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Global health

Medical students bring rural health-care lessons back home

Teaching and Learning

By Michelle Osmond

In one week, eight Memorial medical students will fly to the other side of the globe to Kathmandu, Nepal.

It’s an 18-hour trip that the students pay for themselves and they don’t receive academic credit. But they all agree it’s worth it.

Memorandum of understanding

For the fifth year in a row, Faculty of Medicine students are heading to Nepal to Patan Academy of Health Sciences (PAHS) where, for four weeks, they’ll learn aspects of global health they can bring back home.

In 2013 Memorial University signed a memorandum of understanding with Patan Academy.

That same year, the two institutes launched the International Summer Institute in Global Health Training (InSIGHT) program, an annual global health program for pre-clerkship medical students.

InSIGHT takes students to Nepal to learn about the deep impact of social determinants of health and see them in clinical context in a resource-challenged country. The program is led by Dr. Jill Allison, global health co-ordinator at Memorial, and Dr. Shree Mulay, associate dean, Division of Community Health and Humanities at the Faculty of Medicine.

Memorial MD students working in a clinic in Nepal as part of the InSIGHT program
Memorial MD students working in a clinic in Nepal as part of the InSIGHT program.
Photo: Submitted

For the first two weeks, the students explore challenges and innovative solutions at the community level.

They look at gender, family politics, reproduction, livelihoods, water and sanitation, food security and politics and how they influence health and well-being.

This includes a rural visit to explore health-care delivery in remote, mountainous areas. The second half of the program is spent witnessing the impact of these factors in a clinical setting.

For Alison Hamilton, who participated in 2016, her experience with InSIGHT was the start of her career in international medicine.

“It’s all about what we can learn from the community rather than what we can do for them.” — Alison Hamilton

The future doctor been passionate about social justice and global health since high school, but she didn’t want to “swoop in to fix a problem” identified by Westerners. She says the InSIGHT philosophy is not what she first thought.

“Dr. Allison has created this program that is organized entirely around learning; it’s all about what we can learn from the community rather than what we can do for them,” said Ms. Hamilton.

“I was particularly amazed to learn that the challenges facing rural health care in Nepal are quite similar to those facing rural health care in Newfoundland and Labrador. This was a highlight for me: learning how much two communities on opposite sides of the world could benefit from comparing their common problems and successes.”

Medical students talk with a community member in the clinic
Medical students talk with a community member in the clinic in Kathmandu in 2016.
Photo: submitted

Learning, not solving

While there, Ms. Hamilton and her team members participated in a symbolic project, chosen by community members.

One of the partners for InSIGHT is a riverside slum community inhabited by people who have migrated from rural communities. People find themselves there because they are persecuted for their caste, they lose access to land or are widowed and abandoned by families and end up in the city to work as day labourers, hauling bricks and rocks or cleaning streets.

A view of the city of Kathmandu, Nepal.
A view of the city of Kathmandu, Nepal.
Photo: Submitted

Dr. Allison says it is a temporary community that they call home, but the government will not permit them to build permanent structures. The residents have been told their homes can only be built of bamboo and plastic.

Last year, the community women’s group asked the students to help build a wall in the daycare, which the women demonstrated how to do while complying with government restrictions.

“This is the true meaning of InSIGHT — learning about the complexity of life for those in under-resourced communities.” — Dr. Jill Allison

Together, Dr. Allison says, the students worked with community members, learning about the precariousness of life in a slum community, the challenges posed by day labour and what it means for women to leave their children and undertake backbreaking work in the city in order to survive.

“We learned about the resilience and ingenuity of the community as they created a daycare for their children,” she said. “The daycare also ensures that older girls get to go to school rather than having to provide childcare to younger ones. All these insights are there and symbolized in the wall. This is the true meaning of the InSIGHT program — learning about the complexity of life for those in under-resourced communities.”

“InSIGHT is dedicated to social accountability, health equity and social justice. But it’s not just about experiencing and advocating those things abroad, but also at home,” Dr. Allison continued. “The program challenges participants to take lessons learned in international settings and apply them back to whatever practice they decide to pursue, no matter where they are.”

Prayer flags at a Kathmandu temple.
Prayer flags at a Kathmandu temple.
Photo: Submitted

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