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Internal medicine continues outreach with focus on "human infrastructure" abroad

Yale Medicine Magazine, 2009 - Spring


For nearly three decades, the School of Medicine’s international health program has provided career-changing experiences for medical residents by sending them to developing countries. Now Yale is taking the Yale/Johnson & Johnson Physician Scholars in International Health Program a step further by developing “human infrastructure” at partner sites.

Rather than helping only American doctors develop a sense of global citizenship and commitment to caring for the poor, the program has made ambitious plans to build the long-term capabilities of its sites abroad. The program, which typically sent American doctors to as many as 15 foreign sites, now focuses on only six. A sense that Western institutions had profited asymmetrically from a brain drain from developing countries—a realization prompted in part by increased international communication among researchers in the AIDS era—drove the change.

“It became clear that we as faculty and Yale as an institution have an obligation … to people all over the world,” said Asghar Rastegar, M.D., new director of the international health program, which has partnered with Johnson & Johnson since 2001. Based in part on Rastegar’s own experience as a faculty member at Shiraz University in Iran, the redesign emphasizes bilateral benefits and long-term in-depth commitment. Physicians in the program now serve in the host country as both learners and teachers; and they bring equipment and materials with them, helping the site itself expand its capacity to care for the sick. In turn, the host countries send physicians on learning trips to the United States.

The pilot program, developed by Majid Sadigh, M.D., associate professor of medicine, is in Kampala, Uganda, at Mulago Hospital, the teaching hospital of Makerere University. The hospital has a ward staffed full time by Yale faculty and residents working side by side with their colleagues from Makerere, and sends physicians to New Haven for specialty training. Fred Okuku, M.D., a resident physician, spent six months at Yale learning to perform mammograms and ultrasounds, then returned to Uganda with the training and equipment—a mobile mammography van—to diagnose early-stage breast cancer. The inexpensive cancer treatment available at Mulago—surgery—will save lives that would otherwise have been lost to a late diagnosis.

Though the program has slimmed from 15 sites to just six, those six—in Eritrea, Honduras, South Africa, Uganda, Liberia and Indonesia—are being transformed by the new philosophy. At Tugela Ferry, South Africa, a site directed by Gerald H. Friedland, M.D., professor of medicine, and devoted to research on and care of patients with HIV and tuberculosis, the husband-and-wife team of Scott Heysell, M.D., M.P.H., and Tanya Thomas, M.D., is spending a year at the local hospital. In war-ravaged Liberia, Yale has joined five American medical schools in a collaboration with the John F. Kennedy Medical Center. And Rastegar is working with Eritrea’s first medical school to develop an internal medicine residency there.

The international health program outreach continues to expand, sponsoring classes in international medicine for medical, nursing and physician associate students interested in global health. These projects, said Michele Barry, M.D., HS ’77, a longtime co-director of the program who stepped down in March to become senior associate dean for global health at Stanford University, will bring fresh hope to caregivers in the sites’ low-resource communities. “I think there is a role for us to really stop the brain drain—to stop people like Fred Okuku from thinking he only has a hospice,” Barry said.

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