SUNY Downstate Medical Center
SCHOOL OF PUBLIC HEALTH
Global Health Elective
Global Health Elective Guidelines
PUBH 4540: Health Care in Developing Countries
The purposes of this elective are to provide fourth year medical students with an opportunity to observe and study the structure and functions of a health care delivery system, or some aspects thereof, in a resource poor country, and to have a cross-cultural experience in such a country. Students can accomplish this goal through participation in public health and preventive medicine programs situated in public health departments, rural community health clinics, rural hospitals with active community and/or preventive health programs, and mobile public health programs.
Students must spend a minimum of six weeks and may spend a maximum of eight weeks in this elective. Living and working conditions in many resource poor countries are often difficult. Students should not attempt this elective if they are unprepared to adapt to a foreign culture and to potentially difficult local living and working circumstances.
Each participant must submit a written report at the end of the elective, describing service rendered, observations made, or the results of special studies performed. This report must be of 1,500 words or more in length, and is a requirement for satisfactory completion of the elective. Preceptor evaluation at the site overseas must also be satisfactory.
Interest in this elective is extremely keen, and the number of students who can be accepted is limited. Students interested in this elective should submit an application form to the School of Public Health (Room B4-318) early in the third year. All applications from third year medical students must be received by December 31st of the third year. Applications will not be accepted after that date. Applications from fourth year students will not be considered because of the long period of time generally required for planning this elective and obtaining host country approvals.
All applications are reviewed by the Global Health Election Screening Committee. Applications from students who have had serious multiple academic difficulties in third year clerkships are generally not given a favorable decision. Such students are sometimes required by the Promotions Committee to spend their fourth year on the clinical campus.
The committee cannot give approval to students who wish to take small children with them overseas. The health risks to small children in resource poor countries are very significant.
Many overseas sites do not have housing facilities to accommodate spouses, and some will not accept students who wish to bring spouses. Students with spouses should be aware that the School of Public Health cannot assume any responsibilities for arranging housing, etc. for their spouses, and has no responsibility of any kind for them.
After a review of the applications, selected applicants will be invited for interviews. Although an applicant's academic performance to date is given significant weight, factors such as motivation, commitment to a career in public health or preventive medicine, and commitment to future medical service overseas are also taken into consideration.
After reviewing all applications and interviewing selected applicants, the screening committee will make recommendations to the course directors. Applicants are generally informed of the committee's decision by late March.
Once accepted, all students participating in this elective will be required to complete a HIPAA authorization form for the release of medical information outlining any existing medical conditions.
Timing of the Elective
Participants are strongly urged to arrange to take this elective between late March and mid-May of the fourth year. Earlier periods conflict with internship/residency interviews and fourth year curriculum requirements. In addition, funding for the elective is not finalized until late November.
Living expenses at many overseas sites are generally minimal, averaging $5.00/day based on the experience of past student participants. Airfares, however, can be considerable, particularly for sites in Africa, Asia, and the Pacific. Round-trip airfares for this elective in the past have ranged from $800 to $2,500. Additional costs include visa fees, and fees for immunizations not available at the medical center. Immunizations not routinely available at the medical center include typhoid, yellow fever, and cholera. Average malaria prophylaxis costs around $60 for a course of several weeks. The School of Public Health arranges with the Student Health Service to provide immunizations available here, e.g., tetanus toxoid, Hepatitis B vaccine, and polio vaccine, and to provide prescriptions for those not available here. The Student Health Service can, however, administer them after the student fills the prescription(s).
Students should be aware that there are, in addition, other incidental costs. For example, our cooperating site in India currently charges a registration fee of $450.00, and the one in the Dominican Republic a registration fee of $600.
Stipends are currently available from the School of Public Health to provide partial support for travel and to cover any registration fees. These funds are primarily provided to the School of Public Health by the Alumni Fund of the College of Medicine. The amount of funding available to an individual student has averaged from several hundred dollars to $2,500 in recent years. Thus, students should carefully assess their ability to cover the remainder of expenses that will be incurred. The selection committee, in conjunction with representatives of the funding groups, recommends the level of funding for individual students.
Students planning to participate in this elective should be in good health. Applicants should inform the School of Public Health if they are on any medications or are suffering from any illness, even those not requiring regular medications. Anti-malarials and other drugs required overseas may cause serious drug interactions with certain medications.
In many health care settings in resource poor countries, there is often a high prevalence of HIV infection and Hepatitis C infection among patients. Because universal precautions are not routinely practiced in many such settings, there is an increased risk of exposure to these and other blood-borne pathogens. Consequently, all students enrolled in this elective are warned to refrain from participating in surgical and other invasive procedures as well as the delivery of newborns where there is always a risk of exposure to bodily fluids.
The Student Health Service will provide each student in this elective with a prescription for a five-day supply of post exposure prophylactic therapy, which you must take along with you, and instructions as to where you can obtain the drugs. Students will also receive detailed instructions concerning the course of action to be taken in the event of possible exposure.
Global Health Sites
Students may apply for placement in an already approved site. If students opt to select and arrange overseas sites on their own initiative, they must submit their plans to the School of Public Health by December 31st of the third year. This is necessary to permit the identification of appropriate preceptors and sites who meet the elective's standards. A formal relationship must then be established between the School of Public Health and the site and its preceptors. The School of Public Health cannot undertake to establish new sites to meet student preference.
The School of Public Health will not approve sites in countries for which the U.S. Department of State advises against travel, or which are covered by the U.S. government's sanction program. This includes, but is not limited to: Cuba, Libya, Iraq, Sudan, Bosnian Serb-controlled areas of the Republic of Bosnia and Herzegovina, Nepal, Pakistan, Haiti, Columbia, Liberia, Algeria, Somalia, North Korea, Iran, Syria, and Burma (Myanmar); countries where, in the School of Public Health's judgment, students would be at risk because of security problems; and countries which have routinely denied students entry for this type of elective.
Some current departmental sites are located in:
- Dominican Republic (Spanish)
- India (English)
- Thailand (English)
Students wishing to go to countries where Spanish, French, or some other language is spoken should have adequate fluency in that language.
Students may arrange their own overseas sites in resource poor countries. These sites must be approved by the School of Public Health.