International Medicine

Global Health Newsletter

Reconciling compassion with practice: Annual Global Health Symposium explores critical questions

Global Health Allies at the symposium (from left): Pamela Mazzeo, MD, Barbara Picard, CRNP, Carine Golfetto, RN, Kelly Vuong, RN, Eden Kahle, MD, and Debra Voulalas, MD.

On Sept. 21 and 22, 2012, more than 175 physicians, nurses and other health professionals gathered at The Union League of Philadelphia for the Fifth Annual Pediatric Global Health Symposium, sponsored by The Children’s Hospital of Philadelphia. The symposium, titled “Reconciling Compassion with Practice in Global Health,” brought together experts from around the world to discuss the ethical and cultural challenges facing global health professionals. Some of the questions they raised are outlined below.

What are our priorities?

In the keynote address, medical ethics expert Ezekiel Emanuel, MD, PhD, vice provost for Global Initiatives at the University of Pennsylvania, identified an ethical framework for making long-term decisions in global health that prioritized global health interventions as follows: to save more lives, to save more lives with the longest prognosis and return people to high-quality lives, and to cure rather than treat chronic conditions. He emphasized that decisions should be based on quantitative head-to-head comparisons and should be sustainable over the long term.

What is good enough?

“Is it good enough?” was a question several presenters explored. Sara Stulac, MD, MPH, director of pediatrics and oncology for Partners in Health (PIH), described PIH’s mission — to provide medical care and advocate for the rights of marginalized populations — and emphasized that fighting inequality requires compassion and solidarity. She spoke of her work in rural Rwanda, describing a case in which PIH not only cured an 11-year-old girl’s illness, but also provided financial support to her family — an example that highlighted the fact that, in many cases, simply treating a patient’s illness just isn’t “good enough.” Stulac emphasized that all people deserve access to care, and that to improve that access we must support the sustainable growth of local and national health systems and advocate for appropriate interventions. Arthur Caplan, PhD, director of the Division of Medical Ethics at New York University Langone Medical Center, raised the “good enough” question in a different paradigm: cholera. He described how decisions associated with fighting cholera — in particular, which vaccines to use, and whether vaccines should be stockpiled to fight epidemics — highlight how much ethical standards vary across the world. For example, responding to a cholera epidemic with a one-shot vaccine wouldn’t be considered “good enough” in the United States. But is it OK to do it in a low-income country? And who gets to decide: international donors and agencies or the target community/country? To answer those questions, Caplan said, we must study these complicated issues in low-resource settings.

What Is the role of compassion in public health?

In a lively panel discussion, David Addis, MD, MPH, director of Children Without Worms; Betsey Behr Brada, PhD, from Princeton University’s program in Global Health and Health Policy; and Pat Daoust, MSN, RN, chief nursing officer for the Global Health Service Corps, discussed the role of compassion in public health. They shared personal stories that illustrated the complex ethical and cultural challenges that global health professionals face and looked at how actions we perceive as compassionate can be interpreted in a different way by others. They also spoke about how important it is for global health professionals to have compassion for themselves and each other, and to find a “safe place” to discuss how their work affects their lives.

Who benefits?

Who benefits from global health training experiences? Who is burdened? These are some of the questions global health training expert John Crump, MB, ChB, DTM&H, McKinlay professor of Global Health at the University of Otago, New Zealand, and Jeremy Sugarman, MD, MPH, MA, Harvey M. Meyerhoff Professor of Bioethics and Medicine at Johns Hopkins University, explored during panel discussion. Crump described the guidelines that he and his colleagues developed to measure the costs and long-term benefits of global health training experiences. The guidelines focus on the importance of proper preparation, training and supervision of trainees; the need to establish structured programs between partners and a comprehensive accounting of costs; and the value of having both long- and short-term partnerships. Sugarman described the online tutorials that he developed with colleagues from Johns Hopkins and Stanford that highlight three domains in global health training: trainee behavior, the broader context of short-term programs and research. He also shared data from the initiative to support theclaim that ethics training is needed and that the curriculum is reaching a broad audience, and described the next step in the project: to determine if the curriculum results in knowledge and behavior changes.

What causes poverty?

Sister Lenore Gibb, an educator with the Grey Sisters of the Immaculate Conception, has spent decades working with the poor in Consuelo, a small town in the Dominican Republic. In her presentation, she explored the causes of poverty and the role compassion plays in helping to alleviate it, and emphasized how important it is to be compassionate and to accept compassion from others.

Gibb also described the concept of compassion fatigue and spoke about how important it is for global health professionals to find an “authentic source of compassion” to sustain and inspire them during difficult times. To give compassion, she said, we must first learn how to receive it.

Where can I go from here?

In other sessions, young global health professionals talked about their careers and discussed the challenges and rewards of their work, and global health experts spoke about the different training opportunities and career tracks available in the field. For more information on CHOP’s Global Health Program, and to view presentations from the 2012 symposium, visit http://www.chop.edu/globalhealth.

New Global Health Initiatives

Learning together: CHOP staff design and lead training sessions for community health workers in the Dominican Republic

Global Health Allies and health promoters with children in the barrios of Consuelo (from left): Maura Murphy, MPH, Ajoa Abrokwa, MSHEd, Merlin Ramirez, Yuly Espinal, Rosa Merlin Ramirez, Barbara Picard, CRNP, and Nellie Gomez, RN.

Ajoa Abrokwa, MSHEd, a maternal/child health educator with CHOP’s Early Head Start Program, spends much of her time traveling to homes in West Philadelphia to share information about child health and development with families. 

But in November 2012, she went farther afield, traveling to Consuelo, Dominican Republic, to train a group of community health workers — known as “health promoters” — as part of the Hospital’s Global Health Allies program.

The weeklong trip was more than a year in the making. Before leaving the United States, each of the four allies — Abrokwa, Barbara Picard, CRNP, Nellie Gomez, RN, and Layla Ware de Luria, MSW — worked with Global Health program manager Maura Murphy, MPH, to develop a curriculum focused on specific aspects of child or maternal health. The women planned presentations on breastfeeding, injury and violence prevention, prenatal care, child development and other topics — all of which were warmly received by the health promoters during their morning training sessions in Consuelo.

The group also traveled to a different neighborhood in Consuelo each afternoon to lead special workshops for women from the community — an experience Abrokwa found deeply inspiring. “The women were so positive,” she says. “They were very grateful for the information we provided — and they were so excited that we were there to support them.” 

For Abrokwa, the trip reinforced how important it is to pay close attention to the small details of people’s lives: their stories, their surroundings, even their facial expressions. It’s these observations, and this willingness to engage on a personal level, she says, that help you uncover people’s true needs — including those they may be unwilling or unable to articulate. “Developing a plan is easy,” she says. “The real work is in hearing their stories — you learn so much.”