Mentorship is a Partnership

December 1, 2022

From the December 2, 2022 Global Health Issue of the Transformational Times

Perspective/Opinion 

Mentorship is a Partnership 

By Laura D. Cassidy, MS, PhD  

Dr. Cassidy, the Associate Dean of Global Health, has been a long-term mentor for the Dr. Elaine Kohler Summer Academy of Global Health Research program.   

Being flexible and resilient are important and unexpected skills that medical students develop as they embark upon global health research. Unlike a highly structured medical school experience, students learn to adapt when things do not go according to plans. They pause, engage in the culture, and practice patience and kindness. 

I learned as much from my medical students as they did from me—if not more.  I have enjoyed mentoring many PhD students and, in 2018, I had the wonderful opportunity to mentor my first medical students in the Dr. Elaine Kohler Summer Academy of Global Health Research Program. We traveled to Kigali, Rwanda to meet with my partners and then to Kampala, Uganda where Sarah Benett (M1) and Brittany Fickau (M1) participated in a research project with my colleagues at the Child and Family Youth Foundation. They learned many important and expected research skills, from how to design an international study, to working with clinicians, to administering the Malawi Developmental Assessment Tool (MDAT) in young children, to analyzing data, and to preparing a manuscript. 

I learned about the pressure that medical students impose upon themselves—their perception of needing to work twelve-hour days to being highly productive—and it was difficult for them to slow down and engage at African speed. An important unexpected skill that they developed was to pause and observe the culture.  In this crowded city in a low- to middle-income country (LMIC), being “punctual” takes on a new meaning. Someone can plan to be early for a meeting or clinic but if there is a bad traffic jam, they may sit for hours in traffic. The meeting may happen three hours later or not at all.  

At first, there was stress because of their internal pressure to be productive and, yet, they were dependent on a system and culture that they could not control. They learned to work with women and children in a clinic that served residents of informal settlements.  They did not speak the same language.  They were dependent on clinic staff and interpreters.  They learned to form meaningful relationships and to network.  There were reflections on how to be efficient with very limited resources and the importance of listening…even when you don’t speak the same language. One of the most import skills we all cultivated was flexibility. When things don’t go according to plan- pivot and be resilient. 

All these experiences became even more important in 2020 when the pandemic hit.  The next two M1 mentees, Lauren Tostrud and Hannah Racicot, were planning to do their summer research program in Rwanda. We did the best we could to zoom there frequently, and they worked diligently with our partners on important literature reviews about the effects of the Hutu genocide against the Tutsis. We stayed in our homes and watched movies about sub-Saharan Africa and the culture and discussed them.  Throughout the pandemic, they never complained, they remained excited about their work, and I learned about the ways they implemented the skills they acquired into their medical school training. 

I am honored to serve as a mentor to these bright and dedicated students and this role does not end after a semester or graduation. Together we learn, we support each other, and we thrive. 

Laura D. Cassidy, MS, PhD, is the Associate Dean of Global Health, Professor and Director of the Epidemiology & Social Sciences Division, and Founding Director of the Master of Science Program in Global Health Equity at MCW. 

Transforming Today’s Medical Learners Into Tomorrow’s Global Health Leaders

 From the 4/23/2021 newsletter

Perspective/Opinion 

 Transforming Today’s Medical Learners Into Tomorrow’s Global Health Leaders 

Lee Ann Lau, MD, FACS

Dr. Lau describes the GME Scholars in Global Health Program, a two-year voluntary curriculum for residents interested in exploring issues of global health equity...

We have all witnessed the global nature of health through the lens of the current pandemic. It is timely that our globally engaged faculty along with the Medical College of Wisconsin Office of Global Health have started a new training program for residents and fellows to build character and competencies to enhance care for patients and their communities. 

Reviewed and supported by MCWAH’s GME Committee, the GME Scholars in Global Health program is a two-year curriculum created to teach global health principles and concepts to residents and fellows. It is designed to cultivate cultural sensitivity, allowing the Scholars to appreciate the global burden of disease and understand how they can use their specialty training to collaborate to address health care inequities and improve access to care from neighborhoods to nations. With multi-disciplinary interactive didactics and biannual deeper dive seminars, the program will emphasize leadership and networking while developing global health skills and knowledge.

The inaugural cohort includes thirty-seven residents and fellows from twelve medical and surgical specialties. Many Scholars are new to the field of global health, but some already have extensive experience they wish to strengthen. During the application process, GME Scholars expressed a desire to incorporate global health skills and knowledge into their future careers. Gaining a broader perspective on how cultural, psychosocial, and economic factors impact the illness and injury experience and outcomes was noted as a priority to provide better care, both locally and globally. Scholars also noted interest in research and obtaining a better understanding of how environment and infrastructure impact care delivery.

 The Scholars are invited to compliment the core curriculum with other experiential learning activities during MCW’s Global Health Week and by participating in the Consortium of Universities for Global Health Virtual Capitol Hill Day, which includes teaching for how to effectively engage legislators.

To launch the new training program in January 2021, the Scholars participated in a discussion about the definition of global health, led by Dr. Stephen Hargarten, Associate Dean for Global Health; and Tifany Frazer, Office of Global Health Manager. The group reviewed the Biden-Harris Administration’s Statement on Global Health Security and considered what recommendations they would make if given the opportunity to influence the new administration’s global health agenda. Not surprisingly, the cohort’s main priority was COVID19 treatment, pandemic management, and vaccine distribution. However, they raised many other important issues including health care equity, rejoining the World Health Organization, addressing climate change, promoting maternal fetal health, and infectious disease research, as noted in their combined word cloud.

The curriculum is co-lead by Drs. Mac Longo, Radiation Oncology; and Ashley Pavlik, Emergency Medicine. Evaluation lead is Dr. Stephen Humphrey, Dermatology; and scholar development lead is Dr. Steve Hargarten, Associate Dean for Global Healtha. The program receives input from eighteen faculty members from more than ten specialties who have dedicated their content expertise to the training program. The didactic lectures and discussions will include a wide range of topics with a global health focus, including noncommunicable diseases, travel medicine, global EMS and disaster medicine, tropical dermatology, private/public partnerships, trauma care, imaging considerations, and eye disease. This rich learning environment will foster the passion and creativity needed for tomorrow’s global health leaders, strengthening their competence, care, and character.

For questions about the program or to apply, please contact the Office of Global Health Manger, Tifany Frazer at tfrazer@mcw.edu.

 Lee Ann Lau, MD, FACS, is currently completing the Hospice and Palliative Medicine Fellowship at MCW after spending 13 years in private-practice general surgery. After graduation, she is planning to start a faculty position with MCW in the Department of Medicine’s Division of Geriatrics and Palliative Medicine.

Global Engagement Elicits the 3Cs

From the 12/4/2020 newsletter
 

Perspective 
 
 
Global Engagement Elicits the 3Cs
 
 
Stephen Hargarten, MD, MPH and Tifany Frazer, MPH – MCW Office of Global Health
 
 

In this essay, Dr. Hargarten and Ms. Frazer share how the missions of MCW, the Kern Institute, and the Office of Global Health overlap, and celebrate how students – taken outside of their normal cultural contexts to experience medical care in low- and middle-income countries – return with new appreciations for the value of competence, character, and caring in medicine …  
 
 
A MCW medical student recently reflected on a positive experience with a mentor: 
 

“We can easily forget we are treating a person and not just the disease. Despite feeling like we know best, we sometimes forget to include patients in the decision-making process. The doctor and patient collaborated to help develop their own healing systems outside from dependency on medications. Medications for chronic pain were replaced with relationships.”

As we celebrate MCW’s 10^th Annual Global Health Week, we are reminded that global engagement opportunities expose our students to new healthcare practices, build their character by challenging their personal beliefs, and stimulates the development of innovative solutions for patient care. As one trainee reflected, after observing that access to technology is restricted in low resourced settings, “You have to use and rely on your clinical skills and judgment. You likely become a better steward of resources, and arguably a better clinician.”
 
A report by the Lancet Global Independent Commission on “The Education of Health Professionals for the 21st Century” asked academic institutions to rethink professional education reforms in our century. It stated “the extraordinary pace of global change is stretching the knowledge, skills, and values of all health professionals.” The Commission called for “more agile and rapid adaptation of core competencies based on transnational, multi-professional perspectives to serve the needs of individuals and populations” and sought transformative education to develop leaders for the 21st century. 
 
The transformational gift of Robert D. and Patricia E. Kern validates the belief that the healthcare environment of the 21^st century is a global one, encompassing everything from engaging with researchers worldwide to providing clinical care in culturally diverse local communities. MCW trainees’ reflections following their global health research and clinical rotations are reviewed and demonstrate the following themes: perspective, awareness, ambivalence, and practice. A trainee reflected: 
 

"The list of health disparities I witnessed ultimately would take me hours to describe. As a physician, this experience forced me to alter my expectations and become more flexible in regards to medication compliance, progression of disease processes, and utilization of diagnostics and treatments given these limitations in resources." 

This student experience parallels the Kern Institute’s national movement and vision to transform medical education along the continuum. Engagement with diverse communities, whether local or international, reflects the current and future common realities of healthcare and humanity and what type of doctor is needed for the future. Another trainee reflected, 

 
“I am certain I have been impacted in more ways than I can truly describe. I know that as a physician and even more so as a human being I have been undeniably transformed."

 
Similar to the Kern Institute’s advancement of the Triple Aim of Health Care through its “Triple Aim for Medical Education,” faculty and staff active in global health efforts facilitate stronger connections to become caring, competent, and compassionate physician leaders committed to improving population health and enhancing patient outcomes, locally and globally. Our trainees benefit from experiences in low, middle, and high resourced settings, that compare and contrast health and health care in a variety of complex socioeconomic, political, and cultural environments. As the Kern Institute seeks to develop innovative models to optimize health system performance, physicians who are more comfortable “using a truly globalized approach (integrating therapies and treatment from a variety of resourced settings and cultures)” are more likely to improve health through enhanced care at a better value. 
 
Immersion in clinically and culturally diverse settings allows medical students and faculty to examine their preconceived notions of medicine and their roles as healers. The AAMC posted a story on their website indicating that “global health curriculum and electives provide lessons in patient advocacy, health equity, and humility.” A medical student quoted in the article reflected on a global health rotation in a low resource environment, “Working in this environment requires self-awareness, strength, and humility to accept and then overcome challenges to one’s way of being, thinking, and perceiving the world.” This parallels the Kern Institute’s expected outcome to cultivate physicians with the attributes of “fairness, honesty, kindness, leadership, and teamwork.”  
 
Most of the institutions collaborating in the Kern Institute are, with MCW, fellow members in the Consortium of Universities for Global Health (CUGH) including UW-Madison, Mayo, UCSF, Vanderbilt, and Dartmouth. Our connections to these institutions through CUGH would provide a ready-made platform for us to broaden the reach of Kern innovations, testing our ability to sustain and replicate these initiatives through a global health lens. 
 
As a medical student stated,
 

“As a future provider, this experience has expanded my character and ability to care for diverse patients in several ways. Foremost, it re-enforced that the basic principles of medical care are present across all cultures and peoples. Physicians have a responsibility to help alleviate physical and emotion suffering in all those that seek our care, and to do this, we must establish trust, and show empathy."

As the Kern Institute’s leadership continues to seek broad input on what this transformational gift can impact, we know that continued investment in global health-focused educational offerings is necessary for creating compassionate, caring, competent physician leaders with strong resilient character for the 21^st century.
  

Stephen Hargarten, MD MPH is a Professor of Emergency Medicine, Founding Director of the Comprehensive Injury Center, and Associate Dean of Global Health at MCW. 

 
Tifany Frazer, MPH is the Program Manager of the MCW Office of Global Health. 

Waiting in Lines

 From the 12/4/2020 newsletter

 
 
Waiting in Lines
 
 
Bruce H Campbell, MD – Transformational Times Editor
 
 
In recognition of MCW’s annual Global Health Week, Dr. Campbell shares some of what he has learned from his global humanitarian trips …
 
 

“At its best, medicine is a service much more than a science.”
- Paul Farmer, MD

Long lines form when the global health team show up. In El Salvador, people arrive in the backs of trucks and then wait hours for one of our provider groups to assess their stomach pains, headaches, or dental problems. The men, all in long pants despite the heat, talk while women in bright dresses tend the children. In rural Kenya, women in cotton print Kanga wraps and men in tattered clothes come from all directions by foot, bicycle, or “boda boda” (the ubiquitous motorcycle taxis), waiting on long benches in the equatorial sun. At the medical center in Eldoret, Kenya, the hallways adjacent to the ENT Clinic are packed with people wearing US-donated t-shirts bearing the names of sports teams, universities, and companies – shirts re-sold to them by roadside vendors.
 
There is no way we could ever operate on everyone who shows up. What could we possibly offer to so many people?
 
 “This is crazy!” I say to one of our hosts. “We’ll never get through them all.” During a typical workday at home, I see several patients, prepare Epic notes, check diagnoses and billing codes, click all of the boxes, and close the charts. If I am lucky, I can get through twenty people.
 
“We told them that the Americans would be here this week, so they showed up.” He shrugs. “No problem.”
 
The ENT Clinic in Eldoret, Kenya is an exercise in controlled bedlam. The handwritten records fall apart as I flip through them. The quality of the scans and ultrasounds remind me of those I saw in my training forty years ago. We jam two or three patients in the same exam room so the Kenyan and US doctors, nurses, and medical students can peer over one another’s shoulders; there is no HIPAA or pretense of privacy. Patients for whom we have something to offer nod and move to the nurse’s desk to schedule surgery. Patients for whom we have nothing nod and head home.
 
At the end of the day, I look down the hallway. There are still several people who have been waiting since early in the morning. “They’ll be back tomorrow,” says my Kenyan colleague. And they are.
 
I wonder how it feels to wait hours for an opportunity – maybe the only opportunity – to see a specialist and then be told to return the next day or, maybe, never at all.
 
My very first humanitarian trip was to El Salvador where we saw dozens of unfailingly gracious patients. At the very end of the final day, there were still many people outside the clinic. My wife, Kathi, who had dusted off her nursing skills for the trip, accompanied an interpreter to talk to those in line. “Lo siento (I’m sorry),” the interpreter said. “We can see no more patients. The doctors and nurses must return to San Salvador before dark and they will not be back until next year.”
 
“That’s all right,” one of the women responded as she shook Kathi’s hand. “Thank you for coming to help us. We will return next year, as well.”
 
The next day, as we waited in Houston for our connecting flight, Kathi told our traveling companions about her encounter with the grateful woman. While she was speaking, the gate agent announced that our flight to Milwaukee would be delayed several hours because of a major storm disrupting air traffic all along the eastern seaboard.  
 
“This is outrageous!” A sunburned man near us angrily strode to the counter and berated the agent. “My family and I are heading back from vacation in Mexico and I must be at work for very important meetings tomorrow morning. I demandthat you re-route us now! We will not wait!”
 
The gate agent, in a remarkable display of self-control, apologized and said there were no options; every airline had been affected by the storm. The man paced the waiting area, yelling into his cell phone and circling back to the counter at intervals to loudly register his displeasure. Finally, he announced that he and his family were heading to a hotel and that the airline had better cover his expenses. “You’ll be hearing from me!” Off he stormed, family in tow.
 
“What a contrast!” Kathi noted. “Imagine if the Salvadorans who waited had reacted that way.” We were not blind to the grinding poverty in El Salvador and had heard stories about the people’s lack of opportunity, safety, services, and health care (a process Paul Farmer terms “structural violence”), but every one of us noted how grateful and gracious the Salvadorans had been during our one-on-one interactions.
 
Later that evening, a plane arrived. It was a long day, but we did sleep in our own beds that night. 
 
As Paul Farmer notes in his book, Pathologies of Power: Health, Human Rights, and the New War on the Poor, 
 

“The voices, the faces, the suffering of the sick and the poor are all around us. Can we see and hear them? Well-defended against troubling incursions of doubt, we the privileged are precisely the people most at risk of remaining oblivious, since this kind of suffering is not central to our own experience.”

Each global health opportunity has allowed me to view life through a brighter, sharper lens. The lines are always long and colorful. My memory is filled with people, each one hoping that they will hear a word of hope and healing when their time of waiting is finally done.
 
 
 
 
Acknowledgement: Thanks to the MCW Moving Pens and to my wife, Kathi, for valuable advice. A previous version of this essay first appeared in my blog, Reflections in a Head Mirror, in 2017.
 
 
Bruce H Campbell, MD FACS is a Professor of in the Department of Otolaryngology & Communication Sciences and in the Institute of Health and Equity (Bioethics and Medical Humanities) at MCW. He is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for Transformation of Medical Education. He serves as Editor of the Transformational Times. 
 

Fact: Malaria in pregnancy causes 200,000 stillbirths per year in Africa

A poem for Global Health Week

Fact:
Malaria in pregnancy causes 200,000 stillbirths per year in Africa 
 

 
As the shadow attaches to her toes
so the mother slings the still
born over her shoulder until night
when her birthed treasure is buried
with the others under the blankets.
At cock’s crow she presses the pink
of his unformed lips to her breast.
Soon the dead will have another
Birthday, and she will tell him stories.
 
 

Cameron Conaway
From “Malaria Poems” (Michigan State University Press, 2014)
 
 

Cameron Conaway is an adjunct professor in the Professional Communication Program at the University of California-San Francisco. He was the first poet-in-residence at Bangkok’s Mahidol Oxford Tropical Medicine Research Unit (MORU).