Rethinking “Global Health”

The FPH Global Health selective was off to a great start last week, with a presentation by Dr. Bob Bollinger that brought up lots of (sometimes uncomfortable) questions about the purpose of global health and the challenges involved in global heath work. One of the key questions that we pondered was, well, what is “global health”? Is it strictly international? What relationship does it imply between “developed” and “developing” countries? How do we perceive our role in whatever we think global health is? Nick and Caleb’s post has gotten the train rolling with some great online food for thought.  Here are some more thoughts from other Med’14ers. Enjoy, and respond!

*****

What is my role in global health? This question, seemingly harmless at first glance, has become harder and  harder for me to answer the more that I think about it. As a student interested in global health, I have grand  aspirations of traveling to developing countries, working with the local people, and really making a difference. However, as we talked about the upcoming possibility of traveling abroad for the summer and doing research, I  realized that my contributions would be rather limited. Upon further reflection, I realized that the primary  beneficiary of a summer trip abroad would be me. The experience would teach me about research, the culture of another country, and would open my eyes to new possibilities. What started as a selfless urge to help others;  now seems rather selfish. Hopefully, this initial investment in myself will translate into the ability to contribute  in a sustainable way in the future.

*****

I came into this first session not knowing much about the intimate details of doing work in global health. I believe Dr. Bollinger’s lecture helped me gain a great deal of information on not only the benefits and rewards of dedicating oneself to global health, but also the difficulties that must be overcome. Dr. Bollinger’s key rule that the first response to any idea will usually be negative opened my eyes to the fact that foreign governments will not always be receptive of outsiders with new ideas, even if they are well-intentioned. Finally, I found Dr.  Bollinger’s anecdote on the Indian government official who attempted to bribe him to be both fascinating and thought-provoking. The story sheds light on some of the ethical dilemmas that we could face as future global
health practitioners. Would it ever be acceptable or reasonable to go along with a bribe if doing so could save thousands of lives? That is a question we may all have to grapple with at some point in our careers.

*****

I’m not quite sure what I expected from this selective. I’ve always been interested in global health, but I don’t know much about it. Bob was very enthusiastic about his work, and you could get a real sense of how he genuinely wanted his efforts to go towards making the world a better place. I can’t imagine all the difficulties he and others in his field of work had to go through. It sounds almost impossible, yet people devote their lives to it, and do make it work. I hope that I can find something that I am just as passionate about, because when you’ve found it, you can accomplish so much through perseverant work. To me, it’s not worth it just to do a job that will get you by, but not help others. Research sounds dreary to me though; I hope that I can find clinical opportunities that will fit my personality. I have no idea what those would look like or where to find them, but this selective will hopefully be a good place to start!

*****

Dr. Bollinger’s talk was certainly eye opening to the problems that we face when doing Global Health research. In addition to difficulties we also talked about his work specifically in Pune, India. It was amazing to see the degree of progress at the BJ medical school in Pune over the last 10 years. Starting from the upgrading of technology and resources to the organization and better training of members and the development of a more efficient research system. It was interesting to note the amount of time it takes to initiate such a project, keep it running and eventually get results. Global Health initiatives are a long-term commitment from both sides and it certainly is reflected in Dr. Bollinger’s work in India. I really liked our discussion on the problems we face while doing global health work; whether it be in research or giving out medical services to certain areas. There’s always this problematic idea that we are doing more harm than good, taking advantage of a population for research purposes or helping a group for only a small period of time. Personally, I think all of this really comes down to the length of a project and keeping connections to that area once a project has been completed. This is definitely being emphasized in many global health initiatives and I think it’s a way to combat this problem. Our continual connection to a community will really help in its progression and development.

*****

Global health involves promoting population health and decreasing health disparities in the global arena. The world’s most vulnerable populations should be targeted, and the issues that affect them most should be prioritized. These populations (women, children, elderly, refugees, etc.) and issues (infectious disease, infrastructure development, etc.) will inevitably vary from one region of the world to another, and a strategy that is successful in one may not be suitable in another. As a result, “successful global health workers” must be integrated in the target community and have a comprehensive understanding of the cultural, socioeconomic, and political environment. Providing training to local community members and sustainability should be a primary focus for all global health initiatives. A component of global health may also involve training or raising awareness in students. Although students may be enthusiastic and well-intentioned, they may not have the skill set needed to contribute effectively to global health projects, particularly on a short-term basis. This should not preclude interested students from exploring global health. However, they should have a realistic perspective on how much they can contribute with limited skills and/or time and embrace the experience as a learning opportunity. As a side note, this week’s episode of The Office touched on some of the conflicts and issues that surround global health. A group of young adults in a church group went to Mexico for 3 months to build a school. The leader of the group had a savior complex. She encouraged the group to think of the earth as a burning building and its people as family members who needed to be saved. She did not speak the language fluently, and she believed that at the end of 3 months, the group would be practically Mexican. One of the group members was forced by his parents to go on the trip, and he abandoned the group when given the opportunity. The group also allowed Michael and Andy to join them on their trip to Mexico, even though they knew nothing about the project. This episode highlighted some of the issues that can cause global health trips/projects to be limited in their success.

Hopkins’s drug problem

Hey y’all, I have been totally delinquent in posting this, but here’s brief shout-out to our friends at the Hopkins chapter of Universities Allied for Essential Medicines, whose October 14, 2010 Op-Ed in the  Baltimore Sun highlights our university’s lagging leadership in promoting access to the medical technologies developed by its researchers. With President Ron Daniels touting the university’s commitment and achievements in global health, the piece points to a significant gap in that commitment.

I would love to know what you think about the article and universities’ role in promoting access to medicines. Should this even be a university’s concern/mission? How far should can/should universities go in defining and fulfilling their responsibilities to global communities? Holla back!

International AIDS Conference

The 18th International AIDS Conference began yesterday in Vienna. A great opportunity to take a step back and reflect upon the road ahead in the context of stagnant funding and ever greater challenges in the prevention of transmission. If you can’t afford the flight, there are live webcasts on the Kaiser Family Foundation website.

Design for Development

Featured in Time magazine’s 100 most influential people list (alongside the likes of Lady GaGa), is Amy Smith of the MIT D-lab, an innovative program that trains students in designing machines that respond to the needs of communities in developing countries. Some of her designs to date include “a hammer mill that converts grain to flour and an incubator that does not require electricity”. The program is  ”committed to making a long-lasting impact in the communities where we work” through fieldwork and long-term relationships with partner organizations. I’m smitten!

Also on the list is Matt Berg, who is using txt msgs to develop a child health tracking system in resource-limited settings. Check it out!

Microbicides–When will they deliver?

The AP recently reviewed current research on the effectiveness of vaginal microbicides, gels that provide prophylactic protection from HIV infection.

These gels promise to be an amazing tool in the fight against HIV, especially in areas of the world where condoms are 1) not easily accessible/available 2) not allowed to be used for a variety of reasons (religious edict, cultural taboo/condemnation, et cetera). Consequently, vaginal microbicides, like the female condom, have promised to provide a “women-controlled protection” believed to be key in fighting the HIV/AIDS epidemic.

However, trials of numerous microbicide continue to end in disappointment, baffling researchers and frustrating activists looking for another preventive measure in their armamentarium against HIV:

“Frankly, blocking transmission of the virus appears to be a lot harder than anyone understood it would be at the beginning,” says meeting co-chair Dr. Sharon Hillier of the University of Pittsburgh and a principal investigator of the Microbicide Trials Network.

Similar trials looking at rectal microbicides have been equally disappointing.

As things stand now, I cannot help but ask “when will the research deliver?” On the Global Campaign for Microbicides website, they have a section describing how microbicides work. Yet, as you read, you get the impression no one knows how they work…because they don’t. There have been no proof-of-concept studies, there has been little date supporting the effectiveness of any of the trials. Essentially, the research seems to be driven by the ideal of a microbicide, by the idea of “how great it would be if we had a preventive gel.” I can’t help but be a little cynical as more and more research dollars are pumped into a preventive measure that continues to not only prove ineffective but also puts people at increased risk of HIV infection.

So, again, I ask, “when will they deliver?” Or perhaps a better question is to ask, “will they ever deliver?”

At some point, we will need to step back, look at the basic science of the immune response and that data that continues to pour in from microbicide trials and see that maybe microbicides won’t be the next magic bullet against HIV. We need to package HIV prevention and not hope for one great prevention.

Access to Medicines/Tribute to Carl Taylor

  • GHIG meeting featUAEM.

Thursday May 14, 1pm. AMEB 470.

We constantly hear from our lecturers about how prolific Hopkins researchers of the past and present have been in making groundbreaking discoveries in medicine, but we still have a long way to go in ensuring that the end products of these discoveries help those who need them the most. Global access to medicines is an exquisitely complicated issue that spans many academic fields, from biomedical research to intellectual property law, but it is one on which we can take action and have tangible impact as students. How, you ask? Well, first off, by coming to this Thursday’s GHIG meeting, featuring super-duper-special guests from the Hopkins chapter of Universities Allied for Essential Medicines. I hope you’ll all be able to make it, but if not, be sure to check out their website to learn a bit about their current campaign to improve our university’s access policies.


  • Carl Taylor Memorial Lecture: A Special Celebration of Carl Taylor’s Life and Work

Friday, May 14, 2010, 1:30. Wolfe St. building, W1214.

As we begin our careers in medicine/global health, we must remember that we stand on the shoulders of giants. Born in the Himalayas to medical missionaries, Carl Taylor was immersed in the health and social challenges of the neglected  peoples of the world from his youngest days. He went on to become the founder of International Health as an academic discipline as well as the founding chair of what is now the largest department at the Bloomberg School of Public Health, where he was still teaching until shortly before passing away in February at the tender age of 93. He was a pioneer, a dedicated teacher, and spent his life helping communities empower themselves to shape their own fates. The School of Public Health will be holding a memorial lecture in his honor this Friday, which will be a great opportunity to learn about his life and his work, and why, as global health aficionados, we all owe him a big one! If you can’t make it,  his latest book Just and Lasting Change gives a great overview of his approach to social justice and health.