Around the world, health
care providers are struggling to meet even the most basic of needs for their patients.
Resources are often inversely proportional to the severity of national or local needs.
In one country, medical schools churn out cardiologists, for example, but do not train
general care practitioners. Another country's system involves the constant struggle to
meet government-mandated health standards.
With UCSF taking the lead, academic and government leaders from six countries recently
came together to share ideas on how to train doctors and nurses in the delivery of
efficient, effective and culturally appropriate primary care services.
"This is a way for UCSF to contribute to the health care needs of the developing
world," said Haile Debas, dean of the UCSF School of Medicine and vice chancellor for
medical affairs. "This is our opportunity to see what we can learn from other
countries, it's not about what we can teach them."
Debas and Kathleen Dracup, dean of the UCSF School of Nursing, introduced members of
the newly formed "Global Partners for Primary Care Innovation" (GPPCI) at a
symposium held Nov. 16 at UCSF. The long-term research and teaching partnership plans to
exchange medical, nursing, and academic students and faculty among five countries and
The scholars and government officials are leaders in primary care nursing and medical
education from China, Cuba, South Africa, Thailand, and the United Kingdom. The
partnership has been in the planning stages for 18 months. The group's members met for the
first time earlier this month, spending a week in workshops formalizing the partnership
among the institutions and government agencies involved.
During the Nov.
16 symposium, participants presented examples of innovative interdisciplinary projects in
primary care training from their home countries.
Julio Portal Pineda, for example, described the community-based health care system in
Cuba, where health care leaders hold dual positions in their regional or local departments
of health and government. "Our country is a small one, but it has been able to
develop a strong basis for its health care system," said Portal, chief of
postgraduate education in Cuba's Ministry of Public Health. According to Portal, Cuba's
equivalent of a county health department director also serves as the vice president for
the region, or province. The system, Portal said, makes it easier to facilitate change and
make health care a priority in the country.
It also means doctors must be trained as community leaders in addition to healers.
This kind of system-driven education and training is also seen in the United Kingdom,
where 75 percent of the government's health care budget is allocated to primary care. The
government sets outcome requirements for public health trusts. One of these trusts, for
instance, might be given the task of reducing the incidence of heart attacks by 20 percent
in five years.
"That's a huge challenge," said Elizabeth Murray, a visiting scholar at UCSF
and director of undergraduate education in the department of primary care and population
sciences at the Royal Free and University College Medical School in London.
To meet the government-issued requirements, nurses are trained to collect and analyze
population data and identify high-risk groups in their community on which to focus
outreach and prevention services. Murray described a nurse combing through charts by hand
to gather data that resulted in a new transportation program for homebound elderly.
Other innovations included a community-driven research agenda in clinics near Durban,
South Africa and the use of Buddhist meditation in making attitudinal changes among health
care providers in Thailand. Participants expressed their gratitude at being able to come
together and explore the diversity of approaches to health care and the education and
training of doctors and nurses around the world.
The partnership brings together health care providers from poor countries and rich
ones, centralized and community-based systems and those from different cultures with
different values systems, said Barry Kistnasamy, dean of the Nelson R. Mendela School of
Medicine at the University of Natal in Druban, South Africa.
Despite the differences, Kistnasamy said, "we commit ourselves fully to the goal
of this partnership." The global partnership will be administered by the department
of family and community medicine and Community Health Systems Nursing. The venture is
being developed with support from the deans of medicine and nursing, Steve Barclay, vice
chancellor for Administration and Finance, the UC Institute on Global Conflict and
Cooperation, the department of anthropology, history, and social medicine, and the Center
for the Health Professions.
Those wishing to participate in GPPCI programs at UCSF or abroad should contact Chris
Kiefer, PhD, professor of anthropology; Jack Rodnick, chair of family and community
medicine; William Holzemer, chair of community health systems nursing; Peter Lovett,
assistant professor of family and community medicine; or Jeremiah Mock, assistant research
scientist, Center for Health and Community.
Source: Camille Mojica Rey