ahead of time. • Register with the Consulate prior to arrival and maintain contact throughout your stay. • Reconfirm your hotel, flight arrangements, and contact info prior to departure. • Provide a friend, family member or contact at the University with a copy of your itinerary, and inform them of changes while you are away. • Ensure arrangements for how you can obtain additional funds if needed
Visit a travel clinic ASAP – Refer to Health Canada Travel Medicine Program Centres for Disease Control and Prevention: Traveler's Health for more information.
Avoid packing unnecessary items which might be stolen – Do you need your computer, jewellery, watches, cameras, iPods, BlackBerrys, and large sums of cash?
Attend one of the pre-departure sessions. **Note: attendance at one of these sessions is MANDATORY. Failure to attend could jeopardize your travel abroad opportunity or your local experience with marginalized populations.
If you will be out of the country for more than 7 months, you must notify the Ontario Ministry of Health. You will need to go into your local OHIP office in person and show them documentation that proves you will be travelling abroad and list the date of your placement abroad term.
Before You Go 1. Read the entire Office of Global Health Health Safety and Risk Management Policy and sign the necessary forms. 2. Complete the Acknowledgement and Assumption of Risk, Statement of Responsibility, Release, and Identification of Insurance Policy form and return it to the Office of Global Health. 3. Complete the Office of Global Health Elective/Travel Abroad Experience Approval form and return it to the Office of Global Health. 4. Complete the Risk Assessment form and return it to the Office of Global Health 5. Complete the UWO Health Self-Assessment form and return it to the Office of Global Health.
6. Complete the Permission to Release Information form and return it to the Office of Global Health. 7. For Students who will be using the USC Health Plan, pick up your out-of-country coverage card from the Info-Source in the UCC. 8. Change your address on the Registrar’s website to ensure you receive mail from UWO. To do this, log in to the Student Services Portal. 9. Arrange for someone to file your income tax for you on your behalf if you will be away during the month of April. 10. Arrange a Power of Attorney for someone you trust to carry out your banking (including OSAP) and legal matters in your absence. 11. Make two photocopies of your passport (and other important documents). Leave one with a responsible friend or family member in Canada; carry the second copy separately from your passport.
On the Ground Safety 1. Wash your hands! Be careful as to what you eat and drink. Check on the safety of local water –boiling all drinking water is necessary is necessary in some areas. Peel, boil, avoid uncooked foods (including salads), remember ice (it may be necessary to do without ice as impure water is often used to make it). Consider carbonated beverages. 2. Take your malaria prophylaxis as directed. Sleep in a mosquito net. 3. Use PPE as much as you can - Don’t touch the rash!!!! Don’t recap needles! 4. Find out from your colleagues where to go for medical treatment if needed and get out of town if a serious problem arises. Follow medical precautions (ie. immunizations). Who are the doctors with a familiarity with our system of medicine that others or you trust go to or one you trust? Take a first aid pack with some basic medication in case you are not in contact with a good doctor. Ensure you have good medical insurance. 5. Remember to be safe and keep patients safe. Don't be burden on system.
Attitudes • Manage your own expectations. There will be elements beyond your control. When you are feeling frustrated, remember how this will look 10 years from now. Try to be understanding, flexible, and adaptable. •
You will not likely be as active clinically as you would be at home when you may not understand the language and cultural context. You may need to be self-directed, not procedure-oriented. Learn to arrange for, and enjoy, downtime. Get exposure to what is out there, learn the culture, take a book. Remember that the host institution’s hospitality and friendship contributes supervisory time of already overworked doctors, nurses, midwives, public health nurses, and other staff. Though
local accommodation, food, and transport may be provided for a small charge and a small tuition fee may be asked in teaching centres, you are getting much more than you are paying for. •
Be careful how you travel, and try to bring a friend. If you wouldn’t do it at home, don’t do it there (sex, drugs, etc.)!
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Respect local customs that are a part of your host country's heritage. Be the kind of guest that you would welcome to Canada.
Packing Considerations • •
Pack light! Donations/medical supplies
Take ONLY if requested/discussed ahead of time. Pack you letter of invitation and list of contents ►
For the wards: Stethoscope Penlight Thermometer Lab coat Small notebook Medical handbooks, Lonely Planet, Where There is No Doctor, Oxford Handbook of Tropical Medicine, Pocket Internal Medicine formularies Personal medical supplies, over the counter analgesia, antipyretics, BCP, cough/cold medicines, Gravol vs. Immodium, etc. Formal clothing (shirt +/- tie for men, skirts for women)
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Consider
Otoscope/opthalmoscope Portable BP cuff Phrase book Gifts for your hosts Canadian photos Camera Electrical converters batteries International cell phone Money belt, alarm clock etc Ziploc bags, snacks, cutlery drink crystals dehydrated foods, toiletries etc Teaching resources to share US cash Hand sanitizer, Sterile gloves, N95 mask
Your emergency contact card Your passport, student VISA, travelers’ cheques, plane tickets, etc… **Note: make sure that your passport is valid for at least one month after your planned return date. Some countries require passports to be valid for longer. The address and phone number of the Canadian embassy/consulate that will be nearest to you. Any prescription medications (in their original containers) that you will need while on your exchange and a first aid kit. A small amount of local currency or U.S. dollars
Upon Your Arrival •
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Email the Office of Global Health at neil.arya@schulich.uwo.ca as soon as you arrive at your destination and provide us with your local address, phone number, and email address. Make contact with the host Institution Exchange Coordinator. Register with the nearest Canadian Consulate or Embassy upon arrival in your host country.