A father and global health fellow’s experience in the Dominican Republic
Published on in Global Health Update
Published on in Global Health Update
In July 2011, Marc Callender, MD, joined Children’s Hospital of Philadelphia (CHOP) as a David N. Pincus Global Health Fellow where he served for two years in two clinical settings in Consuelo and La Romana, Dominican Republic (DR). He had always had a vision of working in an international setting. During his undergraduate and medical school years, Dr. Callender participated in a few short-term mission trips focused on clinical care and public health outreach in rural regions of the DR, but his vision of working on a longer-term project was rejuvenated when during his residency at Johns Hopkins he received a CHOP David N. Pincus Global Health Fellowship recruitment email. He applied and was accepted into the program.
Through the David N. Pincus Global Health Fellowship, CHOP provides fellows with an immersive experience designed to enhance their clinical, research, teaching, advocacy and leadership skills. As a fellow, Dr. Callender expected to be stretched both intellectually and clinically and to grow in his understanding of community-based medicine in a low-resource environment. What he did not anticipate were the profound effects of conducting home visits and engaging with local leaders, and how these enhanced the compassion and empathy he felt for his patients.
“In residency, we are given the opportunity to follow a patient and his/her family for a period of three years, but these interactions are generally limited to the office setting. The fellowship taught me so much more about the other factors that influence a patient’s health,” says Dr. Callender. “I learned to appreciate the work of the local community health workers (promotoras) and gleaned so much from one phenomenal nurse and advocate, whose commitment to the community was inspirational and infectious.” Throughout the fellowship, he also learned about the tremendous work it takes, at both institutional and grassroots levels, to build a successful and sustainable global health program.
For Dr. Callender, the simultaneous milestones of starting the fellowship and becoming a father greatly influenced his experience as a global health fellow. In the field, he recognized the importance of involving fathers in decision-making for their children’s health. These observations piqued his interest in targeting health communication to fathers. He observed that the global health literature emphasizes maternal and child health outcomes, while paternal engagement and interventions targeting fathers are relatively sparse.
These factors informed his fellowship research project, a qualitative study developed with his mentors including Dr. James Guevara. Dr. Callender sought to understand, via structured in-person interviews, what role fathers in underprivileged communities played in their children’s health outcomes. He learned that men and women in Consuelo held traditional views of fatherhood that emphasize economic provision and character formation. For example, many fathers controlled both the timing and quantity of food and other resources purchased for the family. Dr. Callender also found that fathers were particularly sensitive to how they were perceived by members of their community with respect to their ability to provide financially for their partners and children. In part, because of the stresses of underemployment and the social pressures to provide, intimate partner violence and paternal neglect were several recurring themes throughout the interviews, demonstrating the prevalence of these concerning realities.
Inferences drawn from Dr. Callender’s study highlight the importance of targeting messaging to fathers and encouraging their engagement through interventions that address pediatric malnutrition and food insecurity. Given the impact of religious beliefs and community perceptions of paternal engagement, Dr. Callender’ s exploratory study suggests that future interventions should include partnership with churches and other organizations that have high community visibility.
In addition to presenting his findings to community leaders in Consuelo, Dr. Callender also presented his work at the Pediatric Academic Society (PAS) meeting in 2013. Having shared study findings with the community in Consuelo, Dr. Callender hopes his project will positively impact father-child relationships in this community, and notes that participating in the research has helped to “sharpen my vision and practice at home as I engage with my own family.”
Dr. Callender completed his fellowship in 2013. He left the DR having developed close relationships with many patients and their families, and he feels fortunate that he could provide support for some families who experienced particularly challenging circumstances. He clearly remembers one patient whom he cared for at both the primary care clinic in Consuelo and the pediatric HIV clinic in La Romana — a baby girl born to Haitian immigrants. She unfortunately lived for only four short months, and her late diagnosis of HIV and rapid decline exemplified a complex interplay of challenging medical, public health and cultural factors. In the weeks preceding her death, Dr. Callender had the opportunity to closely support the patient’s father as they worked together to preserve the child’s life — this shared experience forged a trusting relationship that extended beyond her death.
Dr. Callender also observed an opportunity for capacity building in the areas of acute and emergency care for children in resource-limited settings like the Dominican Republic. This influenced his decision to return to the U.S. to practice pediatric emergency and inpatient medicine in a community setting, where he currently interacts with patients from a vibrant Hispanic immigrant community in Annapolis, Maryland. He often has the opportunity to serve and navigate care for patients who have recently arrived in the U.S. from various areas of Central America. He credits his experience practicing medicine in global health contexts as an immense asset to his ability to deliver appropriate care to these patients and their families. Additionally, working as a global health fellow sharpened his professional skills in team building, which he considers an essential skill in his current acute care practice setting.
“The fellowship has granted me a broader public health perspective that impacts my work as a community-based hospitalist,” notes Callender. He looks forward to future opportunities when he and his family may participate in other global health efforts to build upon his skills and clinical experiences. “The David N. Pincus Global Health Fellowship has left an indelible impression on our family identity and will continue to be a pivotal point in the development of my professional and personal life.”
Through the continued generous support of the Pincus Family Foundation, starting in July 2019, the CHOP David N. Pincus Global Health Fellowship will evolve from a two- to a three-year program, allowing for increased research time and resources to pursue a Master in Science degree through the London School of Hygiene and Tropical Medicine. For those interested in a global health career, Dr. Callender recommends cultivating that interest by connecting with institutions and organizations like CHOP that have demonstrated a commitment to sustainable global health partnerships. “Assess the leadership and philosophy of the various programs available. The leaders of CHOP’s Global Health Center and the David N. Pincus Global Health Fellowship are thoughtful about the work they do and the relationships they develop, sincerely prioritizing investment in people over and above specific programs or outcomes,” he advises.
If you are an early career pediatrician or pediatric subspecialist seeking the skills to become a leader in pediatric global health, this is the fellowship for you. It is an expertly mentored and fully funded three-year experience in global health practice. You can apply to become a David N. Pincus CHOP Global Health Fellow by emailing Tanya Tyler: firstname.lastname@example.org to request a global health fellowship application.