Global Health Roadmap
TECaN Top 10 Things to Know when Starting a Global Health Project
1. Collaborations
Key Point: Build off of pre-existing relationships to help establish collaborations and respect the goals of your local co-investigators.
One of the keys to a successful global health project is to work collaboratively with the site you have chosen. In many instances, the easiest way to get started is to affiliate yourself with a pre-existing relationship and build your project from there. You may need to look outside of your division or department, or even your University, to make these connections. If you have a particular part of the world that you’re interested in working, see if others from within or outside your institution have worked in that area. This will also allow you the opportunity to understand some of the unique challenges associated with working in that country.
If you’re starting this collaboration on your own, there are a number of important things to keep in mind. First and foremost, the research you work on should be conducted to benefit the country you’re working in. Further, a “West is Best” approach is unlikely to be successful. Figure out what is needed in the region you’re working in, and design your project around those needs. Start small with clear and achievable aims, and scale up from there. Identifying a local Co-PI is essential to the longevity of a project. This on-the-ground person or persons can help to maintain local interest in the project, and to keep things moving forward. Remember, this is a partnership, so treat your co-investigators with respect, and strive for equality among all partners. Define clear roles and expectations for all team members and be sure to foster an environment of trust with readily available lines of communication between the partnering sites. Maintain these lines of communication with regularly scheduled meetings via Skype or WhatsApp, etc. Without good communication, you’re unlikely to have a successful partnership.
Lastly, learn from your partners, start with what they know and build upon what they have. Ultimately, your goal should be to build sustainable capacity that isn’t dependent on your funding sources (which are time limited), and your in-country partners take pride in the work they’re doing.
References:
1. John CC, Ayodo G, & Musoke P. (2016). Successful global health research partnerships: What makes them work? American Journal of Tropical Medicine and Hygiene.
2. Walker RJ, Campbell JA, & Egede LE (2014). Effective Strategies for Global Health Research, Training and Clinical Care: A Narrative Review. Global Journal of Health Science.
2. Mentors
Key Point: Find a diverse group of mentors to help guide you. Not all of your mentors need to be neonatologists and not all your mentors need to have done global health.
Find a diverse group of mentors to help guide you. Your mentors don’t all have to have neonatology or global health experience. A lot depends on your area of interest. For example, you may have a mentor in your area of interest who has not done a global health project, but you may also find someone that has done a lot of global health research but who has not done work that is in your area of interest. Why not work with them both? Together you may be able to develop a research proposal/project that appeals to everyone’s interests and experiences. You will find that together they may have the resources and tools to help guide you on your chosen research project or career path. One mentor may be helpful in navigating the grant writing or IRB process, while another may be helpful in establishing relationships with potential global partners. It is important to build a strong team around you and use everyone’s unique skills and knowledge.
Additionally, mentors don’t always have to be at your institution. One of the great things about global health is that collaboration happens all over the world. If you meet someone at a conference or while doing a global project, stay in contact! You never know how they might be helpful down the line, or how you will be able to help them.
3. IRB Approval
Key Point: The IRB process can take a long time.
IRB submission and approval differs by institution. When conducting an international study, IRB approval will likely be needed at EACH partner institution. Contact each institution at the start of the study to determine the timeframe for IRB approval, necessary documents, and associated fees. Make sure to have a local champion, ideally someone who is going to be a co-investigator, be in charge of submitting your proposal to the IRB at each site.
4. Funding
Key Point: Consider a wide range of funding sources, including those within and external to your university.
The first step in acquiring funding for your global health project in fellowship is to name the primary type of work you hope to do. This is most often going to be research, clinical, education or quality improvement (QI) work. Next, draft a budget that includes your research and professional costs (travel, insurance, boarding, communication with local team members). You should then write both a budget and project proposal. This will be required as a part of your applications for funding.
The type of work you will be doing and your budget will direct where to look for funding. For example, if you are going to be doing research then your, consider both research funding and funding specifically designated for global health research. Similarly, if you are doing a QI project, you might apply specifically for a QI grant. Depending on your budget, you may need to apply for multiple grants or awards.
When considering funding sources, start with those closest to you and then go more broadly. Begin by talking to your project mentor and program leadership about funding that might be available only to fellows in your program or people working on your specific project. Next, look within your hospital, hospital system, the affiliated medical school, and then within specialty societies in your county and state. Most county and state medical societies have funding set aside to support trainees, as do most state sections of the American Academy of Pediatrics. Lastly, look to national organizations that target a specific disease or problem, and those that are likely to support medical trainee projects, such as the American Academy of Pediatrics, American Medical Association, and the American Medical Women’s Association. Lastly, there are a number of philanthropic organizations that offer funding for trainees doing projects in global health.
Below is a list of funding opportunities that you may want to consider:
NIH Funding Opportunities
- Fogarty's global health research and research training programs offer a variety of funding opportunities in many different areas of global health
- May utilize ASSIST as a simplified application process
Trans-NIH Programs and Collaborations
- Fogarty collaborates with components of the NIH and other partners to foster global health research on a variety of research and training opportunities involving low- and middle-income countries (LMICs)
- In addition to Fogarty-supported programs and the trans-NIH programs and collaborations, many Institutes and Centers at NIH offer funding opportunities to support research on global health topics, or in areas relevant to global health
NICHD Funding Opportunities
- Division of Extramural Research (DER)
- Varying opportunities not solely related to global health, however supportive of research across countries
Non-NIH Funding Opportunities
- Large list of various organizations that provide funding opportunities for health professionals
Resource from UChicago website
- Large list of various organizations that provide funding opportunities for health professionals
Global Health Service Partnership (GHSP), Peace Corps
- Founded in 2012, GHSP is a collaboration of the Peace Corps, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and Seed Global Health
- The Global Health Service Partnership (GHSP) helps address critical global shortages of health care professionals by sending physicians and nurses to work alongside local faculty to build institutional capacity and help strengthen the quality of medical education
- GHSP Volunteers serve in Liberia, Malawi, Swaziland, Tanzania, and Uganda. Service commitment for 1 year.
Thrasher Research Fund Early Career Awards
Institutional Funding
- Many academic institutions have a Global Health Education office which can provide opportunities for funding for faculty of that institution
5. Project Goals and Scope
Key Point: Keep project goals aligned with the needs and interests of the site and ensure the scope will be manageable given your available resources.
Optimal productivity requires setting meaningful goals and breaking them down into manageable parts. A 1st step is to identify a meaningful project. Do this by brainstorming with your local partners to identify their most pressing questions/needs. Then list these in order of priority with the goal of tacking the most pressing 1st.
Focus the project scope by making goals SMART: Specific Measurable Achievable Realistic Timebound. Small initial wins pave the way for bigger ones by building team cohesion and confidence. The late Steve Jobs famously said, “if not for the blue box (his 1st invention with Steve Wozniak) there would be no Apple.”
6. Valuing Local Partners
Key Point: Include local providers in all phases of the process, from initial planning to publication.
Valuing local partners is essential to successful global health work. It’s important to include the local physicians, researchers, and other medical personnel in all phases of the process, from initial planning to publication.
Once you have established a partner for collaboration, first ask them what they see as important areas for improvement or research. What hypotheses or goals do they have to improve the health of their own community? Starting a project of any sort without agreed upon goals will lead to problems in the future.
Next, think about having a Co-PI and research coordinator from the local collaborating group. They will help navigate the practical aspects of your study and any cultural challenges that are sure to arise. Local partners will also be instrumental in obtaining IRB approval at partner sites and eliciting local buy-in for the project. Don’t forget to discuss potentially contentious topics (budget allotments for grants, authorship on manuscripts) early in the planning and remind them that you are including your local team frequently.
It is also important to consider how you can foster leadership and mentorship among the team. Use this project as an opportunity to train and equip young faculty and researchers globally. They will be the key to making your project sustainable and mutually beneficial.
7. Conferences & Publications
Key Point: Aim to present at a wide range of conferences, especially those that have travel grants available for international collaborators. Think outside the box for publication. Global health studies are published in pediatric, neonatal, international health, nursing journals, and many more.
Below is a list of conferences to consider for presenting your global health work:
Pediatric Academic Societies (PAS) Annual Meeting
- Annually in the spring
AAP National Conference
- Annually in the fall
- Can present abstract in multiple sections- Global Health, Maternal and Child health section/ QI section depending upon your project
Vermont Oxford Network Quality congress
- Has been held in Chicago, IL over recent years.
- Annually in the fall.
- Offer TECaN/VON HBB Co-facilitator Scholarships, to facilitate Helping Babies Breathe program to cover a portion of travel costs
- Held in Washington, DC
- Annually in the Spring
- AAP SOICH (Society of International Child Health) typically offers 6 scholarships to cover registration fees
Global Health and Innovation Conference
- Held annually in the spring
American Public Health Association Conference
- Held annually in the fall
Annual Pediatric Global Health Conference
- Held at CHOP
- Held annually in the fall
Consortium of Universities for Global Health(CUGH) Conference
- Held annually in the spring
8. Cultural Competency & Cultural Relativism
Key Point: Make sure to research the political climate, culture, and religion of the region you are going to. Be aware of your presence in another culture.
Visiting a new culture is exciting, but being away from a familiar environment and having to adjust and adapt to different customs, language, and food can be distressing. To avoid this “culture shock,” educating yourself beforehand about the country you will be visiting can help mitigate the challenges of the unfamiliar setting. Reading about local politics, culture, customs and religion of the area can be enlightening; however, there are alternatives to reading text that can help enrich the cultural education. Video documentaries about the history of many countries may be found online, and travel shows exploring food and culture (such as Anthony Bourdain’s Parts Unknown) are available on streaming media services, or from your local library. However, be informed in context, and avoid over-generalizations based on your pre-reading.
Identifying how your own culture influences how you think, speak, and behave, and how this impacts your interactions with your host culture can also help with adaptation and reduce distress. L. Robert Kohls’s Survival Kit for Overseas Living is a guide for Americans planning to live and work abroad that helps readers identify their cultural biases and be open minded to differences in their host culture.
Cultural relativism is the principle that the beliefs and activities of a community must be understood in terms of that community’s own culture. It is further defined as the view that moral or ethical systems, which vary from culture to culture, are all equally valid and no one system is really “better” than any other. Our relation from one culture to another affects our pattern of behavior and in some cases judgment system. The impact of cultural relativism on the success of global health fieldwork is extremely significant. One historical example of lack of cultural relativism is evident in the mission to eradicate polio. The resistance met in Northern Nigeria partly due to lack of cultural relativism resulted in a cohort of the population being unvaccinated against polio.
Cultural Relativism becomes even more crucial not only in the inception of a project but especially in the implementation. It is important to recognize early the influential bodies or figures in that community. It could be religious leaders, political figures or local leaders. Building capacity with these people goes a long way to having recommendations and interventions received, incorporated and practiced.
The success in the field of Global health is heavily dependent on the comprehensive evaluation of the location and a detailed understanding/respect of the culture while setting personal bias and experiences aside. Understanding the impact and role of religious leaders, local healers and other influential figures in the community is of paramount importance. Involvement of these influential figures with first helping them understand the mission and the purpose of the project would make for an easier transition and acceptance for recommendations later made for a successful fieldwork mission.
Reference:
- www.unaids.org/en/HIV_data/epi2006/default.asp
- www.avert.org/aidsbotswana.html
- www.odi.org.uk/rapid/projects/r0166/docs/Aids_report_country_study_Botswana.pdf
- 2002 It’s never as easy as ABC: Undertakings of Aids in Botswana. Suselte Heald, Brurel University.
9. Safety
Key Point: Ensure your own safety while traveling, including obtaining immunizations and medications that you may need to take abroad.
Visit a travel medicine clinic early when trip planning. Many universities offer this service through a university travel clinic. You’ll need vaccinations and medication appropriate to your exact destination. Information about destination specific needs can be found at https://wwwnc.cdc.gov/travel.
Bring basic first aid supplies and personal health items. Make sure to bring prescriptions for medication as each country has different regulations, as well as enough medication to last through your stay. Many travelers fill a prescription of an anti-diarrheal before traveling, as these medications may not be available in all areas.
It is also important to get travel insurance. This ensures that you are not paying out of pocket for medical emergencies encountered abroad. Evacuation services are often included in travel insurance, but it is important to check the specifics of your policy statement before traveling. Many universities offer travel insurance, otherwise the CDC has information on where to obtain coverage. CDC information on travel insurance can be found at: https://wwwnc.cdc.gov/travel/page/insurance
Finally, register your travel with your university and with the State Department at https://step.state.gov/STEP/Pages/Common/Citizenship.aspx.
10. Resources
The Helping Babies Survive series contains a collection of courses related to newborn resuscitation, care of newborn babies, and care of premature babies. Master trainer courses are offered throughout the year and the site contains information about upcoming trips and how to order additional materials.
The site can be accessed at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/helping-babies-survive/Pages/default.aspx