Do electives contribute to, or detract from the Global Health Organisations targets 2025?

by Rebecca Bromell, 6th Year Medicine, University of Otago

The Global Health Organisations (GHO) targets 2025 refer to six goals for improving health and outcomes of mothers, infants, and young children, addressing both concerns associated with poor growth and nutrition and those with overabundance [1]. This range of concerns represents challenges faced by all countries. Therefore, the opportunity to have an impact on these targets exists for elective students from any part of the world. Whether or not electives do contribute to achieving these targets, or end up detracting from them, depends on many factors, such as the level of focus on mothers and children; the length of the elective; and the extent to which the elective can be considered token ‘voluntourism’ [2]. An elective provides opportunity to contribute to the GHO targets by either taking knowledge to other places or receiving knowledge from them.

Elective students often have the means to undertake placement overseas and come from places with the resources to address and tackle the concerns raised in the GHO targets. They may have received both formal teaching and situational learning on how to address concerns such as maternal anaemia, rates of breastfeeding, and both childhood failure to thrive and obesity. For example, Dunedin Hospital utilises oral and infused iron to combat anaemia, provides access to lactation specialists for all mothers, and advice to parents regarding childhood growth. The Dunedin Study was founded on goals of managing high risk pregnancies and improving perinatal outcomes, and later studied childhood growth, contributing to worldwide understanding of the concerns raised by the GHO targets [3].

Elective students with this knowledge have the opportunity to share it in places with differing levels of experience. However, to try to do so effectively, they must be able to respect and understand the differences in resources and culture that may facilitate solutions or create barriers to providing accepted interventions. In medical school I have often been taught about the need for trust and a good relationship between a provider and a community in order to deliver effective outcomes. A lack of understanding of an environment can prove a challenge as the community may not trust outsider knowledge, or providing certain treatments may not be feasible given differing resources. Achieving the targets may be also more difficult as mothers and children are among the most at-risk groups in society.

One half of my elective will be in the Cook Islands interacting with the community at all levels of care. The Cook Islands has over 30% of children considered obese [4]. While it is easy to simply advise a healthy eating regime, this fails to account for resources and cultural norms. From personal contacts within the Dunedin Cook Islands community I have learned that fresh healthy foods are expensive and sometimes scarce in the Cook Islands, and a significant proportion of the diet can consist of processed or unhealthy foods. There is also a cultural expectation that food should be offered at any gathering, with a surplus expected, and a refusal of food seen as a slight. Hence, trying to reduce levels of childhood obesity relies on a shift in cultural mindset, which will be impossible for anyone to achieve alone, especially in a short elective period. Benefit will come more from aligning oneself with local medical staff and bodies working to address maternal and childhood health outcomes, as they have the trust of the community and will be able to adapt ideas and concepts from other places to better suit the resources and needs of their people.

Elective students can also contribute to the GHO targets by gaining knowledge from their placements. Electives are a learning opportunity for students to experience new ideas, concepts, and strategies for addressing health concerns. While innovative solutions can be born of a lack of resources, at other times, placements spent at institutions at the forefront of medical research can provide insight into future health interventions, and potential novel strategies to bring back to one’s base of training. The second half of my elective is in Boston, learning Neonatology at a Harvard-affiliated, world-leading facility, under the personal supervision of its head, Professor Terrie Inder, an Otago graduate who exemplifies a global approach to learning and sharing of knowledge [5]. While there, I hope to learn what is being implemented and trialled regarding improved outcomes for babies in the poorest of conditions – those born at a low weight, often very prematurely, with multiple problems that may lead to poor growth during childhood. This facility is also in the unique position where it can influence policy from which many medical institutions take their protocols, thus leading to improved outcomes for babies worldwide.

While electives can present a great opportunity to further the GHO targets through both the sharing and acquisition of knowledge, there are always situations where a student can hinder interventions. The attitude and approach taken can compound a student’s difficulty in understanding cultural and resource factors and thus inhibit connecting with the community. Another concern of ‘voluntourism’ – volunteering abroad - is when one’s presence detracts from the aid local groups are trying to provide the community. While trainees require supervision and teaching, this should not be done at the expense of patient need [6]. However, by recognising and avoiding these pitfalls, once initial orientation and learning occurs, and contact has been enough that a student understands and has some rapport with a culture and people, they can become an asset to medical provision. They may comprehend why certain interventions may work, or may need adapting, and how they can contribute to the health of mothers and children. Thus, any elective can contribute to the GHO targets 2025, provided the student is actively dedicated and willing to immerse themselves enough to do so.

 

[1] World Health Organization. Global nutrition targets 2025: policy brief series (WHO/NMH/NHD/14.2) [Internet]. Geneva: World Health Organization; 2014 p. 1-2. Available from: https://apps.who.int/iris/bitstream/handle/10665/149018/WHO_NMH_NHD_14.2_eng.pdf?ua=1

[2] White M, Cauley K. A Caution against Medical Student Tourism. Virtual Mentor [Internet]. 2006 [cited 1 June 2019];8(12):851-854. Available from: https://journalofethics.ama-assn.org/article/caution-against-medical-student-tourism/2006-12

[3] Dunedin Study | The Dunedin Study - Dunedin Multidisciplinary Health & Development Research Unit [Internet]. Dunedinstudy.otago.ac.nz. 2019 [cited 1 June 2019]. Available from: https://dunedinstudy.otago.ac.nz/studies/assessment-phases

[4] The Authors. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents and adults. Yearbook of Paediatric Endocrinology [Internet]. 2018 [cited 30 May 2019];390:2627-2642. Available from: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2817%2932129-3

[5] Commisso M. Inder Named Avery Professor of Pediatrics | Harvard Medical School [Internet]. Hms.harvard.edu. 2019 [cited 1 June 2019]. Available from: https://hms.harvard.edu/news/inder-named-avery-professor-pediatrics

[6] White M, Cauley K. A Caution against Medical Student Tourism. Virtual Mentor [Internet]. 2006 [cited 1 June 2019];8(12):851-854. Available from: https://journalofethics.ama-assn.org/article/caution-against-medical-student-tourism/2006-12