Global Health/Health Disparities

      

Our program offers residents the chance to take part in international and rural rotations.  

Goals and Benefits 

  • Compliment your residency experience 
  • Facilitate career decisions/planning
  • Strengthen diagnostic skills
  • Shift dependency on diagnostic tests
  • Build further sense of global health needs
  • Provide service to a community in need
  • Gain a potentially “life altering experience”

Past International Rotations

Tugela Ferry, South Africa

Setting: Rural
Prerequisites: Best to be at least a 3rd year or end of 2nd year. Very independent practice location

Expenses: You pay for travel, room, board, etc. Room was available, but had to pay for it. You buy your own food from grocery store. Depending on the site, there is a $3000-$3500 stipend.

Comments: Very rural, somewhat isolating, experience. A lot of HIV and TB. Not a lot of supervision.

Application process: Through "Johnson and Johnson Global Health Scholars program".

Beijing, China

Setting: Urban
Prerequisites: None, just have to apply through GME for approval

Was room and board provided? No, but arranged through the program right off the medical campus with easy accessibility to the hospital (walked there daily) and close to the subway for city exploring in the time off

Expenses: Flight about $1000, room and board about $40 daily (but had a roommate so this cost was shared for me to only 20 daily)

Application process: Through "Johnson and Johnson Global Health Scholars program".

Quito, Ecuador

Setting: Urban
Prerequisites: Spanish language skills necessary

Was room and board provided? No.

Expenses: About $2,500 for travel, housing, and food for the month. Additional cost for any additional trips to nearby tourist destinations

Comments: Quito the capital of Ecuador, situated in the Andes mountains. The U of M has several medical faculty contacts at the social-security hospital, Hospital Carlos Andrade Marin and the medical school, PUCE. They helped me craft an away rotation based on my areas of interest. I primarily did inpatient internal medicine and cardiology and as well as survey research of ambulatory patients.

Application process: Through "Johnson and Johnson Global Health Scholars program".

Rurrenabaque, Bolivia

Setting: Rural
Foreign language proficiency: Spanish
Specific medical knowledge/experience: None

What sort of costs does the resident incur? Flight to/from Bolivia (roughly $800-1000). $500 payment to Concern America (American NGO that supports the development effort there), the $500 goes to support the organization and your involvement. Concern America recommended that I bring down $1000 in cash for my room and board, weekend travel, etc. Concern America put me up in a room in the clinic free of charge (with bathroom/shower with running water). So even with weekend trips, I'd say roughly $500-800 would be plenty for the month. Bolivia is VERY inexpensive.

Comments: The experience was an excellent exposure to rural primary care in Bolivia. The focus of the NGO supporting the work is largely outreach, so on average 2-3 days per week were spent travelling either by car or by boat to outlining communities that had no access to medical care. These trips were the best and worst of my experience. Best in that like most home visit-type experiences, you obtain a much deeper understanding of your patient's living conditions and limitations as far as clean water and sanitation. However, these trips were very physically difficult: heat, insects, unfamiliar food, no running water, often no access to toilets (not even latrines). Additionally, I felt torn between the enormous effort it would take to pull off a trip such as we were, but yet the medical services we were able to provide on the road were very limited (antibiotics, wound care, skin infection treatment).

The experience did not include any exposure to inpatient medicine, which I would have enjoyed. I saw a large number of skin infections, several not seen in the U.S. such as leischmaniasis. One of the most excellent aspects of the program is the support before, during and after provided by office staff from Concern America in the states. They have offices in California and Chicago. I was extremely impressed by the ongoing work and development over years that Concern America has in the communities they serve. Concern America in Bolivia worked with the health promoter model, using "Where There is No Doctor" as their instruction manual. I was able to participate and help teach a one week course to health promoters which was really interesting.

Application process: Through "International Health Immersion Program" on Concern America website.

Lima, Peru

Setting: Urban; Hospital Dos de Mayo, Servicio de Enfermedades Infectiosas

Prerequisites: Spanish

Expenses: Travel, room and board. There are cheap places to stay that can be found.

Comments: Most common diseases are TB and HIV. There is definitely some Tropical Medicine too (we saw Leprosy, Systemic Bartonellosis, Leshimaniasis, Malaria).

Application process: Program director actually made the primary contact.

Ahmedabad, India

Setting: Urban, Inpatient and Outpatient

Prerequisites: Fluency in Gujarati is a must. None of the patients spoke English.

Expenses? None of the expenses were paid. Travel is the most expensive. Round trip ticket cost me $1500. Did not have significant room and board expenses because I was able to live at a family friend's place. Actual room and board will cost you ~$800-$1,000.

Comments: I was able to get a combined inpatient and outpatient experience. Saw patients from lower class and lower middle class with a variety of diseases. Aside from common cardiovascular diseases and diabetes related complications, I had exposure to various diseases such as Malaria, TB, Typhoid, Hepatitis and infectious diarrhea. Language and costs are the major limitations.

Application process: On an individual basis

Haiti (affiliated with the Albert Schweitzer Hospital)

Setting: Rural hospital

Prerequisites: No need to have any special language skills; they provide you with a translator

Was room and board provided? Yes

Expenses: Cost of flight is roughly $500

Application process: No specific application dates

Chile, Ecuador, Cuba

Settings: Rural and urban hospitals

Prerequisites: Spanish proficiency

Was room and board provided: Yes

Expenses: All costs were covered except for Ecuador (resident paid $1,000)

Application process: depends on destination.

Shanghai, China, Rujin Hospital

Setting: Urban Hospital

Prerequisites: Proficiency in Mandarin

Was room and board provided? No

Expenses: Ticket $1100, Room $300, Food is very cheap in China

Are there any special application dates or forms that must be considered?  No

Past Domestic Rotations

Monmouth, Maine

Setting: Rural setting, old farm and logging country, but not very far (<20 miles) from the state capital of Augusta and another more urban area of Lewiston/Auburn. There are two outpatient clinic sites with FPs.

Prerequisites (foreign language proficiency, etc.): None.

Was room and board provided? Housed by the Maine Primary Care Association in a bed and breakfast; food was a responsibility.

Expenses: Maine Primary Care Association covered housing.

Application process: Applications available on the web through Maine Primary Care Association.

Comments: This is the website for the Student/Resident Experiences And Rotations in Community Health (SEARCH) electives sponsored by the National Health Service Corps and the individual primary care associations of the respective states. It's a great experience for anyone who wants another perspective on primary care/health delivery in the "real world." There are sites that are much more rural/underserved than where I went. Very easy to set up, money was provided and it was a great experience.

Shiprock, New Mexico

Setting: Rural hospital, clinic experience

Prerequisites: None

Was room and board provided? Board only

Expenses: Plane ticket paid for by AMA; stipend from Indian Health Service

Application process: Many forms to complete, no specific dates for completion

 

Timeline and Tips

Prior to December

  • Start looking the fall of the academic year prior to when you want to go.  For example, if you want to go academic year 2016-2017 (7/1/16-6/30/17), start looking in the fall of 2015.  
  • See if you can get credit (Rules for offsite rotations)
  • See if you can get funding

December

  • Talk with program director to discuss your time away

February

  • Apply to GME by February 1  - You must already have written acceptance from the hosting program, defining your dates, included in your application to GME. GME needs a minimum of three months to process your application and finalize a contract for you to sign.
  • Fill out the Offsite Application Form
  • Fill out the Waiver
  • Guidelines for Contracting for GME
  • Resident and the residency program (Internal Medicine or Med-Peds) should work together on the application. Note that the program submits the final application. 

February/March

  • GME will review the application and notify about acceptance

*Note- Sometimes plans fall through on your site's side. If this happens after GME approval, you may be able to arrange an alternate site under the same approval, especially at a place where contacts are already in place to speed the process and the time frame is the same. Please keep in mind that there is a long list of residents from all over the University trying to go on Away rotations and there may be a wait list of residents. Find another place and try again!

Prior to Trip

  • Get the necessary vaccinations. Some vaccination sequences take several months to complete so plan ahead
  • University of Michigan Travel Health Clinic - U-M affiliated individuals can get immunizations, advice and medications tailored to your health status and destination, or arrange group travel clinics, through Travel Health Services. 
  • CDC - Centers for Disease Control and Prevention travelers health site - check to see what health precautions are in place for the areas you are interested in traveling to. They even have a Clinician Information Center.
  • Occupational Health Services - You will want to go here to get your health records as well as any of your basic vaccinations done.

For complete details and questions, contact the Residency Program at improg@umich.edu.