The Things I've Learned About Global Health
Many have asked how to get involved in global health since my recent travels to Nepal as a physiotherapist consultant. With my experiences completing an internship in South Africa, membership in the Global Health Division (GHD) as an executive committee member, practicing two years clinically and four months in Nepal, I believe that I have some of the answer. There are thoughts that must be explored before people decide to become involved. I have gained the following insights from pursuing a career in global health. I have been fortunate enough to work with physiotherapists across the globe and absorb the collective experiences of the GHD and various mentors.
My initial thought as a student was that the world overseas was in need of my help. However, as my involvement in the global health community grew, my thoughts of this slowly changed. I began to understand that, while there were a variety of ways to become involved in global health, the issue of ethics required consideration first and foremost. I soon began to realize by naivety and, even as a student, my initial motivations and thoughts prefaced my interactions that were more harmful than helpful to the host country, perpetuating a gap in equity. After reflecting on my experiences, I vowed to try again in two years after practicing as a clinician and to try to be more conscious of my actions in hopes to bring about sustainable and socially responsible change. After graduating, I pursued a short-term global health experience of four months in Nepal. In preparation for this, I delved into predeparture training. I pulled from the experiences of my mentors with international experience and attended courses to increase my knowledge in global health and clinical skills. I liaised with Dhulikhel Hospital a year ahead of time in the hopes of providing what the physiotherapy department needed. However, even after a successful four months in Nepal, I found that my involvement was still perpetuating a phenomenon known as neo-colonialism: a form of dependency of a lower-middle income country on a high-income country. Although some of my actions may have helped a small few, I still questioned whether my actions still proved to be ethical.
Global health is a process. It does not start by embarking on a journey to save others. It actually begins with you. How we perceive ourselves in relation to the world changes our actions and their outcomes. Choosing to look introspectively first allows us to explore the motivations that drive our actions, which have the potential to do harm or good. This skill needs considerable time and training. Like clinical reasoning, which requires education, practice and experience, becoming a skilled global health practitioner requires building essential competencies that are suited for working in resource poor countries or marginalized communities. Individuals who choose to develop these competencies will find themselves looking through a lens of social justice and public health principles.
Why this is a starting point is that there is no tried and true way to become a global health professional. After conversing with countless individuals in my travels, each story was unique and never the same. Those who were working toward lasting change maintained a consistent relationship with host communities by visiting regularly or working in the same location for over a year. With this prolonged engagement, they were activated to think beyond patient outcomes and metrics, and look towards understanding self and others. Ultimately, amongst the diverse stories, common threads were about humility, introspection, solidarity and social justice.
When overseas, your environment is fluid and ever changing. You will be stretched on your end to adapt to the changes that you’ve placed yourself in. In order to overcome that drastic shift from familiarity, one must be ready to navigate and understand what they are feeling and why. I believe that physiotherapists are well poised to take on these challenges. Physiotherapists are naturally gifted in social graces, ingenuity and are fiercely passionate. As a student and professional, home and abroad, I’ve seen my clinical instructors advocate for patients by providing solutions to complex situations limited by socioeconomic issues and deficits in the health care system. We see the larger picture and have the ability to understand the environment around us and the people within it. We care for the welfare of our patients, helping to grow a compassionate collective. While the seeds are the inherent traits discussed above, these are also a set of teachable skills and practices that can be developed through appropriate coursework and mentorship.
The Canadian Physiotherapy Association’s Global Health Division will have an online course available on the PD Marketplace that will draw out these traits in physiotherapists interested in working in Global Health. Topics covered include exploring global health, understanding disability and its relevance to sustainable development goals, post-colonial theory, power and privilege, and cultural competency. It also covers other important topics such as medical tourism and how to avoid these pitfalls by learning how to appraise volunteering and non-governmental organizations. All of these topics aim to develop the essential competencies outlined by Cassady and colleagues for physiotherapists working in resource poor settings1. There is currently a deficit in standardized training for Canadian physiotherapists planning to go abroad. This coursework is meant to prime you as a budding global health professional to think critically about your interactions with others. It will lay the groundwork for your experiences abroad. We hope to contribute to the global community by training our Canadian physiotherapists to practice ethically abroad. However, change does not have to start abroad.
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Global health starts at home – with yourself, with your patients, with your communities and with your country. There are many populations that require our attention in Canada who are facing inequity. I am not trying to discourage you from pursuing an opportunity overseas; however, we can sometimes make great impact with the resources we have at home. Working with marginalized populations in Canada also helps prepare for potential experiences overseas and allows you build on global health competencies. Many of these competencies are transferrable across diverse populations we have the privilege to work with in Canada.
The importance of physiotherapy education to equip therapists does not change across borders. Education in physiotherapy practice is vital in activating inherent traits that allow professionals to flourish in practice. Physiotherapy relies on its clinicians to pass on knowledge, just as in any other healthcare profession. Whether a clinical instructor, physiotherapy educator or mentor, all hold very important roles in the future of physiotherapy. Physiotherapy is a gift. Although we receive compensation for our work, there is a beautiful exchange that happens between patients and fellow colleagues. We give each other knowledge, motivation, and time for individual growth and character development.
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Author: Corey Kim