Published on in Global Health Update
Children's Hospital of Philadelphia (CHOP) is home to a premier pediatric global health training program, the David N. Pincus Global Health Fellowship Program, which offers an educationally rich and immersive experience for future leaders in global child health. CHOP has longstanding partnerships in Botswana and the Dominican Republic (DR), which offer fellows the opportunity to live, work and learn in these international settings for three years.
Pursuing global health
CHOP's Global Health Fellowship Program is what drew Clarisse Casilang, MD, now an attending physician in California. Having moved to the United States from the Philippines at a young age, Dr. Casilang had often accompanied her grandmother on visits to the doctor. She remembers the vivid contrast between the Filipino health care system and the medical care she observed in the United States.
"I realized that barriers to care can arise when providers do not understand the culture of their patients," says Dr. Casilang. This new awareness inspired her to strive for culturally respectful care; a value further solidified during a clinical rotation in Mexico during Casilang's third year of residency.
In Mexico, Dr. Casilang was able to spend more time with each patient than she usually would have in her U.S. practice. This gave her a contextual understanding of her patients' lives and better informed their care. During this time, she also honed hands-on clinical skills and was exposed to conditions she had rarely seen in the United States. "I saw clearly the importance of equitable health services for all," says Dr. Casilang. "It reminded me why I became a doctor in the first place."
The CHOP difference
Dr. Casilang's transformative experience in Mexico ultimately led her to pursue a global health fellowship at CHOP. During the interview process, Andrew Steenhoff, MBBCh, DCH, Medical Director of CHOP's Global Health Center, took time to illustrate the ways Dr. Casilang's talents and experiences could benefit the DR community. Dr. Steenhoff also outlined the opportunities the fellowship would provide for Dr. Casilang to develop and strengthen her current skillset.
Says Dr. Casilang, "Each person I interviewed with shared unique stories about their own global health journeys. It was inspiring."
Upon acceptance to the Global Health Fellowship Program, Dr. Casilang traveled to the DR to prepare for her training. There she connected with a then-current in-country fellow, Maria Dunn, DO. Dr. Dunn helped her get a feel for working and living in Consuelo and La Romana and introduced her to local colleagues who would soon become part of Dr. Casilang's vital support community.
Like all CHOP Global Health fellows, Dr. Casilang had the opportunity at the beginning of her fellowship to take intensive courses in epidemiology and statistics at the University of Pennsylvania (Penn). She also attended lectures led by CHOP and Penn faculty, which oriented her to conditions uncommon in the United States but rampant in host countries — malaria, dengue fever and kwashiorkor, a severe form of malnutrition.
Through one-on-one meetings with faculty across CHOP, Dr. Casilang met potential mentors — including Elizabeth Lowenthal, MD, MSCE, research director for CHOP Global Health — who would guide and support her training. "Everyone I spoke to was an expert," says Dr. Casilang. "It was intimidating at first, but also reassuring." She also spent time studying with CHOP's Global Health Program Manager, Adriana Deverlis, MPIA, to help prepare for the nuances of Dominican Spanish. Throughout each aspect of this preparation period, Dr. Casilang felt supported, knowing that CHOP was invested in her success.
A two-month orientation marked the beginning of Dr. Casilang's time in the DR. This orientation included rotations at the HIV clinic at Clínica de Familia La Romana in La Romana; the Niños Primeros en Salud (NPS) Program in Consuelo; and the country's largest pediatric hospital, Hospital Infantil Dr. Robert Reid Cabral (HIRRC) in Santo Domingo. Upon the completion of her orientation, Dr. Casilang settled into what would become her routine — four days of clinical work and one day of research and meetings each week.
Identifying a community need
As Dr. Casilang began to develop relationships with families who attended the NPS clinic in Consuelo, she began to notice that several mothers had questions about breastfeeding. Through conversations with the head nurse and lead pediatrician of the NPS Program, Dr. Casilang discovered that the community — and the DR as a whole — had low rates of exclusive breastfeeding.
When Dr. Casilang met with local United Nations Children's Fund (UNICEF) leadership in Santo Domingo, the need was confirmed for hospital initiatives that emphasized the importance of exclusive breastfeeding. Dr. Casilang decided to explore how technology and media could help improve breastfeeding rates. With guidance from her mentors, Dr. Casilang focused her qualitative research on the community's current access to health information as well as the local perceptions and attitudes toward mobile technology. Her findings showed a high level of acceptance of the use of mobile technology for accessing health education and, in particular, the promotion of breastfeeding. Through Dr. Casilang's research — and the resulting submitted manuscript — Dr. Casilang hopes to inform future interventions that prioritize stakeholder involvement, minimize barriers to the use of mobile health technologies, promote the frequency of mobile health technology use by adding perceived value to caregivers, and address the cultural needs of users.
Now an attending at the Children's Hospital of Orange County in California, Dr. Casilang credits CHOP's Global Health Fellowship Program with improving her clinical and research skills, as well as teaching her the importance of active listening, a practice that helped her communicate more effectively with patient families while in the DR.
Says Dr. Casilang, "My fellowship made it possible for me to build trusting relationships with community members, to understand their needs and to design interventions to address those needs."
Become a CHOP David N. Pincus Global Health fellow
If you are an early-career pediatrician or pediatric subspecialist seeking to become a leader in pediatric global health, find out more about our immersive, expertly mentored, and fully funded three-year fellowship in global health. Download an application here.