Mobile professional voluntarism and international development : killing me softly?

This book explores the impact that professional volunteers have on the low resource countries they choose to spend time in. Whilst individual volunteering may be of immediate benefit to individual patients, this intervention may have detrimental effects on local health systems; distorting labour markets, accentuating dependencies and creating opportunities for corruption. Improved volunteer deployment may avoid these risks and present opportunities for sustainable systems change. The empirical research presented in this book stems from a specific volunteering intervention funded by the Tropical Health Education Trust and focused on improving maternal and newborn health in Uganda. However, important opportunities exist for policy transfer to other contexts

The ethics of educational healthcare placements in low and middle income countries : first do no harm?

This book examines the current state of elective placements of medical undergraduate students in developing countries and their impact on health care education at home. Drawing from a recent case study of volunteer deployment in Uganda, the authors provide an in-depth evaluation of the impacts on the students themselves and the learning outcomes associated with placements in low resource settings, as well as the impacts that these forms of student mobility have on the host settings. In addition to reviewing the existing literature on elective placements, the authors outline a potential model for the future development of ethical elective placements. As the book concurs with an increasing international demand for elective placements, it will be of immediate interest to universities, intermediary organizations, students as consumers, and hosting organisations in low-resource settings

Optimising student learning on international placements in low income settings

This paper challenges the assumption that student visits to low resource settings inevitably promote the acquisition of cultural competence. Much of the literature and marketing rhetoric advocating the expansion of such ‘exposures’ lists numerous positive outcomes with an emphasis on ‘cultural learning’. With important exceptions, the concept of cultural learning remains uncontested, nestling in the fluffy haze of an inherently benevolent multi-culturalism. The emphasis in current research is on ‘learning’ or ‘competency’ at the expense of definitional clarity around the concept of culture itself. This results in a tendency to overemphasise (and essentialise) difference rather than commonality and conflates cultural learning with narrow (stereotypical) concepts of race, ethnicity and religion. The paper discusses the experiences of students undertaking placements in Uganda through Knowledge For Change, a UK charity hosting the Ethical Educational Placements project, to identify and critique this dimension of ‘learning’. Using an action-research approach combining observational research with qualitative interviews and surveys the paper uncovers the nuance of cultural learning. In important respects the behaviour that students are witnessing and attributing to culture is connected more to the specific organisational contexts that they are placed in and the patient groups they ‘serve’ than any connection to an homogenous ‘national’ culture. Poverty and gender inequality, amongst many other forms of structural inequality, result in ‘othering’ behaviour on the part of health workers towards patients that is a fundamental characteristic of public health organisations in residualised welfare systems. In this complex environment, cultural learning is not so much about celebrating difference. It is more about understanding social context and accepting that you don’t and can’t possibly know a person’s situation; and with that in mind you should treat everyone with the same degree of humility and respect. Adopting and practising ‘epistemic humility’ (Hanson et al 2011; Ahmed, Ackers-Johnson & Ackers 2017) is crucial to meaningful learning in any context. Further, a lack of understanding of the broader structural processes perpetuates inequalities between the Global North and South (Husih, 2012; Ahmed, Ackers-Johnson & Ackers, 2017) and impedes knowledge acquisition, particularly cultural learning. Moreover, hubris – or Western students’ assumptions of superiority over host health care workers (Bauer, 2017; Elit et al, 2011, Ahmed, Ackers-Johnson & Ackers, 2017) – may act as a further obstacle to cultural learning. Cultural learning is as much about learning about ourselves and what it feels like to be ‘othered’ as it is learning about others. International placements in LMICs create critical opportunities for relevant student learning. But achieving this and guarding against the risks of ‘mis-learning’ requires the level of cultural brokerage provided by ‘More Knowledgeable Others’ that we take for granted with clinical learning

Healthcare, frugal innovation, and professional voluntarism : a cost-benefit analysis

This book investigates what international placements of healthcare employees in low resource settings add to the UK workforce and the efficacy of its national health system. The authors present empirical data collected from a volunteer deployment project in Uganda focused on reducing maternal and new-born mortality and discuss the learning and experiential outcomes for UK health care professionals acting as long term volunteers in low resource settings. They also develop a model for structured placement that offers optimal learning and experiential outcomes and minimizes risk, while shedding new light on the role that international placements play as part of continuing professional development both in the UK and in other sending countries

Opportunities and challenges for improving antimicrobial stewardship in low and middle income countries ; lessons learnt from the maternal sepsis intervention in Western Uganda

This paper presents findings from an action-research intervention designed to identify ways of improving antimicrobial stewardship in a Ugandan Regional Referral Hospital. Building on an existing health partnership and extensive action-research on maternal health, it focused on maternal sepsis. Sepsis is one of the main causes of maternal mortality in Uganda and Surgical Site Infection, a major contributing factor. Post-natal wards also consume the largest volume of antibiotics. The findings from the Maternal Sepsis Intervention demonstrate the potential for remarkable changes in health worker behaviour through multi-disciplinary engagement. Nurses and midwives create the connective tissue linking pharmacy, laboratory scientists and junior doctors to support an evidence-based response to prescribing. These multi-disciplinary ‘huddles’ form a necessary, but insufficient, grounding for active clinical pharmacy. The impact on antimicrobial stewardship and maternal mortality and morbidity is ultimately limited by very poor and inconsistent access to antibiotics and supplies. Insufficient and predictable stock-outs undermine behaviour change frustrating health workers’ ability to exercise their knowledge and skill for the benefit of their patients. This escalates healthcare costs and contributes to Anti-Microbial Resistance

The social security rights of older international migrants in the European Union

Europe is now home to a significant and diverse population of older international migrants. Social and demographic changes have forced the issue of social security in old age onto the European social policy agenda in the last decade. In spite of an increased interest in the financial well-being of older people, many retired international migrants who are legally resident in the European Union face structured disadvantages. Four linked factors are of particular importance in shaping the pension rights and levels of financial provision available to individual older migrants: migration history, socio-legal status, past relationship to the paid labour market, and location within a particular EU Member State. Building on a typology of older migrants, the paper outlines the ways in which policy at both the European Union and Member State levels serves to diminish rather than enhance the social security rights of certain older international migrants

The impact of multidisciplinary mobilities on the effectiveness of global health and international development projects

The mobility of healthcare professionals from high-income countries (HICs) to low- and middle-income countries (LMICs) has been growing rapidly over recent decades. The ‘international elective placement’, which was once a preserve of medical student curricula, has now become increasingly common amongst nursing, midwifery and allied health professional students. International volunteering for healthcare professionals has shifted from being mainly missionary or altruistically driven to being a critically important component of clinical experience, professional development and subsequent career progression. Furthermore, there has been a large growth in international aid expenditure since the end of the Second World War and a more recent increase in the desire and ability of populations to travel internationally. These have acted as stimuli for the implementation of a multitude of international development projects designed to build the capacity of healthcare workers in LMICs in order to strengthen local health systems.However, despite the above, there is a distinct lack of research into the real benefits, costs and potential negative effects or externalities associated with such mobilities, or their ability to ethically and sustainably strengthen health systems in LMICs. Most existing literature is written by development actors themselves who often focus on the short-term and have a conflict of interest in proving that their interventions are positive and beneficial in order to justify current and future funding. This portfolio of six published works and eight supporting publications serves to bridge this gap in research and knowledge. Based on the author’s 10+ years of action research experience in the fields of global health, professional volunteering and international development, it suggests that the desired outcomes can be achieved in an ethical and sustainable way but only if certain policies and procedures are adopted and implemented.Combined, the publications generate a unique contribution to knowledge by offering tested, practical ways of enhancing the efficacy of international aid and professional and student voluntarism. For this reason, each publication is directed at key stakeholders and policy makers, providing clear conclusions and recommendations based on in-depth experience and concrete research findings

Anti-microbial resistance in global perspective

This open access book provides an accessible introduction to the mechanics of international development and global health text for policy-makers and students across a wide range of disciplines. Antimicrobial resistance is a major threat to the well-being of patients and health systems the world over. In fragile health systems so challenged, on a day-today basis, by the overwhelming burden of both infectious and non-communicable disease, it is easy to overlook the impacts of AMR. The Maternal Sepsis Intervention, focusing on a primary cause of maternal death in Uganda, demonstrates the systemic nature of AMR and the gains that can be made through improved Infection Prevention Control and direct engagement of laboratory testing in antibiotic prescribing

Enhancing skills to promote the utilization of medical laboratory equipment in low resource settings

Objective This study was to demonstrate the efficacy of an intervention model involving on-going skills enhancement of users, Biomedical Engineers and Technicians (BMETs) in enhancing the utilization of medical laboratory equipment in low resource settings. Methods In an action research study, the condition of 202 pieces of medical equipment in seven regional blood banks in the Uganda Blood Transfusion Service (UBTS) were studied prospectively from January 2018 to December 2018. Of these, 160 pieces were included in the intervention group where users and BMETs were mentored and trained in the use and preventive maintenance for all equipment types. A second group of 42 pieces of medical equipment which were not involved in the intervention program, were assessed for comparison. Twenty-one participants were interviewed to obtain detailed information about their experiences and the impact of the training interventions. Results The percentage of equipment in good working condition and in use in the intervention group improved from 60% to 74%, while the improvement recorded in the second group was slower (48% to 55%) over the one-year period. Equipment in the intervention group were three times more likely to be in good working condition and in use at the end of the study period with an odds ratio of 3.2 (95% CI: 1.49 to 6.83) and P value < 0.001. Conclusion The model applied by Knowledge for Change (K4C) that involves co-learning and mentorship of users and BMETs was successful and should be implemented in other health facilities in Low- and Middle-Income Countries

The BaSICS (Baby Skin Integrity Comparison Survey) study : a prospective experimental study using maternal observations to report the effect of baby wipes on the incidence of irritant diaper dermatitis in infants, from birth to eight weeks of age

Background Baby wipes have been shown to be safe and effective in maintaining skin integrity when compared to the use of water alone. However, no previous study has compared different formulations of wipe. The aim of the BaSICS study was to identify any differences in incidence of irritant diaper dermatitis (IDD) in infants assigned to three different brands of wipe, all marketed as suitable for neonates, but which contained varying numbers of ingredients. Methods Women were recruited during the prenatal period. Participants were randomly assigned to receive one of three brands of wipe for use during the first eight weeks following childbirth. All participants received the same nappies. Participants reported their infant’s skin integrity on a scale of 1 to 5 daily using a bespoke smartphone application. Analysis of effect of brand on clinically significant IDD (score 3 or more) incidence was conducted using a negative binomial generalised linear model, controlling for possible confounders at baseline. Analysts were blind to brand of wipe. Results Of 737 women enrolled, 15 were excluded (admitted to neonatal intensive care, premature or other infant health issues). Of the 722 eligible babies, 698 (97%) remained in the study for the full 8-week duration, 24.6% of whom had IDD at some point during the study. Mothers using the brand with the fewest ingredients reported fewer days of clinically significant nappy rash (score≥3) than participants using the two other brands (p=0.002 and p<0.001). Severe IDD (grades 4 and 5) was rare (2.4%). Conclusions Rarity of severe IDD suggested that sensitive formula baby wipes are safe when used in cleansing babies from birth to eight weeks during nappy changes. The brand with fewest ingredients had significantly fewer days of clinically significant IDD. Daily observations recorded on a smartphone application proved to be a highly acceptable method of obtaining real-time data on IDD