Title:Formation of a Global Caregiver

Learning comes to life through practical experience in global health

When Kevin Bushey (M’18) was applying to medical schools, choosing one with strong global programs wasn’t an afterthought—it was a requirement.

As a Filipino-American, Bushey felt strongly about taking part in an international rotation, and he wanted to do it in the Philippines. Before graduating this spring, he spent a month working at Mary Johnson Hospital in Manila, an experience he says will change the way he practices medicine for the rest of his life.

“It was incredible for a number of reasons,” the Minnesota native says. In addition to helping him understand how medical practice differs between the Philippines and the U.S, his experience made classroom learning come to life. “I had the opportunity to see and manage tropical diseases I had only read about. And it was a cultural immersion—it gave me an opportunity to learn another language, to see how other people live and what challenges they face in their community.”

Impact Through Immersion

As technology continues to virtually shrink our world, global health education has become more and more important, both to students and educators. “Health is an inherent human right,” says Irma Frank, DDS, senior associate dean for international programs in the School of Medicine. She defines global health as understanding how different populations approach providing equity in health care. That understanding comes from a variety of methods, including immersion, research, and structured education.

Across the university and across disciplines, students take advantage of meaningful opportunities to explore global health through hands-on experiences abroad. Through the School of Medicine’s Office of International Programs, Frank helps place students around the world to do rotations or to conduct research. These international electives are offered for medical students the summer after their first year and during their fourth year.

This summer, for example, 10 students who just finished their first year went to Santiago, Dominican Republic, to work with the Institute for Latin American Concern, where they provided medical assistance to the underserved population.

“To fully understand the health care systems in other countries, it is very important to have a practical experience abroad,” Frank says, so that students can witness the different ways physicians with varying resources and challenges care for their patient populations, and then reflect on the experience.

“This process creates a stronger drive for students to maintain a global perspective in their own careers,” she notes. “With improved technology, the students have been able to maintain relationships with the people they worked with abroad.”

In recent years, there has been a greater interest in global health among incoming medical students, Frank says. Many request an international elective, conduct independent international research, and participate in a growing number of student groups related to global issues such as infectious diseases and refugee health.

In fact, now many students arrive for medical school at Georgetown with some global health experience already, whether in the U.S. working with international populations or overseas through undergraduate programs like those offered through the School of Nursing & Health Studies (NHS).

When it began in 2002, the global health program at NHS was one of the first of its kind in the country. The curriculum focuses on comparative health systems, epidemiology, demography, health promotion, and maternal and child health, says Bernhard Liese, MD, DSc, MPH, chair of the Department of International Health at the school. In recent years it has also incorporated the political dimension of global health, both from a governance perspective and from an economic one.

He cites tobacco use and sugar consumption as examples. “Everybody knows that tobacco causes cancer. What has the international community done to deal with the tobacco industry? And what about sugar-sweetened beverages? International health regulations, occupational health issues, pandemic preparedness issues—these issues cut across all nations.”

Undergraduates majoring in global health in NHS are required to spend a semester doing research or policy work abroad. The program serves as a senior capstone and grants students the opportunity to conduct research projects in conjunction with NGOs, universities, and health ministries in other countries. Students have studied heart disease in Australia, HIV in Brazil, and vector-borne diseases like dengue fever in India. It’s a huge undertaking, but one that demonstrates how vital the school believes an overseas experience is for a student.

Meaningful Mentorship

Hannah Kelly (NHS’18) spent the fall 2017 semester in Korogwe, Tanzania, a rural town in the northwestern part of the country. She worked at the National Institute for Medical Research (NIMR) studying maternal and child health, but she also incorporated a qualitative component to her work, spending time in the labor and delivery ward of a local hospital. She cites her time being mentored by a nurse named Margareth as having a particularly significant impact.

“Margareth took her mentorship to the next level, calling me ‘mydia’ which means daughter as she answered all of my questions about her work,” says Kelly, who plans to attend medical school. With Margareth as her guide, Kelly participated in morning rounds, observed vaginal and cesarean deliveries, and learned about all aspects of obstetrical care in Tanzania.

“Margareth was also my guide as I navigated hardships I witnessed in the delivery ward,” Kelly notes. “I was able to grasp the Tanzanian perception of life and death through our conversations, which prepared me for the shock of the deaths I witnessed in the hospital. Having such an invested mentor was an invaluable experience. Margareth’s maternal-like guidance and openness allowed me to explore her perspective as a health worker, which in turn affirmed my desire to pursue medicine.”

Kelly was struck by the lack of resources at the Korogwe hospital. With no X-ray or CT machines, doctors had limited non-surgical options for diagnosing people suffering internal pain. Electronic medical records are virtually nonexistent there, so most patients came to the hospital with their medical history jotted down on a piece of paper, she recalls.

A Gold Mine of Experience

Michael DeLuca (NHS’09, MS’15, M’16) developed an interest in international health even before he came to Georgetown as an undergraduate.

“I did a gap year working in clinics in Ecuador, Peru, and Costa Rica,” recalls the emergency medicine resident at Massachusetts General in Boston. The experience inspired him to start a small charity providing medical equipment for rural health care in Ecuador and Nicaragua. He entered Georgetown as a biology major, but switched to the School of Nursing & Health Studies when he learned about the international health major.

As part of his study, he worked on a project in central Ghana with a gold mining company that set up a malaria control program. “Most of the overseas internships are in public sector institutions like ministries of health, but this was with a private company, and in a gold mining camp. It was a unique place,” he says. “Thousands of people. A mass of humanity, mostly single men, working hard and not making much money. Things could be kind of volatile.”

In this environment, DeLuca’s job was to measure how the community was responding to the anti-malaria program, which he describes as somewhat invasive.

“The chemicals were safe, but they were spraying in people’s homes. It was contentious,” he explains. “But by improving malaria treatment, increasing education on prevention, and removing standing water, they were able to reduce cases by 70 percent. It was an aggressive program, but they forged relationships with community leaders, and they developed a radio program for people to call in to ask questions or file complaints. My role was to look at themes in those call-ins, and look for concerns for potential sources of resistance.”

The program’s remarkable results, including a decrease in both mortality and hospitalizations from malaria among workers and their families, also saved the company money. After he returned to Georgetown, he received a grant from the Cosmos Club Foundation to conduct a cost-benefit analysis of the program, looking at impact both on the company and the community.

Before embarking on their practical research trips, NHS requires international health majors to take a research methods course and another in community-based learning. The goal is to establish a solid theoretical knowledge and prepare students for the range of experiences they may encounter. The students participate in both an overseas and a domestic internship, which DeLuca cites as valuable stepping stones for NHS graduates, pivotal to his career as well as important to him personally.

After college he worked in international development for USAID projects in southern and eastern Africa, helping countries track health care spending and resource allocation. He returned to Georgetown to earn his MD as well as a masters in biohazardous threats and infectious diseases.

“I’m now looking to combine my interest in the macro, global health sector with the individual patient care I do as an ER doc,” he says. “In policy development and research in global health security, I can be the clinical voice in the room.”

New Perspectives

For his part, Bushey says his time in the Philippines has helped in the transition to his internal medicine residency at the University of Nevada-Las Vegas, where there is a sizable Filipino population. He still chats weekly with many of the residents, interns, and attending physicians he worked with in Manila, and hopes to return in some capacity in the future.

That’s exactly the outcome Georgetown wants, say two of the university’s global health leaders.

“The perspective gained from the practical experience abroad is invaluable,” Frank says. “It is our hope that this knowledge of other countries is reflected upon and put to use in our students’ own careers. This knowledge allows students to apply the best medical techniques they have been exposed to, whether it is domestic or international.”

“We look at the world from our own perspective, but we sometimes need to change the paradigm and step into the shoes of other people and look at the world from a different perspective,” Liese says. “It is extremely important to open the aperture of the students and say, look, diversity and experiencing a different culture is a blessing. It is really enriching to your life.”

Studying Global Health at Georgetown

Undergraduate

• BS in the Biology of Global Health This degree from the College’s Biology Department offers undergraduates training and research opportunities around the science of global health and the social and environmental factors that impact vulnerable populations.
• BS in Global Health This degree by the Department of International Health at NHS trains students in the fields of public health, political economy of health, health science, and health systems management.
• Science, Technology and International Affairs Major, Biotechnology and Global Health Concentration Housed in the School of Foreign Service (SFS), this major concentration focuses on the biotechnology revolution, emerging infectious disease, technology’s role in health care systems, and health equity.

Graduate

• Executive Master’s in Health Systems Administration This NHS program offers a global Experiential Seminar focused on comparative health systems.
• MS in Biohazardous Threat Agents and Emerging Infectious Diseases This master’s program, offered by the Department of Microbiology and Immunology in the Medical Center, trains students in biodefense against natural and man-made threats and disease agents.
• Master of Global Human Development This practitioner-focused program offered through SFS prepares students for a wide range of careers in the development field.
• Master of International Development Policy This McCourt School of Public Policy program emphasizes evidence-based policymaking and program evaluation for development professionals.
• LLM in Global Health Law This program, housed at Georgetown Law, is open to highly qualified candidates in public and private sectors with their JD (or a first degree in law from outside the United States) and strong interests or backgrounds in global and domestic health laws and policies.
• LLM in Global Health Law and International Institutions This program, jointly run by Georgetown Law and the Graduate Institute of International and Development Studies in Geneva, Switzerland, is open to highly qualified candidates in public and private sectors with their JD (or a first degree in law from outside the United States) and strong interest or background in global health law and policy.
• MS in Global Health This interdisciplinary degree, based in the Graduate School of Arts & Sciences, emphasizes a development-oriented approach and focuses on quantitative, qualitative, and applied social sector research in developing countries.
• PhD in Global Infectious Diseases An interdisciplinary, doctoral-only degree program, the PhD in global infectious diseases prepares students to address the spread and treatment of infectious diseases through laboratory and population science.