News at Medicine - January 2018 - Bringing global health home

Bringing global health home
June 15, 2017
In one week, eight medical students will be getting on a flight to Kathmandu, Nepal. It’s an 18 hour trip that they pay for themselves and they don’t receive academic credit, but they all agree it’s worth it.
For the fifth year in a row, Faculty of Medicine students are heading to Nepal to Patan Academy of Health Sciences (PAHS) where, for four weeks, they’ll learn aspects of global health they can bring back home.
Memorial University signed a Memorandum of Understanding with PAHS in 2013. That same year, the two institutes launched the International Summer Institute in Global Health Training (InSIGHT) program, an annual global health program for pre-clerkship medical students. The program takes students to Nepal to learn about the deep impact of social determinants of health and see them in clinical context in a resource challenged country. The program is led by Dr. Jill Allison, global health coordinator at Memorial and Dr. Shree Mulay, associate dean of Community Health and Humanities at the Faculty of Medicine.
For the first two weeks the students explore challenges and innovative solutions at the community level. They look at gender, family politics, reproduction, livelihoods, water and sanitation, food security and politics as they influence health and wellbeing. This includes a rural visit to explore health care delivery in a remote mountainous area. The second half of the program is spent seeing the impact of these factors in a clinical setting.

Learning, not solving

For Alison Hamilton, who participated in 2016, InSIGHT was the start of her career in international medicine. She’s been passionate about social justice and global health since high school but she didn’t want to ‘swoop in to fix a problem’ identified by Westerners. She says InSIGHT was nothing like that.
“Dr. Allison has created this program that is organized entirely around learning; it's all about what we can learn from the community rather than what we can do for them,” she said. “I was particularly amazed to learn that the challenges facing rural health care in Nepal are quite similar to those facing rural health care in Newfoundland. This was a highlight for me, learning how much two communities on opposite sides of the world could benefit from comparing their common problems and successes.”

Social accountability

While there, Hamilton and other members of the team participated in a symbolic project, chosen by the community members. One of the partners for InSIGHT is a riverside slum community inhabited by people who have migrated from rural communities. People end up there because they are persecuted for their caste, they lose access to land or are widowed and abandoned by families and end up in the city to work as day labourers, hauling bricks and rocks or cleaning streets.
Dr. Alison explains that it’s a temporary community which they call home but the government will not let them built permanent structures. They have been told their homes can only be built of bamboo and plastic. “Every year we meet with the community women’s group and last year they wanted us to help build a wall in the daycare,” explained Dr. Allison. “They taught us how to build with plastic and bamboo to comply with government restrictions. Together the students worked with community members, learning about the precariousness of life in a slum community, the challenges posed by day labour and what it means for women to leave their children and undertake backbreaking work in the city in order to survive,” she explained.
“We learned about the resilience and ingenuity of the community as they created a daycare for their children. The daycare also ensures that older girls get to go to school rather than having to provide childcare to younger ones. All these insights are there and symbolized in the wall. This is the true meaning of the InSIGHT program – learning about the complexity of life for those in under-resourced communities.”
“InSIGHT is dedicated to social accountability, health equity and social justice. But it’s not just about experiencing and advocating those things abroad, but also at home. The program challenges participants to take lessons learned in international settings and apply them back to whatever practice they decide to pursue, no matter where they are,” said Dr. Allison.