Global Health Advocacy in EM
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Written from the perspective of a Canadian Emergency Medicine Resident in July 2013 as a presentation to peers and colleagues for academic purposes only. Part 1: Advocacy in Emergency Medicine - Patients, communities and the world at large Part 2: Global Health trends - Political, social, economic and environmental determinants - Emergency Medicine as a global priority Part 3: Examples of Emergency Medicine development and activism - Global Emergency Care Collaborative - Uganda - International Emergency Medicine research at WHO - Getting involved without leaving the country
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Global Health Advocacy in EM
- 1. Global Health trends and lessons learned: Towards better advocacy and development in Emergency Medicine Farooq Khan MDCM PGY5 FRCP-EM McGill University July 24th 2013
- 2. Objectives • Appreciate the role of the emergency physician as an advocate for public health – (on local and global scale) • Understand how global health trends can impact local health care • Be introduced to potential global health activities that are compatible with the average EP’s practice
- 3. Outline • Part 1: Advocacy in EM – Patients, communities and the world at large • Part 2: Global Health trends – Political, social, economic and environmental determinants – EM as a global priority • Part 3: Examples of EM development and activism – GECC - Uganda – International EM research at WHO – Get involved without leaving the country
- 4. Advocacy in EM Part 1
- 5. Health as a human right
- 6. Advocacy • Emergency Medicine is an ideal specialty for advocacy – Frontline witnesses: • Consequences of public health hazards • Failings of the system – Ability to act
- 10. Veysman B BMJ 2005;331:1529 ©2005 by British Medical Journal Publishing Group
- 13. 66th World Health Assembly 2013
- 15. Global health trends outline • Globalization and social inequity • Economic crisis • Universal Health Care and poverty • Changing health demographics • The role of EM in – Non-communicable disease and injuries – Sustaining Health systems – Humanitarian action, disasters, and pandemics – Climate change
- 16. Political, social, economic and environmental realities • Globalization and widening social inequities – Urbanization, migration, global alliances • Economic crisis – Reductions in public spending, unemployed youth and impoverished elderly
- 24. Global recession
- 27. Complex health challenges • Threat to sustainability of Universal Health Care (UHC) – Rising health expenditures – Rising public expectations – Increasing use of technology • Decreased access to health services and medical products • Exclusion of those without financial means
- 29. Political, social, economic and environmental realities • Changing picture of poverty – The poor in Middle Income Countries (MICs) – Global health less about geography and more about inequity – Exchange of ideas vs delivery of aid
- 30. Health and demographic trends
- 31. Health and demographic trends • MDGs – Decreases in Malnutrition, Maternal and child mortality, HIV/TB/malaria – Increase access to water and sanitation – Caveats: resistance, resurgence, inequities in access
- 32. • Aging • Rise in Non Communicable Diseases (NCD) – Cardiovascular disease, Diabetes, Cancer, Mental Health – Injuries The Lancet Volume 380, Issue 9859, (15 December 2012–4 January 2013)
- 35. WHO core functions 1. Providing leadership on matters critical to health and engaging in partnerships where joint action is needed; 2. Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; 3. Setting norms and standards, and promoting and monitoring their implementation; 4. Articulating ethical and evidence‐based policy options; 5. Providing technical support, catalysing change, and building sustainable institutional capacity; 6. Monitoring the health situation and assessing health trends.
- 37. Complex health challenges • Fragmentation – Multiple voices in health governance – New organizations, financing channels and monitoring systems – Duplicate/parallel services – Miscommunication “Fragmentation is literally killing people. Together we must take action to fix it, now.” - Dr. Jim Yong Kim, President of the World Bank World Health Assembly, Geneva May 2013
- 38. Combating fragmentation through Integrated Acute Care • Integrated across specialties – EM, Surgery, Anesthesia, Obstetrics (EESC) • Integrated through the care delivery pathways – Prehospital care, In-Hospital care, Community rehabilitation (GACI) • Integrated through policy – Prevention, Promotion, Monitoring/Evaluation – Health system strengthening • Research, Best practices, and Capacity building tools
- 39. Complex health challenges • Funding – Donor priorities vs beneficiary priorities – Tied aid
- 40. Funding for global health aid
- 41. Vicious cycle of neglected health programs Lack of funding Lack of research capacity Lack of evidence base
- 42. EM Sustaining UHC • Ensuring access to curative and preventative services • Ensuring financial protection • Health policy and system strengthening • Allocating supplies, human resources, geographic distribution • Linking health to sustainable political, social, and economic development
- 44. Health security and humanitarian action • Complex Humanitarian Emergencies – MSF and the Syrian conflict • Interdependence of relief and development
- 49. Emerging infectious disease and pandemic preparedness • Zoonoses • Real time intelligence • Rumor verification • Early alerts • International response
- 54. Complex Health Challenges • Dealing with transnational threats to health – International Health Regulations – Pandemic influenza preparedness framework • Protecting human health while minimizing disruptions to travel, trade and economic development
- 55. Climate change
- 59. Summary • EM plays an fundamental part in the future of integrated health systems • Political and economic pressures threaten the sustainability of UHC in developed countries leading to rises in ED use • Social and environmental changes alter disease patterns presenting to our ED • EM has a central role in response to pandemics, disasters and humanitarian crises
- 60. Examples of EM development and activism Part 3
- 61. Sustainable EM development • Task-shifting and capacity building with GECC – Training midlevel Emergency Care Practitioners (ECPs) at Nyakibale Hospital in Rukungiri, Uganda • Training the trainer • Hands-off supervision
- 64. Introduction to Injury Prevention An interactive discussion for senior and qualified ECPs Nyakibale Hospital Rukungiri, Uganda Farooq Khan MDCM, PGY4 Emergency Medicine McGill University, Montreal, Canada
- 68. • What about task-shifting in North America? • Budget cuts and increasing complexity of emergency care • Role of midlevel providers? – PAs, NPs, ACPs
- 69. WHO Global EM capacity research • Challenges – Political and ethical considerations – Relative lack of personnel with expertise in: • Study design • Data management and analysis – Lack of time – Lack of funding – Publication bias
- 70. Activism and social consciousness • Public health/Community outreach projects and partnerships • Municipal and Provincial programmes • Professional societies (EuSEM, AfJEM, IFEM) • Research, publishing in open access journals • Petitions/protests • Press/Open letters • Forums • Social media
- 71. Excerpt from F. Abergel PCR-SP, ASSS-Montreal
- 81. “Using social media to communicate academic knowledge is not a problem in itself, it actually opens up vast new possibilities, but it forces us to ask what will happen as more and more researchers use social media and other open-access outlets for their work. How will we cope with the din? And, most importantly, who will get heard?”
- 82. Take home messages • EM is an ideal specialty for advocacy • Complex global trends have concrete downstream local effects on EM • EM advocacy is easily achievable through concerted small actions: – Awareness of public and global health issues – Sharing knowledge – Engaging communities – Expressing opinions
- 83. Acknowledgements • Dr. Meena Cherian – WHO Emergency and Essential Surgical Care • Dr. Mark Bisanzo and Dr. Heather Hammerstedt – Global Emergency Care Collaborative • Dr. Kirsten Johnson – Humanitarian Training Initiative • Dr. Robin Cardamore – Montfort Hospital • Dr. Raghu Venugopal – University Health Network and MSF • Dr. Meera Muruganandan and Dr. Nicolas Hawbaker for photographs of Uganda
- 84. Primary source All other references appear within each slide
Notas del editor
- The goal is not to change your practice, take a step back and reflect upon the big picture of your careers and where you fit as part of a global community, and maybe inspire you to take it in a slightly different direction.Appreciate the role of the emergency physician as an advocate for public health (on local community and global scale)Understand how global health trends can impact local health careBe introduced to potential global health activities that are more compatible with the average EP’s practiceMost EPs in Canada have family/financial commitments etc preventing long term travel, and usually work in an urban North American academic appointment or community hospital and tend to stay there. So I'd rather share with you how to become involved globally as much as possible from the comforts of your own home, or within the confines of your schedule.
- Underlying principle of Universal health care, Canada health act and our social and moral obligation as professionalsHealth is not a privilege or a commodity
- Not just another arm of the CanMEDS competency framework. I think advocacy speaks to the very reason why we do our jobs.Larry Weiss, former persident of AAEM has spoke about “how emergency medicine is an ideal specialty for advocacy: as the frontlines of medical care who interact with every aspect of the healthcare system, we are the most well-positioned physicians to advocate for our patients, our communities, and our society. We see the problems with public health—smoking, obesity, injuries and violence, homelessness etc. We see the problems with under-, over-, and mis-utilization of healthcare”. We see the plight of the marginalized populations in our own societies. “And we have the ability and power to act on these problems every day”
- The concept of a public health approach to EM is not new (Lewis Goldfrankand Art Kellermanpublished on the topic in SAEM Journal in 1994)And academically it has always been challenging to incorporate advocacy into curricula although (hopefully you will see that) it is becoming increasingly important, and also increasingly easy to do.
- “Health advocacy is being formalized as a professional activity for physicians across North America, but the accommodation of this activity into conceptions of daily practice has been controversial and confusing. There appears to be a lack of clarity around what a physician should do as a health advocate and how this should manifest in daily practice. In this article, the authors explore how the medical community has characterized the health advocate role and the roots of the debates regarding its place within training and practice, using the example of the CanMEDS Health Advocate Role. They argue that the confusion might be a result of subsuming two distinct activities, agency and activism, under the rubric of health advocacy. They propose that these activities and their associated skills are sufficiently distinct as to merit separate discussions. Agency involves advancing the health of individual patients ("working the system"), and activism involves advancing the health of communities and populations ("changing the system"). The authors suggest that distinguishing between agency and activism within health advocacy provides opportunities to explore their distinct goals and skill sets in a manner that will advance the debate about health advocacy, a conversation that remains critically important to the medical profession.”Common ground in the Venn diagram involves “understanding the system” and its pieces. I would argue that raising awareness and a certain degree of participation in activism leads to being better equipped to fulfill the role of agency for our patients.
- Declining altruism?Although at least 2 editorialists in JAMA and BMJ in the last decade seem to think that medical altruism in general is declining or threatened. Sociologists believe that there is a growing tension between self-interest and collective altruism because of commercialization, consumerism and the pressures of modern society.“professionals have an ideology that assigns a higher priority to doing useful and needed work than to economic rewards, an ideology that focuses more on the quality and social benefits of work than its profitability” Relman JAMA
- Many of us still think of it as not really within our purview, and assume that someone else is doing it.But who is that someone else, and should we leave it to someone else to advocate for issues that affect our patients and our ability to help them?
- Here in North America we have robust public health departments, we have a network of academia, and we have professional societies, CAEP ACEPWho is that someone else on the global scale?I recently spent 6 weeks working at the WHO HQ in Geneva and it seems that EM is not represented on its own on the global scale. Acute care is enveloped in either surgery, humanitarian health action, or violence and injury prevention.The EESC was composed of 1 anaesthesiologist interested in emergency and surgical care, and her army of 3 interns (myself included), its only been around 10 years, almost disintegrated in 2008, and is seriously underfunded and neglected compared to other programs.
- It was there that I had the privilege of attending the WHA where health ministers and policy makers from every UN member state convene to set the agenda for health concerns around the world and there was a particularly inspiring speech by the world bank president who is incidentally a doctor who said:“It makes no sense to pour resources into responding to downstream complications, without investing in upstream prevention and disease management that could often keep those complications from happening in the first place”I think part of this thinking is what has made emergency medicine a tough sell in public health circles because it is seen as the very end of the health spectrum, evidence of failure of preventative measures, however we all know the role we play in keeping our system functioning, and linking various actors in care delivery, when patients need it most, catching those who fall through the cracks (missing opportunities for prevention/treatment) and helping them navigate the system. Furthermore we play a vital role in secondary prevention, mitigating death and disability from catastrophic injuries and unpredictable illness.So I asked myself why was this still under-recognized and what could I do about it? It is not as simple as just going out into the world and promoting EM as a specialty from a soapbox and probably those of us who have tried have been frustrated by the complexities, slow pace, inefficiencies and apparent injustices of the public health arena
- So to go from being an agent to an activist I looked to the world to help me understand health systems.
- One of the lessons i learned is that to understand health trends and health systems to affect change in them, one needs to stop looking at health only through the lens of a physician and try to visualize it from political, social, economic and environmental points of view.We will try to do a whirlwind tour of some of these outside determinants of health that were the basis for the WHA Agenda and make up a lot of what the WHO is working on, to give you a context of which issues underlie making changes on a global scale but also how they relate to you locally.
- instead of shared prosperity, globalization has been accompanied by widening social inequalities and rapid depletion of natural resourcesRapid unplanned urbanization is a reality, particularly in low‐ and middle‐income countries. many migrants are exposed to increased health risks in their search foreconomic opportunity.At the same time we’re undergoing an unprecedented economic downturn that leads to Reductions in public spending, unemployed youth and impoverished elderlyAll of this has an impact on the kinds of patients we see in the ER
- Those of you have trained at Jackson in Miami know that there is quite a difference between the reality of the patients who present there with trauma and...
- ...the kind of life that is lived elsewhere in the same city
- But this not just a reality in the US, it is happening around the world as some developing economies rise (like Brazil, Russia, India, China, South Africa) and others struggle to keep afloat (Europe and North America)....
- Wealth is being concentrated among the few, as this figure shows with the number of billionaires and what percent of the nation’s GDP they represent, with middle classes disappearing and poverty effectively rising
- In response to this, some developing countries are undergoing revolutions with mass gatherings and violence that would be the nightmare of any ED
- and economists are predicting that other countries closer to home may face a similar fate
- And it’s not like we haven’t had our fair share of this phenomenon here in Montreal
- While the financial measures put in place countries like Greece, Spain and Portugalare already leading to some unexpected changes in health patterns
- Increased suicides, widespread drug shortages
- and unexpected outbreaks such as HIV and Malaria which hasn’t been seen in 40 years
- In some countries health spending remains below what is required to provide even the most basic services in particular in EM. By contrast, in many developed economies, health care costs continue to rise faster than gross domestic product due to reasons we’ll talk about in a bit (the growing burden of non-communicable diseases in ageing populations) combined with rising public expectations, and increasing costs of technology. For countries facing a continuing economic downturn, the net effect will be to threaten the financial sustainability of health systems. Smart solutions – those that focus on prevention, early detection of disease and the promotion of healthy lifestyles – will be needed to sustain the universality of health coverage where it has been achieved and to make further progress where it has not. Without such changes, pressures on public funding are likely to increase exclusion among those without the financial means to access care.
- As certain health systems expand through economic development and appropriate health policy, others are shrinking.We are living the consequences of the economic downturn, a shift in health policy through a change in government and ultimately cuts in healthcare expenditures that translate to loss of coordinators and nurses, hiring freezes, the disappearance of specialized services, drug backorders, and ultimately entire subsets of the population that can no longer access healthcare, this usually ends up being the most vulnerable ones (homeless, elderly, refugees)I would argue that if we are not aware of these trends and what they can lead to, and ignore lessons learned in other countries, then we may not notice as our practices will dramatically change and our patients lives and livelihoods will hang in the balanceIn particular our own poor and destitute local population who are not always easy to identify or reach.
- Around the world, the poor are also being hidden into rising and seemingly prosperous economies of Middle-income countries, whose health statistics are still far from optimumFor example Russia whose estimated HIV and TB rates are similar to that ofBotswana, but are refusing international aid despite not having proper statistics on the burden of disease in their own country.However this type of phenomenon strengthens the arguments of many critics of international aid that in fact what is needed is development. Teaching a man to fish rather than giving him fish. (we will get back to this concept when we talk about humanitarian aid)In fact, one of the main focuses of the new WHO agenda was highlighting the interconnected links between universal health and sustainable development, and we will see how and why emergency medicine will play a stronger role in service delivery plans
- Some of you may have heard of the MDGs, which have been milestones that the worlds health policy makers have strived towards in the last decade with a deadline to meet them by 2015
- And much progress has been made on these fronts, with a few caveats and setbacks, and still a lot more work left to be done... However the folks over at WHO are already talking about the post-2015 agenda
- Particularly due to the results of the massive Global burden of disease project for which an entire issue of the lancet was dedicated to in Dec 2012Which showed things that we already knew to be true in NA are in fact true in the rest of the world, basically that people are growing older (due to higher life expectancy) and what’s killing them is NCDs which were basically ignored in the previous MDGs.
- In particular it confirmed projections that injuries are poised to skyrocket as a leading cause of death worldwide.(The most robust data is for RTAs, but injuries as a whole includes falls, drowning, burns, poisoning, and intentional injury as well)
- And that is where we come in. The role of acute care, in all of its forms is being recognized more and more as an essential component of health systems that needs to be defined, studied, strengthened and implemented.Moving research in acute care from being part of being part of the 10/90 gap (whereby 10% of the world’s resources are allocated to research affecting 90% of the population) towards being a driver for health and development.The importance of this role of ours is now being recognized at the global level, which holds promise of many opportunities for our unique skill set and point of view to make a profound impact on millions of lives around the world.
- As examples of principles of public healthThe current health situation including: demographic and epidemiological trends and changes, urgent, emerging and neglected health issues; taking into account the burden of disease at the global, regional and/or country levels.• Needs of individual countries for WHO support as articulated, where available, through the country cooperation strategy, as well as national health and development plans.• Internationally agreed instruments that involve or impact health such as declarations and agreements, as well as resolutions, decisions and other documents adopted by WHO’s governing bodies at the global and regional levels.• The existence of evidence‐based, cost‐effective interventions and the potential for using knowledge, science and technology for improving health• The comparative advantage of WHO, including:(a) capacity to develop evidence in response to current and emerging health issues;(b) ability to contribute to capacity building;(c) capacity to respond to changing needs based on an on‐going assessment of performance;(d) potential to work with other sectors, organizations, and stakeholders to have a significant impact on health.
- There are a couple of programs at the WHO that are attempting thisThe EESC and the GACI
- Though achieving this is not without its challenges but I think that the most important one that EM faces both locally and globally is the issue of fragmentation of health systems and of global health action, and I could probably talk a whole hour on just this complex and almost unsolvable issue,Multiple voices: “Nation states. Civil society networks, individual nongovernmental organizations at international and community levels, professional groups, philanthropic foundations, trade associations, the media, national and transnational corporations, and individuals and informal diffuse communities that have found a new voice and influence thanks to information technology and social media – all of these actors have an influence on decision making that affects health.”Health governance involves “two distinct concepts: governance of health, which addresses many of the issues referred to above and which essentially involves a coordinating, directing and internal coherence function. The second concept, governance for health, relates to an advocacy and public policy function that seeks to influence governance in other sectors in ways that have a positive impact on human health.”
- But there is a push globally to mitigate the fragmentation by integrating careHere in Canada we are probably ahead of the curve in terms of Integrated healthcare, moving away from disease centered programs, which makes us excellent consultants for other countries. But we should also keep mindful of stresses that threaten the sustainability of our system and maintain our local advocacy in order to be leaders for the rest of the world.
- In my opinion the root of fragmentation is probably money: who gives it, why and for what, who ends up receiving it and how.Donors have their own priorities and often money poured into the public health, or into aid or development comes with strings attached
- Globally the landscape of health funding is changing with single government agencies, global and private funds (like the Bill and Melinda Gates Foundation) having much more actionable dollars than the classic UN organizations funded by contributions from member states.This has a huge impact on which programs are able to flourish and which end up being neglected
- Sometimes programs get stuck in a vicious cycle like the one hereYou will see that professionals like you can help EM as a specialty spiral outfrom this vicious cycle by getting involved through dedicated volunteer work, persistent advocacy, effective interaction and people skills, and the support of a single donor with a vested interest (e.g. elevator conversation with Bill Gates) to catalyze a change and fuel a cycle of productivity instead.Although be wary that the momentum gained by multilateral partnerships and the presence of funding from interested donors can be lost by poor coordination and leadership, and money can end up being spent simply because it is earmarked for spending rather than for a worthwhile endeavour
- “Universal health coverage is conceived not as a minimum set of services but as an active process of progressive realization in which countries gradually increase access to curative andpreventive services as well as protecting increasing numbers of people from catastrophic financial consequences when they fall ill.The outcome statement of the United Nations Conference on Sustainable Development (Rio+20)1 has further emphasized the relationship between universal health coverage and the social, environmental and economic pillars of sustainable development.WHO will focus on health service integration, reflecting concerns for more people‐centred services, efficiency, and value for money, and a general shift in emphasis away from categorical, disease‐focused programmes. WHO will respond to the need for integration across the whole health care continuum from primary prevention through acute management to rehabilitation. Better links between medical, social and long‐term care have significant benefits in terms of care for noncommunicable diseases, maternal and child health, and for the health of ageing populations.”That health system sustainability is an area where EM is key, as we are the point of access to curative services and I would argue preventative ones, and we can advocate for protecting patients and the systems financially through best practice and cost-effective approaches. Being involved in policy gives us political and administrative backing to do our jobs and making sure that supplies and HR are properly distributed geographically. The biggest challenge is doing this in a way that fosters economic, social and political development(“The second concept, governance for health, relates to an advocacy and public policy function that seeks to influence governance in other sectors in ways that have a positive impact on human health”)
- One area where EM plays a central role is in emergency risk management: this a hot topic in public health particularly in the wake of recent disasters“Prioritizing holistic response to emergency risk management as a health policy that integrates prevention, emergency risk reduction, preparedness, surveillance, response and recovery, thereby reducing mortality, morbidity and the societal disruption and economic impact that can result from epidemics, natural disasters, conflicts, environmental and food‐related emergencies.”This field is well within our expertise as Emergency Physicians
- One area where EPs excel is in humanitarian reliefThis is MSF’s HQ in Geneva and their campaign for relief in SyriaThere is move now to recognize that humanitarian relief and development are deeply interdependent.
- It is an incredible challenge to provide quality coordinated care to vulnerable, marginalized and neglected people, when infrastructure and resources are limited and environments are chaotic and unpredictableSound familiar?I feel like everyday in the ED we deal with a mini-disaster so we have the skill set that allows us to perform under these types of conditions.
- But in order to be effective in a setting like Syria, or Darfur or Haiti, one needs to understand the context, the other players, the standards of humanitarian care and that sort of expertise can be found in courses such as the HTI, led by the McGill University’s own Dr. Kirsten Johnson, that will teach you close to everything you need to know about going out into the field and responding to a disaster in a socially responsible and professional manner.
- Here is an example of course that embodies what is now a global movement to harmonize and standardize humanitarian response
- There is an information session about the course tonight and again next week.
- But we’re not all going to go seek out disasters, however some can come to our doorstep.There are all sorts of emerging infections, part of our job as the front lines of healthcare is to be aware of the some of the surveillance data and recommendations for outbreak response
- Brucella is making a comebackChikungunya is a disease most of you have probably never heard of but is quite widely spreadAnd the latest data in nature shows an under-recognized global epidemic of dengue that might surpass malaria as a leading cause of fever in the return traveler
- Dengue in places like Portugal that have not seen it since the 1920s
- Thenovel coronavirusthat came under a lot of focus at the WHA
- This is the JWLee Centre for Strategic Operations at the WHO, where world experts are working on very interesting policies on early warning and surveillance, rapid risk assessments and responses in outbreaks.
- There is an increasing body of evidence on how climate change affects health and it is very interesting
- WHO has published on how we can expect changes in patterns and increases in vector borne illnesses, more unpredictable weather patterns leading to cyclones, floods, droughts, and also an increase in incidence of heat stress related illnessesI don’t think that we’ll experience a tsunami here in Canada, but..
- … tropicalstorms have been known to hit close to home
- And at the very least we do deal with yearly heat waves that could get worse and worse.Knowing about these patterns and expecting them will lead to better recognition, better treatment algorithms and better preventative measures
- Awareness of such trends not only allows an understanding of the current determinants of health, but also allows prediction of future priority areas of prevention, health promotion, allocation of resources and needs for capacity building
- As some of you may remember I presented before about the virtues of field work based one my experience after coming back from Tanzania, and as much as I enjoyed seeing patients there, I have come to the realization the short-term mobile clinic setting was not effective or sustainable in a way that is needed. And if you don’t have 6 months to commit to missions with MSF and maybe only have 2-4 weeks to spare then I’d like to talk to you about an international project that was much more satisfying and had a longer lasting impact
- ECP program is 2year program where the 2nd years supervise the 1st years.Pre-made curricula, based on global standards of practice but adapted to the local settingPromoting independence and fostering teaching skills of the local nurse practitioners
- Expanding withprehospitalemergency response outreach programECPs involved in teaching community nurses and lay people through workshops and pictorial materials how to provide basic emergency care
- Training them to be local experts inprovidingtrauma care (performing complex laceration repairs and inserting chest drains), but also keeping trauma registries with injury surveillance data.
- While I was there I created an injury prevention module for them to start incorporating patient advocacy into their care based on WHO guidelines
- They have published burden of disease papers, but perhaps their most interesting research is in the safety and efficacy of the task-shifting model as evidenced by the Ketamine study published in Annals of EM in April 2012
- Another fascinating and exciting area of teaching is in ED ultrasound. The ECPs mastery of the ultrasound probe empowered them toremarkably increase their diagnostic ability and inform safer and more cost effective treatment and management plans.I used the PIH U/S manual as a guide to teach U/S concepts within the resource limited context
- There is a push by the authors of that manual to develop training curricula that can be used in a variety of settings.This is a picture of one of my role models and mentors, Dr. RaghuVenogopal, working with MSF, and holding the U/S machine up so that a health provider in Chad can perform the diagnostic test herself.As I said before, I see these kinds of activities as simply an extension of the advocate role when you try to view a global community without the constraints of national boundaries and social divides
- In the face of rising help cost budgetary cuts and increasing complexity the work that we have to do, might it be a good idea to train more mid-level providers such as emergency nurse practitioner, physician assistants, and advanced care paramedics to accomplish task shifting in our setting?
- Another are of global health I was involved in was at the WHO participating in collaborative research into Emergency Medicine capacity in LMIC, as part of raising awareness and attempting to quantify the unmet need for EM and acute care in these areas.This was particularly challenging as the WHO relies on volunteers and the EESC does not currently have as much capacity for research in acute care as academic institutions such as ivy league universities in North America do.Also it can be difficult in general to publish in scientific journals that place a higher value on RCTs, which tend to be technically unfeasible or unethical in the LMIC context, and furthermore, as Paul Farmer would argue, in a global health context, rigorous observational studies provides more useful information to the policy maker or program implementer than RCTs that, in the name of minimizing bias and achieving ethical equipoise, strip away all of the social and economic disparities that make up the context in which that knowledge needs to be applied. They in essence have more external validity.
- I want to prove to you that its not that hard to be involved in the activism arm of advocacy, even globally, and you don’t have to step too far out of your comfort zone to do it.“Civil society networks, individual nongovernmental organizations at international and community levels, professional groups, philanthropic foundations, trade associations, the media, national and transnational corporations, and individuals and informal diffuse communities that have found a new voice and influence thanks to information technology andsocial media – all of these actors have an influence on decision making that affects health.”
- Example of Municipal Health Programme:Emergency (Urgences) as a cross cutting/lateral program in the ASSS-Montreal’s service delivery plans offers multiple opportunities for involvement at the municipal health systems and public health level.
- Example of activism in the form of protest
- Examples of activism in the form of peer-reviewed publication/editorials/commentary, and in the form of media interviewsAll raising awareness about how federal cuts to refugee health care are having impacts on provincial health care.Is this subset of our population that no longer has access to the same level of care the first symptom of a threat to the sustainability of Canadian Universal health care?
- Example of an open letter to PM Stephen Harper by MSF, detailing how talks on new trade agreements with South East Asia include provisions that bolster Pharma companies Intellectual Property rights to the point of delaying or halting generic drug manufacturers from providing LMIC and NGOs with life-saving medications at a price that makes it possible for the poor to benefit from them.Also an example of a poster campaign on the same issue.
- An example of an online forum to connect with professionals around the world, participate in discussions about global health and keep up to date with issues through daily digest emails and customizable threads to follow.
- This is an example of the GIEESCMednet, which is a similar forum run by the WHO EESC with a similar purpose of gathering and liaising with stakeholders in Emergency and Surgical Care
- Cannot talk about activism without mentioning social media and its impact on knowledge sharing
- EPs are already leaders in using social media to promote Free Open Access Medical Education (FOAMed) innovation, and knowledge sharing. This technology makes it so much easier to assist in EM development across borders we just have understand its potential and have the willingness to try.
- The blogosphere and the twitterverse are no longer arena’s to be laughed at or ignored by academia and professionals. Medical blogs have increasingly relevant and good quality content on them and can serve as a platform for all professionals to share ideas and raise awareness on issues like never before.
- This is by no means anexhaustive list of twitter feeds that I follow regarding Global Health and it has changed the way that I acquire knowledge and share it.I see it as a great tool for bridging the gap in health advocacy between agent and activist.
- With Social Mediacomes a new set of politics of circulation of knowledge in academics that do not follow the rules of peer review that we are used to and I think that it is wise to exercise some caution when interpreting this knowledge.“academics may need to pay more attention to the politics of circulation that increasingly define how academic knowledge is discovered and transmitted. If we don’t understand the politics of data circulations that define contemporary media cultures then we may also find that academic practice is reshaped without sufficient reflection and reaction.”