Foundations.

Perspectives from a new Global Health Student and Humanitarian Health Care Ethics Research Group Trainee

Gautham Krishnaraj, MSc Global Health Candidate (McMaster University)

From Montreal…

In September 2014, at the peak of the Ebola outbreak that inundated the minds of media and global citizens alike, I found myself in an unlikely situation. I, as a third year Microbiology & Immunology student at McGill University, was working as part of a global coalition of health professionals to research, compile and brand training protocols for the International Medical Corps (IMC). Here, I was able to see the laboratory techniques and virology concepts I was learning in the classroom be applied in real time by the IMC’s Multi-Agency Training Collaboration (MATCO) to support the Ebola response in West Africa. As an aspiring Humanitarian Health Care Professional, it was an exciting first exposure to this fast paced, international, and interdisciplinary sector.

…to Hamilton,

Two years later, I find myself in Hamilton Ontario, in a ‘classroom’ that seems to defy all classical connotations of the word. The program, McMaster University’s 12 month Masters of Science (MSc) in Global Health, is a wildly successful (2015 CIBE Program of Excellence) experiment in international collaborative education. This morning’s lecture is a prime example of why; it’s happening 6,000 kilometres away at the University of Maastricht – and next week, students from the Netherlands will tune into our classroom here in Hamilton. Each lecture is followed by a chance to virtually connect with our global groups to work on assigned policies with real-world relevance and impact.

Working through time zones, language barriers, and diverse motivations, we face real challenges and prepare for the rigours of pursing a profession in this sector. One of the first ethical challenges we must consider is the language of correspondence itself; how are we (native english speaking Canadian students) placed in a position of power within our global teams? How does this influence the sharing of ideas and accessibility of information, and how can we work with our peers to dismantle these structures and enable full participation? Furthermore, how do language and regionality impact where, how and to whom humanitarian aid is delivered? With our expert mentors and a plethora of toolkits at our disposal, we will work together to tackle these challenges in pursuit of a greater understanding of this diverse sector. As a trainee in the Humanitarian Health Ethics Group, I hope to delve even deeper into the ethical underpinnings of humanitarian aid, and the impact of working in austere environments on the provision and providers of palliative care. Indeed, we must strive to keep the humanity in our humanitarian workers.

…India…

Perhaps one of the most anticipated elements of McMaster’s MSc. in Global Health is the two-week Learning Symposium at Manipal University, in the Karnataka State of India. Field-based training has been identified as an invaluable asset in the professional development of humanitarian health professionals, and despite having travelled quite extensively, I eagerly anticipate the opportunity to do so under academic/professional auspices. Students from partnering universities will come together from around the world to receive a unique field orientation and engage in critical dialogue surrounding our theses and scholarly papers. In preparation for this international experience, I have looked to Global Health Training – Ethics and Best Practices Guidelines for Training Experiences (Crump et al., 2010) for preliminary ethical considerations to guide my journey through the Program. Crump, Sugarman and the Working Group on Ethics Guidelines for Global Health Training (WEIGHT) identify three main populations in Global Health Training; Sending/Host Institutions, Trainees, and Sponsors, each with unique responsibilities and recommendations.

Focusing on the trainees for the purposes of this discussion, the first responsibility of the trainees is to “Recognize that the primary purpose of the [international] experiences is global health learning and appropriately supervised service.” This may come partly in response to countless case studies such as those presented by Dr. Robert Huish (2012) in a special issue of the Journal of Global Citizenship and Equity Education. Huish draws attention to the various complex ethical conundrums faced by an increasing number of medical students undertaking International Health Electives. Major challenges included “Navigating different cultures [of medicine], moving beyond one’s scope of practice, and unilateral capacity building” (Huish, 2012) (Elit et al., 2011). These situations not only place the trainee under immense stress, but also increase the liabilities of the institutions and diminish the quality of care received by the local populations.

The McMaster program appears to address these challenges and reflect the priority of learning by means of a tightly facilitated curriculum with a diversity of mentors to guide personal, professional and academic growth. Furthermore, being immersed in the Symposium’s academic setting should allow deeper engagement with cultural and local contexts, ideally allowing us to “demonstrate cultural competency and engage in appropriate discussions about different perspectives” (Crump et al., 2010).

…and beyond.

It remains to be seen if the two-week Symposium will provide sufficient field exposure for students to concatenate theoretical to practical competencies, and then demonstrate them during our practicums and thesis research. The fields of Global Health and Humanitarian Health Care not only share inherent ethical challenges, but also both suffer from a lack of professionalization and standardized competency based-training (Johnson, 2013). McMaster’s blended (online, in-class, field-based) classroom model is also particularly adaptable to the mobility needs of Humanitarian Health Care Professionals. I anticipate that this program will continue to evolve with each passing cohort, and provide valuable insight into the future of ethical Global Health and Humanitarian Health Care training for years to come.

References:

Crump, J. A., Sugarman, J., & Working Group on Ethics Guidelines for Global Health Training (WEIGHT. (2010). Ethics and best practice guidelines for training experiences in global health. The American Journal of Tropical Medicine and Hygiene, 83(6), 1178-1182.

Elit, L., Hunt, M., Redwood‐Campbell, L., Ranford, J., Adelson, N., & Schwartz, L. (2011). Ethical issues encountered by medical students during international health electives. Medical education, 45(7), 704-711.

Huish, R. (2012). The ethical conundrum of international health electives in medical education. Journal of Global Citizenship & Equity Education, 2(1).

Johnson, K., Idzerda, L., Baras, R., Camburn, J., Hein, K., Walker, P., & Burkle, F. M. (2013). Competency-based standardized training for humanitarian providers: making humanitarian assistance a professional discipline. Disaster medicine and public health preparedness, 7(04), 369-372.

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