Developing Global Health Skills in Ireland

November 7, 2019

By Ruth Yan, Key Correspondent for the Irish Global Health Network

I was honoured to be invited to the inaugural Global Health Symposium at the College of Anesthesiologists in Dublin on October 25th, 2019, where I sat amidst a sea of decorated doctors
and global health leaders.

We started by looking at a vision for global health education, then shifting our focus to what  we’ve learned from past projects, notably the importance of partnering with existing systems and
projects to ‘build capacity’ and develop the health workforce. Finally, we looked at what that meant for us moving forward.

Global Health Education – Professor Diarmiud O’Donovan, Professor of Global Health in Queens University, Belfast

O’Donovan spoke of the pitfalls of overseas work with those starting out. He said that students embarking on medical electives overseas often have this grand idea about changing the world, and doing and seeing things they wouldn’t be able to do at home.

Unknowingly, these trips often commit the ‘seven sins of humanitarian medicine’ coined by Welling et al. (2010). These electives often benefit the student more than the countries they aimed to help.

“The key issue is that our elective students are learners, they’re not providing a service…the biggest beneficiary is the medical students, no question about that,” said Professor Diarmuid O’Donovan.

Both Prof O’Donovan and Dr Laura Heavey, Specialist Registrar, Public Health Medicine, HSE highlighted the importance of reciprocity. Instead of aiming to provide aid (one directional giving), we need to acknowledge the idea of mutual benefit and bidirectional solidarity.

Students must be trained in various competencies, including knowledge, skills, attitudes and values. Prof O’Donovan cited the book Hoping to Help by Judith Lasker as a valuable resource.

He highlighted that one’s attitudes and mindset are extremely important, and proposed the idea of becoming ‘plasticine doctors’, mouldable to the situation at hand.

Support for Global Health in the Irish System – Dr Laura Heavey, SpR, Public Health Medicine HSE

Dr. Heavey gained a new perspective on her role as a doctor after participating in global health work for many years. Unfortunately, that came at a cost – she explained, especially in the form of loss of benefits and being enrolled in a different pension scheme compared to her Irish, nonglobal health counterparts.

She doesn’t regret taking part, but acknowledges that this could hinder a prospective professional’s choice to work in the field and is something we need to address, she said.

Comparative Primary Care – Dr. Martin Rouse, Programme Director, South East GP Training Scheme

The Irish GP system is a well established ‘single culture system’. Unfortunately, this doesn’t necessarily reflect the new influx of migrants, who belong to different cultures. Dr. Rouse introduces the idea of comparative primary care as a benefit of global health training for the Irish health system. “We need to focus on comparative primary care and not just Northern Europe,” said Rouse.

Comparative primary care is currently part of one of the GP schemes, and allows doctors to take part in one of two rotations in either Malawi or Western Australia to learn their local practices and skills in addition to learning about the local culture and attitudes. It goes back to the idea of creating ‘plasticine doctors’ – ones that can easily adjust and adapt to what they have.

Those chosen for this newly accredited scheme are provided with adequate support in line with the newest global health policies, including occupational health, training, and cultural support.

What do trainees think? – Dr. Ellen Curshell, Dean of Faculty of Paediatrics, RCPI

An assessment on what current paediatric trainees think about their global health training showed a low response rate of 21%, but most of those responding had been on global health trips or wished to do so in the future. More than 60% of those that went abroad had pre-travel induction
or training. While the duration of trips were varied, most trips took place between participants basic and higher specialist trainings, and many highlighted that a psychological/wellbeing support was or would be useful.

Dr. Curshell is currently working to make sure these supports are made available to each trainee going abroad.

Migrant Health Ireland 2019 – Dr. Margaret Fitzgerald, National Public Health Lead Social Inclusion and Vulnerable Groups

With the recent influx migration, the idea of global health isn’t overseas anymore – it’s right in our very own backyard, according to Dr Margaret Fitzgerald. There are over 7,000 migrants in direct provision alone, all coming from different backgrounds that our medical system is still  learning to meet.

Our system here is focused on Irish culture and health, according to Dr. Fitzgerald who said there is a need for a new ‘migrant health’ to be embedded into medical training to meet the unique needs of these individuals – many of which are not simply ‘medical’ in nature.

‘I don’t go overseas much anymore… overseas is here – global is local!’ – Dr. Margaret Fitzgerald

As a medical student, this symposium provided a lot of food for thought. Voluntourism to lower resourced settings are increasingly becoming a trend. It seems that we may need to re-evaluate how we approach these electives to ensure reciprocity, whether by working with seasoned doctors to provide a teaching service at the same time, or ensuring that our ‘donations’ are
appropriate to the situation.

We also need to remember that global health doesn’t just apply to overseas work – and that we need to employ some of the same approaches we previously designated as ‘global health specific’ to our day-to-day lives in a clinical setting.

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