Back to Front PageVOLUME 6, NUMBER 4

Beyond Their Borders:Medical Schools Foster a Community of Global Health

By Barbara Gabriel

Donald E. Wilson, M.D., dean of the University of Maryland School of Medicine, is the first recipient of the Herbert W. Nickens Lecture Award.

"The chaos theory suggests that if a butterfly flaps its wings in the Amazon, the result can be a cyclone in Kansas," says Charles S. Finch, III, M.D., director of international health programs at the Morehouse School of Medicine. "Similarly, the consequences of a health issue prevalent in a remote country today can tomorrow reverberate into our own living rooms. We've already seen examples such as the West Nile virus. The physician of the 21st century must be a physician who has a global awareness of health issues." Dr. Finch's conviction that American medical schools and teaching hospitals can greatly benefit from international outreach programs is shared by a growing number of U.S. academic medical centers that are forming alliances with medical institutions around the globe.

While the primary goals of these alliances generally are to bring advances in U.S. health care to less developed areas of the world, schools are discovering that they too have much to learn from their international partners and are beginning to perceive their cross-border relationships as integral to their education, research, and clinical missions.

Johns Hopkins Comes to Singapore

Two years ago, Johns Hopkins University saw extensive discussions between the government of Singapore and university leaders come to fruition with the formation of Johns Hopkins Singapore, a collaboration between Singapore's government leaders and Hopkins that aims to import the talent and experience of Hopkins' researchers and clinicians into the Singapore government-owned National Univer-sity Hospital.

"We started by talking to them about Hopkins' mission and how it might fit in with their needs," explains Steven Thompson, CEO of Johns Hopkins International. "We wanted to fashion an arrangement that would address education, research, and some clinical care. A year's worth of discussions yielded a clinical facility that we developed with various groups within the Singapore government. Additionally, we have several educational programs, from medical student exchange programs up to a post-doctoral fellowship program, and a research center."

Through money from the Singapore government, grants, and additional industry funding, Johns Hopkins Singapore has chosen to focus its research efforts on diseases, primarily cancers, prevalent in Southeast Asia. "It's a win-win situation," Thompson explains. "These diseases are obviously of great concern to people in Singapore and the surrounding region. An added bonus is to have our researchers, many of whom study these diseases in the U.S., to actually be in the thick of things with access to specific populations and international colleagues who are working on the same projects."

Building on Ancestral Ties

When the Morehouse School of Medicine sought to extend its reach abroad, Africa was a natural choice. "Morehouse's overall mission is to serve the underserved," explains Dr. Finch. "Initially that applied to the U.S. But when we officially launched the Office of International Health in 1985, our mission expanded to include the underserved abroad. The ancestral link between black medical students at Morehouse and Africans is the reason African countries have been almost our entire focus up to this point."

After modest attempts to align itself with countries like Nigeria, Liberia, and Zimbabwe, which never manifested themselves into formal projects due largely to lack of funding, Morehouse's Office of International Health joined forces with Tulane University from 1989 to 1996 to complete several successful public health projects with a university in Senegal.

That U.S. Agency for International Development (USAID)-funded collaboration was followed by another public health program that involved traditional healers, also in Senegal. In 1993, Morehouse became the lead institution of a three-year, $9 million HIV/AIDS education project in Zambia. From there, Morehouse used its growing expertise in public health care reform in Africa to join forces with Johns Hopkins to conduct reproductive health training in Uganda.

Today, Morehouse is involved in its most ambitious African-based outreach program to date. Through a formal alliance with the National School of Public Health of the Medical University of South Africa, Morehouse faculty are providing training to African public health professionals in their fight against AIDS. The training is part of the $100 million "Secure the Future" program launched in May 1999 and funded by Bristol-Myers Squibb to help halt the spread of HIV on the African continent.

Dr. Finch says the benefits reaped by Morehouse faculty and students who spend time in Africa are immeasurable. "Through our international activities, our faculty, staff, and students are beginning to understand health issues as interrelated with political and social problems in a way they could not if they stayed in the U.S. With advancements in information technology and transportation, health issues are now global."

Health Care and the Fall of the Soviet Union

Through a USAID-funded organization called the American International Health Alliance (AIHA), Baylor College of Medicine has participated in three formal partnerships with health care institutions in the former Soviet Union. In 1995, Baylor and its affiliated teaching hospital, the Methodist Hospital, entered into a five-year partnership with six local hospitals in the Semipalatinsk region of Kazakstan.

Building on the peer-to-peer relationships that are at the core of the AIHA model, physicians, nurses, and staff from Baylor and Semipalatinsk worked together to tackle some of the most pressing health care concerns in Kazakstan left in the wake of the dissolution of the Soviet empire. Among their accomplishments was the establishment of a cancer registry and screening program as well as infection control programs in each of the six Semipalatinsk hospitals.

When funding for its partnership with Kazakstan ended, Baylor entered into two new AIHA alliances in 1999: one with a hospital in Baku, Azerbaijan, and another with a hospital in Sakhalin, Russia. Armin Weinberg, Ph.D., professor in the Department of Medicine at Baylor and director of its Chronic Disease Prevention and Control Research Center, has served as project coordinator for each of Baylor's partnerships in the former Soviet Union. Dr. Weinberg says the experiences Baylor faculty gain from working with their partners abroad contribute to both their personal and professional development.

"For many of our faculty visiting and working in our partners' communities, it's an exhilarating return to the basics - to why they got involved in medicine in the first place," says Dr. Weinberg. "They have opportunities to interact with colleagues they never dreamt they could meet or work with, and they have the opportunity to observe significantly different approaches to medical management and health care."

Dr. Weinberg is also eager to point out the scientific benefits of working with populations in remote areas of the world. "Valuable collaborative research has grown out of each of our partnerships," he says. "In Kazakstan, we are collaborating with our colleagues in ongoing studies of prostate and thyroid cancers, which occur at a higher rate in that part of the world. As the study of genetics rapidly advances, physicians and scientists who have opportunities to work with populations throughout the world will be in a very competitive position. We must go beyond our own borders to understand the roots of many genetically related illnesses."

Although the scientific payoff of international partnerships may be high, the primary reason Baylor has aligned itself with Kazakstan, Azerbaijan, and Russia is humanitarian. In Azerbaijan, Baylor faculty and their partners at Baku's Republican Clinical Hospital face the daunting task of improving medical services for nearly 2 million refugees and internally displaced persons in the wake of recent conflicts with neighboring Armenia.

Both partner institutions have agreed to focus on emergency obstetrics and maternal and newborn care. "If you look at the future of any country or community, children are a high priority and the factor motivating our decision to focus on this particular issue," Dr. Weinberg says.

Building Partnerships That Last

The humanitarian work done in the former Soviet Union by Baylor College of Medicine and numerous other U.S. medical schools and teaching hospitals is largely made possible by AIHA. Formed in 1992 in response to the breakup of the Soviet empire and USAID's subsequent interest in health care reform in Russia and the newly independent states, AIHA facilitates international partnerships by granting USAID seed money to forge alliances between U.S. medical institutions and those abroad.

Donald Harbick, AIHA's associate executive director for partnership programs, explains that while the nonprofit organization provides logistical planning and money for travel, interpreters, and equipment, the U.S. partners are expected to volunteer the time it takes to make assessments, conduct trainings, and meet goals. "We don't bring in consultants or experts," Harbick explains. "We try to develop a relationship between the NIS [newly independent states] and their U.S. partners in a way in which they work together as equals. They are expected to assess problems together and to come up with sustainable solutions."

Fran Jaeger, MSW, DrPH, administrator of the University of Illinois at Chicago (UIC) Perinatal Center Network, is the coordinator of a hospital partnership between the University of Illinois Hospital and the Second Tashkent State Medical Institute in Tashkent, Uzbekistan. Formed in 1992 as one of AIHA's very first partnerships, it embodies the substantial accomplishments that such an alliance can realize. With committed colleagues on each side, Tashkent partners established a new neonatal intensive care unit, a high-risk pregnancy center, two neonatal resuscitation training centers, a nursing learning resource center, and two women's wellness centers.

Funding for her partnership recently ended, but Dr. Jaeger has no doubt that the work begun by the University of Illinois Hospital volunteers will continue to benefit those treated at the centers in Tashkent they helped build. "E-mails go back and forth every day," she says. "Communications are continuing on both a personal and professional level. The limited resources of our Uzbek partners mean they still have a long way to go in many areas, but what they have seen themselves capable of in the past eight years will reverberate far into the future."

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08 February 2005