Global health education in the Dutch Caribbean:50 years of a unique Groningen-Curaçao clinical clerkship program

The globalization of healthcare has had a significant impact on healthcare delivery and human workforce development in many countries. Consequently, many educational institutions have had to revise the content of their medical curricula to focus on training and preparing future doctors to effectively cater to the needs of the “modern patient”. The focus covers broader aspects of medicine that include environmental and professional culture and the impact of socioeconomic inequalities on the delivery of healthcare. Therefore, in most global health (GH) education programs described, students undertake a specific part of their clinical rotation in a foreign (non-western) educational setting to facilitate authentic learning experiences within a resource-constrained environment. In this paper we present a unique Global Health program for medical interns between the University Medical Center Groningen, Netherlands and the Sint Elisabeth Hospital, Curaçao, Dutch Caribbean that has, for more than 50 years, been providing a one-year internship program as part of the formal Groningen curriculum. The program we describe, illustrates the essential requirements for best practice in GH education that fully complies with recently proposed GH program objectives and competencies. The characteristics of our long running program show the basic requirements necessary for sustainable and successful health education collaboration between institutions in high- and low/middle income countries. Finally, this program, which is part of a Dutch medical curriculum, not only provided unique global health learning experiences for the interns, but importantly also contributed to improving the general healthcare delivery services on the island of Curaçao as well.</p

Clinical Leadership as an Agent for Change:A Health System Improvement Intervention in Curacao

Introduction: The healthcare system in Curaçao is complex, fragmented, and poorly organized and typifies a system in a resource-limited environment. Deficits in competencies and local cultural barriers are factors that hinder sustainable healthcare in such settings and a failure to meet WHO sustainable development goals. This study reports the potential cost-effectiveness and improved health outcomes of the first stage of a healthcare improvement project. The intervention, which is a multidisciplinary team-based leadership training program (MLP), reflects a promising strategy to tackle local healthcare needs. Methods: A Multidisciplinary group of healthcare professionals in St. Elisabeth hospital, Curaçao, was selected to 1) participate in the MLP and 2) co-design a healthcare pathway on the management of decubitus ulcers. Using a qualitative research methodology, we conducted interviews to assess the perceived leadership growth, teamwork, and the barriers to the introduction of the new care pathway in their setting. Six themes were identified that explained the perceived leadership development and interprofessional collaboration. These included 1) Professional background, 2) Healthcare pathway design, 3) Resources, 4) Personal development, 5) Collaboration 6) Execution. Conclusion/Implication: The participants valued the interdisciplinary approach of this health improvement project and acknowledged the added value of a training program that also addressed personal growth. This study shows how MLPs for health professionals can also serve as catalysts for health improvement efforts in resource-limited environments

Understanding the impact of interprofessional collaboration on the quality of care:A case report from a small-scale resource limited health care environment

Background: A critical assessment of current health care practices, as well as the training needs of various health care providers, is crucial for improving patient care. Several approaches have been proposed for defining these needs with attention on communication as a key competency for effective collaboration. Taking our cultural context, resource limitations, and small-scale setting into account, we researched the applicability of a mixed focus group approach for analysis of the communication between doctors and nurses, as well as the measures for improvement. Study objective: Assessment of nurse-physician communication perception in patient care in a Caribbean setting. Methods: Focus group sessions consisting of nurses, interns, and medical specialists were conducted using an ethnographic approach, paying attention to existing communication, risk evaluation, and recommendations for improvement. Data derived from the focus group sessions were analyzed by thematic synthesis method with descriptive themes and development of analytic themes. Results: The initial focus group sessions produced an extensive list of key recommendations which could be clustered into three domains (standardization, sustainment, and collaboration). Further discussion of these domains in focus groups showed nurses' and physicians' domain perspectives and effects on patient care to be broadly similar. Risks related to lack of information, knowledge sharing, and professional respect were clearly described by the participants. Conclusion: The described mixed focus group session approach for effectively determining current interprofessional communication and key improvement areas seems suitable for our small-scale, limited resource setting. The impact of the cultural context should be further evaluated by a similar study in a different cultural context

The Impact of Health Risk Communication:A Study on the Dengue, Chikungunya, and Zika Epidemics in Curaçao, Analyzed by the Social Amplification of Risk Framework (SARF)

Epidemics of dengue, chikungunya, and Zika have been threatening the Caribbean. Since risk communication (RC) plays a fundamental role in preventing and controlling diseases understanding how RC works is essential for enabling risk-reducing behavior. This multimethod qualitative study compares news reports with local’s and health professional’s perspectives, currently lacking in RC research. It was found that RC strategies were obstructed by a lack of governmental structure, organization, and communication. The content analysis showed that the majority of newspaper articles contained negative reporting on the government. Furthermore, this study shows how trust and heuristics attenuate or amplify people’s risk perceptions and possibly positively and negatively influence people’s risk-reducing behavior. A transcending approach (e.g., structural, cooperative, and multidisciplinary) of the prevention and control of vector-borne diseases and the corresponding RC is recommended

Developing quality indicators for the care of HIV-infected pregnant women in the Dutch Caribbean

<p>Abstract</p> <p>Background</p> <p>Effective interventions to prevent mother-to-child HIV transmission (PMTCT) exist and when properly applied reduce the risk of vertical HIV transmission. As part of optimizing PMTCT in the Dutch Caribbean we developed a set of valid and applicable indicators in order to assess the quality of care in HIV-infected (pregnant) women and their newborns.</p> <p>Methods</p> <p>A multidisciplinary expert panel of 19 experts reviewed and prioritized recommendations extracted from locally used international PMTCT guidelines according to a 3-step-modified-Delphi procedure. Subsequently, the feasibility, sample size, inter-observer reliability, sensitivity to change and case mixed stability of the potential indicators were tested for a data set of 153 HIV-infected women, 108 pregnancies of HIV-infected women and 79 newborns of HIV-infected women in Aruba, Curaçao and St Maarten from 2000 to 2010.</p> <p>Results</p> <p>The panel selected and prioritized 13 potential indicators. Applicability could not be tested for 4 indicators regarding HIV-screening in pregnant women because of lack of data. Four indicators performed satisfactorily for Curaçao ('monitoring CD4-cell count', 'monitoring HIV-RNA levels', 'intrapartum antiretroviral therapy and infant prophylaxis if antepartum antiretroviral therapy was not received', 'scheduled caesarean delivery') and 3 for St Maarten ('monitoring CD4-cell count', 'monitoring HIV-RNA levels', 'discuss and provide combined antiretroviral therapy to all HIV-infected pregnant women') whilst none for Aruba.</p> <p>Conclusions</p> <p>A systemic evidence-and consensus-based approach was used to develop quality indicators in 3 Dutch Caribbean settings. The varying results of the applicability testing accentuate the necessity of applicability testing even in, at first, comparable settings.</p

EVALUACIÓN DE RESULTADOS QUIRÚRGICOS DESDE LA PERSPECTIVA DEL PACIENTE

RESUMENMedir la calidad de vida relacionada a salud y los síntomas de los pacientes es un problema difícil. Las medición de los problemas de salud mediante escalas o cuestionarios se ha desarrollado para crear los Instrumentos de Evaluación desde la Perspectiva del Paciente o PRO's por su nombre en inglés: Patient-reported outcomes. Los PROs evalúan la calidad de vida en forma genérica o específica en un continuo, entregando instrumentos que pueden evaluar la gravedad de una enfermedad o el impacto de una intervención desde la perspectiva del paciente en frecuentes escenarios clínicos. El objetivo de la presente revisión es entregar a clínicos e investigadores una introducción hacia los PROs y resumir sus principales propiedades.SUMMARYQuantifying health-related quality of life and specific patient symptoms it is a difficult problem. Health measurement scales has developed to include rigorous techniques to develop patient-reported outcome measures (PROs). PROs assess objectively the QoL in a continuum, providing instruments to measure the severity of a given disease or the impact of a therapeutic intervention from patient perspective in different clinical problems. The following review aims to introduce the PROs to clinicians and researchers and summarize its main properties

N-acetylcysteine reduces oxidative stress in sickle cell patients

Oxidative stress is of importance in the pathophysiology of sickle cell disease (SCD). In this open label randomized pilot study the effects of oral N-acetylcysteine (NAC) on phosphatidylserine (PS) expression as marker of cellular oxidative damage (primary end point), and markers of hemolysis, coagulation and endothelial activation and NAC tolerability (secondary end points) were studied. Eleven consecutive patients (ten homozygous [HbSS] sickle cell patients, one HbSβ0-thalassemia patient) were randomly assigned to treatment with either 1,200 or 2,400 mg NAC daily during 6 weeks. The data indicate an increment in whole blood glutathione levels and a decrease in erythrocyte outer membrane phosphatidylserine exposure, plasma levels of advanced glycation end-products (AGEs) and cell-free hemoglobin after 6 weeks of NAC treatment in both dose groups. One patient did not tolerate the 2,400 mg dose and continued with the 1,200 mg dose. During the study period, none of the patients experienced painful crises or other significant SCD or NAC related complications. These data indicate that N-acetylcysteine treatment of sickle cell patients may reduce SCD related oxidative stress

The strategic role of competency based medical education in health care reform:a case report from a small scale, resource limited, Caribbean setting

BACKGROUND: Curaçao is a Dutch Caribbean island with a relatively high aging population, a high prevalence of chronic diseases and a health care system that is driven by cost-containment. In 2009 the development of a new value-based health care (VBHC) system was initiated on the island, and a key role was identified for the St. Elisabeth Hospital as a (model) platform for implementing this initiative. We therefore decided to investigate for the requirements needed to build a health care environment that is conducive for change and capable of facilitating the smooth migration of existent services into an effective and sustainable VBHC system. FINDINGS: Our findings revealed that our chosen approach was well accepted by the stakeholders. We discovered that in order to achieve a new value based health care system based on a reliable and well-organized system, the competencies of health care providers and the quality of the health care system needs to be assured. For this, extra focus needs to be given to improving service and manpower development both during and after formal training. CONCLUSIONS: In order to achieve a VBHC system in a resource-limited environment, the standard of physicians' competencies and of the health care system need to be guaranteed. The quality of the educational process needs to be maintained and safeguarded within an integrated health care delivery system that offers support to all care delivery and teaching institutions within the community. Finally, collaborative efforts with international medical institutions are recommended

Global health education in the Dutch Caribbean:50 years of a unique Groningen-Curaçao clinical clerkship program

The globalization of healthcare has had a significant impact on healthcare delivery and human workforce development in many countries. Consequently, many educational institutions have had to revise the content of their medical curricula to focus on training and preparing future doctors to effectively cater to the needs of the “modern patient”. The focus covers broader aspects of medicine that include environmental and professional culture and the impact of socioeconomic inequalities on the delivery of healthcare. Therefore, in most global health (GH) education programs described, students undertake a specific part of their clinical rotation in a foreign (non-western) educational setting to facilitate authentic learning experiences within a resource-constrained environment. In this paper we present a unique Global Health program for medical interns between the University Medical Center Groningen, Netherlands and the Sint Elisabeth Hospital, Curaçao, Dutch Caribbean that has, for more than 50 years, been providing a one-year internship program as part of the formal Groningen curriculum. The program we describe, illustrates the essential requirements for best practice in GH education that fully complies with recently proposed GH program objectives and competencies. The characteristics of our long running program show the basic requirements necessary for sustainable and successful health education collaboration between institutions in high- and low/middle income countries. Finally, this program, which is part of a Dutch medical curriculum, not only provided unique global health learning experiences for the interns, but importantly also contributed to improving the general healthcare delivery services on the island of Curaçao as well.</p