Global Health Elective for Medical Students
PUBH 4540: Global Health in Developing Countries
This elective is offered to fourth year medical students who have satisfactorily completed all academic requirements for the third year.
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About The Elective
The School of Public Health's Elective, Global Health in Developing Countries, was initiated in 1980 by the Founding Dean and Dean Emeritus, Dr. Pascal James Imperato, who served as the course director through 2016. Beginning in the academic year 2015-2016, Dr. Denise Bruno, who received her Master of Public Health degree in International Health from the Harvard School of Public Health, assumed the role of director of the elective. At the same time, Dr. Monica Sweeney, Vice Dean for Global Engagement, and Director of the Center for Global Health, assumed the position of course co-director. The objectives of this elective are to provide fourth year students with an opportunity to observe, study, and participate in public health programs in resource poor countries, to study health and health care disparities in such countries, to be of service to disadvantaged populations in these countries, and to have a cross-cultural experience.
As of 2017-2018, some 435 students have participated in this elective in some 42 countries in Africa, Asia, Central and South America, the Caribbean, and Oceania. Most have spent six to eight weeks at overseas sites arranged by the course directors. The program at Downstate is one of the largest and most successful in the country. Some of its procedures and practices have been adopted by a number of other medical school programs, and by the International Health Medical Educational Consortium (IHMEC).
Admission to this elective is highly competitive. Annually, some 50 students compete for approximately twenty places. The admission process includes an examination of the academic record to date, a personal interview with a member of the Global Health Elective Screening Committee, and reference checking with faculty familiar with applicants. Students who have a commitment to a career in preventive medicine, public health, or primary care are given preference. Each student admitted is carefully advised by the course directors, who also arrange the overseas placements.
Our program has always had stringent policies and procedures regarding selection of overseas sites, health maintenance, and safety. Students are not permitted to travel to countries that the Department of State considers risky. Country-specific information is regularly updated from the Department of State, and in certain instances, the course directors speak directly with the country-specific desk officer at the State Department. In addition, the course directors regularly update local conditions through contact with in-country preceptors, some of whom have collaborated with us for many years.
Financial Assistance for the Global Health Elective
The School of Public Health provides partial financial assistance to medical student participants in the Global Health Elective. Applicants to the elective should be aware that this financial assistance is not intended to cover all of the possible expenses that a participant may incur. The stipends given to the participants are only intended to help defray expenses. Therefore, students should be prepared to pay for some expenses from their own funds. Depending on overseas location and unforeseen circumstances that may arise before, during, and after the elective, these expenses might be considerable. Financial assistance for this elective is largely provided from several extramural sources, including the LSK Foundation, the Alumni Fund of the College of Medicine, and by other donors. In 2017-2018, the LSK Fellowship was established through a generous endowment from the LSK Foundation on behalf of its founder, the late Dr. Sonya Binkhorst. Dr. Binkhorst delivered medical care to the poor in developing countries for many years, and has been a staunch supporter of our elective program since 2001. Some of the Alumni Fund support has been provided through specific bequests to the Fund. In 1983, Mrs. Lona B. Kennéy donated a significant sum to support the elective in memory of her husband, Dr. Michael Kennéy, a renowned patho-parasitologist and Clinical Professor of Pathology at Downstate. In 1998, Dr. Joshua H. Weiner, a graduate of the Class of 1941, read of the overseas elective. Having spent time studying tropical medicine in Puerto Rico in his senior year, he expressed a desire to financially support the program. In early 1999, Dr. Weiner donated a significant sum to the Alumni Fund of the College of Medicine to help defray the travel expenses of students participating in the elective. Applicants for this elective should keep in mind that student stipends provided for this elective are only intended to assist in defraying expenses and not to cover them entirely.
Medical students may apply for the Global Health in Developing Countries Elective in the fall of their third year.
The purposes of this elective are to provide fourth year medical students with an opportunity to observe, study, and participate in public health programs in developing countries, to study health care disparities in such countries, to be of service to disadvantaged populations in these countries, and to have a cross-cultural experience. 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 developing 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 (PHAB 5-034) 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 site approvals.
All applications are reviewed by the Global Health Elective 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 developing 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 or early April.
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. At other sites, they can be considerably more. 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, site registration 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 also be aware that there may be other incidental costs involved, including registration/application fees, course fees, visas, etc.
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 and the LSK Foundation. The amount of funding available to an individual student hashas been approximately $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 HIV prophylactic therapy, which you must fill and take along with you. 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. As of March 1, 2018, this includes, but is not limited to: Cuba, Libya, Iraq, Sudan, Bosnian Serb-controlled areas of the Republic of Bosnia and Herzegovina, Pakistan, Colombia, Liberia, Algeria, Somalia, North Korea, Iran, and Syria; 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:
- Costa Rica (Spanish speaking)
- India (English)
- Taiwan (English)
- Thailand (English)
The School of Public Health is actively working to secure additional overseas sites for this elective, which may be available at the time of site assignment.
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 (alternative) overseas sites in developing countries. These sites must be approved by the Course Directors in the School of Public Health.