Part I A

Swedish Family Medicine Residencies

Cherry Hill and First Hill Campuses

International Health Area of Concentration

Curriculum

Objectives

The International Health Area of Concentration is designed to provide motivated residents opportunities to:

      1)      learn first hand how medical care is delivered in underdeveloped settings

2)      learn more about epidemic diseases such as TB, HIV and malaria

3)      learn how social, economic, political forces at the local, regional, national and international levels influence the provision of health care in underserved international settings

4)      immerse themselves in a new culture and appreciate how health and healthcare is viewed through that culture

5)      learn about the provision of appropriate medical care in low-technology settings

6)      gain leadership experience in diverse clinical settings

7)      learn about the role of public health interventions in medically underserved areas

8)      participate in health-related research in international settings

9)      develop an international perspective on the United States’ healthcare system

These objectives will be addressed through the following four-part module. They are designed to give the individual resident the tools to better understand the theory and practice of international health, and to plan a one-month overseas elective in which to put that understanding to practical use. The four parts are as follows:

An on-line curriculum with selected readings, covering several important topics in international health

A one-month rotation at a site in the developing world, carefully chosen to help achieve the above objectives

A series of lectures that complements the overseas rotation

Preparation by the resident of a paper or presentation, using the readings and the overseas rotation to help address a significant topic in international health.

Additional reading resources: For an abbreviated list of the readings, click here.

A. Major global health issues and transitions

Worldwide demographics and burden of disease

Murray CJ, Mortality by cause for 8 regions of the world: global burden of disease study. Lancet 1997; 349:1269-1276.
http://pdf.thelancet.com/pdfdownload?uid=llan.349.9061.original_research.8645.1&x=x.pdf

This is the first of a series of four landmark articles in The Lancet describing "global burden of disease" methodology and its application to causes of mortality worldwide.

Macfarlane S, Public health in developing countries. Lancet 2000;356:841-846.
http://www.thelancet.com/journal/vol356/iss9232/full/llan.356.9232.editorial_and_review.10087.1

Inequalities in health and wealth demand new approaches to providing improved health to people in developing countries.

Dye C, Global burden of tuberculosis. JAMA 1999; 282:677-686.
http://jama.ama-assn.org/issues/v282n7/ffull/jst80025.html

This article uses "burden of disease" methodology to describe changing patterns and impacts of TB worldwide. For a more recent and thorough treatment of TB worldwide, see the following article:

Cegielski JP, The global tuberculosis situation. Infect Dis Clin N Amer 2002; 16:1-58.
http://home.mdconsult.com/das/journal/view/19448802/N/12347508?ja=282634&PAGE=1.html&ANCHOR=top&source=

Pronyk PM, Whose priorities? A response to the issue of antiretrovirals in Africa. Trop Med Int Hlth 2001; 6:575-576.

This editorial asks whether the push to provide large scale HIV medications to African populations is a quick (and premature) fix to more systemic problems with health care in Africa. (This article is not available online, and is reprinted in the notebook in the Learning Center.)

Transitions in patterns of health and disease

Murray C, Evidence-based health policy--lessons from the global burden of disease study. Science 1996; 274:740-743.
http://www.sciencemag.org/cgi/content/full/274/5288/740?ijkey=vd.vBXsmMcpok

Murray and Lopez from Harvard and WHO discuss projected shifts in the global pattern of disease prevalence over the next two decades.

La Porte R, Epidemiological Transitions. Supercourse lecture.
http://www.pitt.edu/~super1/lecture/lec0022/index.htm

Dr. La Porte presents data on patterns of disease among the world's nations as they have evolved over the course of the nations' development and as they are likely to evolve in the coming years. (Note: This is an online lecture in the "Supercourse" series. Click "Start," then use the navigation arrows to move through the lecture.)

Interrelationship of health and socioeconomic factors

Stanghellini A, The situation of sleeping sickness in Angola: a calamity. Trop Med Intl Health 2001; 6:330-334.
http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-3156.2001.00724.x

Burri C, Editorial: Are there new approaches to roll back trypanosomiasis? Trop Med Intl Hlth. 2001; 6:327-329.
http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-3156.2001.00730.x

The Stanghellini article and the accompanying editorial describe the tragic rise in prevalence of African trypanosomiasis in Angola, and its sources in the civil war.

Sachs J, The economic and social burden of malaria. Nature 2002; 415:680-685.
http://www.nature.com/cgi-taf/DynaPage.taf?file=/nature/journal/v415/n6872/full/415680a_fs.html

Sachs and Malaney discuss the sweeping impact of malaria on the demographics, economic vitality, and overall health of a population.

Sheik-Mohamed A, Where health care has no access: the nomadic populations of sub-Saharan Africa. Trop Med Intl Hlth 1999; 4:695-707.
http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-3156.1999.00473.x&prevSearch=%2Ballfield%3Arefugee+%2Ballfield%3Ahealth

The health problems of, and the challenges of providing health care to, some 100 million nomadic people in the developing world.

Family Medicine in the Developing World

(to be inserted)

... Back to Table of Contents | Proceed to Curriculum Part B...