I think investing in health care workers is a great idea, but I wonder if you had any thoughts about the challenge of retention.  I remember reading that due to the shortage of health care workers globally, workers were often hired away after they had completed more advanced training.  That's not to say it isn't a worthwhile idea, but what are people doing to try to keep good people working in the system once trained?

To heal the body, heal the earth.  Utilizing Organic Agriculture for proper nutrition and Green Technology to create and regenerate non-toxic environments are really pragmatic ways to sustain health in all the people of the earth.  In addition to empowering people with the necessary resources to become regionally independent as well as educating in these innovative fields, the co-oping of peoples abilities into a fair-trade economy will further sustain health by sustaining economy.  For those in a health crisis-can anyone say Green Pharmacy!

I completely agree that nutrition education is ANYONES best bet for positive change.   Since most diseases, disorders, causes of death are completely avoidable (ie: cancer, heart disease, kidney failure, etc) We must wake everyone up to the fact that pills cannot substitute a healthy lifestyle.   

Alanna,
We share a passion.  I am dedicated to improving global healthcare capacity through systematic mechanisms.  I have an idea that involves significant changes in the way that we train residents in the United States.  My colleagues and I have been working on a plan to integrate global health curriculum into residency programs across the nation.  This will involve fundamental changes in our current system.  We believe that US academic medical training programs can lead the development and growth of global healthcare capacity throughout the world.  This change will require focused dedication to this pursuit and significant continuous funding.  Please read the discussion below to get a better idea of this project.  
Cheers,
Ryan


Growing A New Global Surgical Workforce: A “Peace Corps” of US Resident Physicians 

By:  Ryan Jense, MD
University of Washington
Department of Anesthesiology


Although many facets of humanity can and do provide valuable energies to stabilize the human ‘super structure’, the United States academic medical education system has only begun its entrance into this field. I believe this to be an incredibly important step towards a quantum leap in stability. If value recognition is added at the highest levels to improving global wellbeing, the United States can further establish its positive leadership role in global citizenry.

We have reached a period of global interconnectedness in which the Federal government and the individual US medical societies should consider revising their mission statements to further reflect their dedication to improving global wellbeing. The Obama administration and congress in collaboration with the Institute of Medicine, American Association of Medical Colleges, American College of Graduate Medical Education, Association of Academic Health Centers, and the departmental Residency Review Committees can support and guide this process.


As an anesthesiologist, I have focused my efforts on global surgical disease, but please understand this logic could be applied to all medical specialties. I have been pursuing an idea that will help bridge the surgical gap of humanity, and in the process, improve the lives of millions. It is a result of, and a response to, evolving global health interests circulating within our communities and our institutions. This idea requires changing culture within the United States medical education system.


Injury prevention and basic surgical care are increasingly recognized as important cost-effective components of global health. Worsening political-economic disparities and global industrialization are greatly responsible for the growing surgical burden. The resulting violence and rapid introduction of mechanization into countries with minimal regulatory systems and dismal surgical care infrastructure have accelerated injury related death and disability worldwide.


The World Health Organization (WHO) estimates that one million people die from road traffic accidents (RTA) each year, with 50% being between the age of 15 and 44 years. A much greater number are disabled from RTA’s. Violence, trauma, and routine surgical pathology also contribute greatly to the overall surgical burden. Furthermore, surgical health needs of women in developing countries continue to be grossly neglected. The WHO estimates that over 500,000 women die each year from complications related to pregnancy/childbirth, and approximately another 10 million suffer delivery-related injuries.


Surgical disparities are ubiquitous. Vast majorities of the world’s population do not have access to basic surgical healthcare. Dismal surgical systems, and a grossly inadequate surgical workforce are to blame. I present you a mechanism that will alter this disparity.


A growing set of data recognizes that US resident physicians are ready and eager to provide clinical, research and educational global health services while in training. This group of physicians represents the future of US and global medicine, and if given the chance, tomorrow they will begin to function in a synergistic way to help grow global medical capacity where it is needed most.


Selected surgical training programs across the US will join forces. This coalition can be thought of as a “Peace Corps” of resident physicians. International global health electives will be integrated into these surgical residency programs. Each program will devote intellectual and human resources to a select international site. Resident and attending physicians (A.K.A. - the doctors who train the residents) will rotate to these sites and serve a clinical, research, and educational role on a continuous year-round basis.


Through careful evaluation, and in coordination with international medical officials, a rigorous curriculum will be developed to serve the needs of the international sites. These curriculums, coupled with appropriate health systems planning, will result in the massive growth of international surgical capacity. The endpoint is the formation of self-sustaining surgical systems at each international site. When that important threshold is met, the model will transition to another site and begin again.


This is an idea of scale, but most importantly, of potential. A tremendous increase in the global surgical workforce will be realized through the sheer number of US physicians serving internationally, and more importantly, through the systematic training of international local providers who will continue to serve in their respective communities.


Underserved international communities will benefit greatly from the implementation of collaborative surgical systems centered on a chosen district level hospital. These “hospitals of surgical excellence” will provide perioperative and surgical services to a grossly underserved population, and will permanently serve as centers of research and medical education for the local population. Beyond the core mission, these centers will support political-economic stability, and also instill a sense of community pride.


A fully funded pilot program is essential to the growth of this idea. We have taken preliminary steps at the University of Washington (UW) to initiate this process. We aim to create an “International Surgical Care Center” within UW Health Sciences to attract expert faculty from around the world to achieve the following goals:

1. Develop specific curriculum to grow the global surgical healthcare workforce through training of international providers and UW personnel.

2. Integrate year-round global health electives into UW surgical residency programs such that resident-attending pairs will function in an educational, research and clinical capacity.

3. Integrate UW capacity into a specific international site to construct/enhance sustainable education, research, and clinical capacity.

4. Provide training in creation and evaluation of surgical infrastructure (initial response, trauma care, etc.) through the UW Harborview Injury Prevention Center.

5. Attract worldwide expertise and become the model academic clinical educational global outreach research center.

We aim to enhance global surgical systems and grow a highly qualified global surgical workforce through the maintenance of numerous collaborative and parallel relationships. A coalition of US academic surgical residency programs will be the driving energy to provide clinical and educational expertise to selected international partners. They will be responsible for maintaining high quality clinical/educational curriculum and expertise for targeted low-income populations.


An umbrella entity such as the World Health Organization will oversee and maintain communication with international Ministries of Health and other officials to promote the relationships between the US academic programs and their partners. Most importantly, our international partners will lead in the evaluation and evolution of site-specific educational models and curriculum to best serve their goals.


Gross success will be measured by evaluating the number of:

1) International students trained

2) Self-sustaining global surgical centers created

3) Patients treated

4) US physicians practicing abroad


I believe the Obama administration will assist in stabilizing the human ‘super structure’ on countless fronts. Value recognition in the form of new humanitarian foreign policy, such as an initiative directed to create and sustain a “peace corps” of global US resident physicians, is a great way to assist this effort. Let’s further embrace our interconnectedness and give the stars to our children.

Ryan J. Jense, MD
University of Washington
Department Of Anesthesiology  

We need to combat the key causes of The Global Health Epidemic - things like climate change have all played a huge role in the onslaught?