Elise in Haiti: Post-Travel Report

 
 
 
 
 
 
 
 
 
By: Elise Vuille-Lessard

Award won:

The Global Health Travel Award for Postgraduate Medical Residents

Bio:

I am a PYG-3 in internal medicine based at the Royal Victoria Hospital. What made me want to participate in the McGill Internal Medicine Global Health Initiative in Haiti was the idea of a long-term partnership between McGill and Haitian doctors and of capacity building, rather than a one-time intervention.

Project Overview:

elise_photo

Elise in Haiti

This project is a one-month elective rotation where a team composed of internal medicine senior residents and staff from McGill works at Hopital St-Nicolas (HSN) in St-Marc, Haiti. This involves collaborating with local residents and staff as well as Zanmi Lasante/Partners in Health (ZL/PIH), the largest non-government health care provider in Haiti. The goal of this project is to maintain a partnership with ZL and the family medicine program at HSN (including exchanging knowledge, teaching, mentoring), while developing competencies for McGill residents in global health.

Lessons learned:

Change is so difficult to implement. Last year’s team had tried to implement the concept of a patient list on the ward, using whiteboards where you put the patient age, sex, diagnosis and plan. Unfortunately, the first day we arrived to the hospital, the whiteboards were empty. We re-emphasised this concept and did some positive reinforcement throughout the month, and finally the boards were being used when we left. Our fear was that residents would stop using them after we left, but 1 month later we were excited to learn that they were still in use. Change IS possible! I was sometimes discouraged thinking what we were doing was a wasted effort, that those interventions we were making would not stay. But when I learned that the whiteboards were still in use after we were gone, I suddenly felt like I had done something good and valuable.

Advice:

Students looking for a global health experience need to find a project that involves a long-term relationship with the local workers and try to avoid sporadic interventions. The main reason for that is that the time spent on-site is limited and maintaining the change afterwards becomes the most difficult challenge. One of the terms I learned with this project is “capacity building”, which includes finding ways of making an intervention sustainable.

 

This experience influenced my future career plans in many ways. I don’t know when I will participate again in a global health initiative, maybe not in the near future, but possibly later in my professional life. One thing this experience did reinforce is my desire to be a teacher. I certainly want to work in an academic setting and teach young people how to become better doctors, in regards to the medicine itself but also the human side of it.

 

Global Mental Health Research for Sustainable Development

Sakiko Yamaguchi

The WHO’s global mental health action plan 2013-2020 relies on evidence-based practices. As such, today’s global mental health research is largely focused on the “evidence” to deliver effective mental health interventions in low- and middle-income countries. Although I have no intention to question the need and importance of scientific evidence, we hardly hear about the “sustainability” of evidence-based practice in global mental health despite the fact that “sustainable development” has been a core concept shaping the development agenda since the 1988 Bruntland Commission. Now that mental health and well-being are included in the UN’s Sustainable Development Goals, I would like to explore a question: “How can researchers link global mental health research with sustainable development?”

Sakiko leading a planning workshop in Sudan.

Sakiko leading a planning workshop for a health project in Sudan.

One answer may be found in implementation science, which provides tools and approaches to integrate evidence into health policy and practices (De Silva & Ryan, 2016). An intervention that is found to be effective in the idealized conditions of a research setting may meet a wide range of barriers in a real world context. The exclusive focus on evidence may divert our attention from the role of culture in a specific setting. In this context, global mental health research should find an answer of not only “what works” but also “how it works” by holistically examining the behavioural, organizational, economic, socio-cultural, and political dimensions of the context where evidence is implemented. Furthermore, researchers have the important role and responsibility to share pertinent individual knowledge available with those at the organizational, community, and society levels (Landry, Amara, Pablos-Mendes, Shademani, & Gold, 2006).

The exclusive focus on evidence may divert our attention from the role of culture in a specific setting.

 

While innovative instruments for knowledge sharing still seem lacking, my past work experience in international development reminds me of the notion of “ownership.” With an understanding that the sustainability of the project outcome results from the beneficial output shared among project participants, development partners generally make great efforts to foster a sense of ownership during the project implementation. In global mental health, community-based participatory research may be one possible approach to generate ownership by addressing the unequal power distribution between researchers and community people.

My initial question is still open for discussion. Meanwhile, the consideration of sustainability and ownership in global mental health research may shed light on the ethical aspects of our research process and application of knowledge.

 

About the Author:

Sakiko Yamaguchi is in the 2nd year of her PhD program in Division of Social and Transcultural Psychiatry, Department of Psychiatry at McGill. After working on government projects for social development in low- and middle-income countries, including post-conflict countries (Peru, Afghanistan, Sudan), she decided to pursue her PhD to better understand the long-term impact of violent conflict on mental health, and explore how international community can respond to the unmet needs of the affected people. She is currently in Ayacucho, Peru for her research project on alcohol misuse among the Andean highland population, who is still suffering from the consequence of political violence and the daily hardships rooted in poverty and socio-economic inequality.

 

The new McGill Global Mental Health Program was launched 30 May 2016. Like them on Facebook and learn more here.

 

 

References

De Silva, M. J., & Ryan, G. (2016). Global mental health in 2015: 95% implementation. The Lancet Psychiatry, 3(1), 15-17.

Landry, R., Amara, N., Pablos-Mendes, A., Shademani, R., & Gold, I. (2006). The knowledge-value chain: a conceptual framework for knowledge translation in health. Bulletin of the World Health Organization, 84(8), 597-602.

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