Near-Peer Emergency Medicine for Medical Students in Port-au-Prince, Haiti: An Example of Rethinking Global Health Interventions in Developing Countries

Background: During a 3-year time frame, a partnership between medical trainees in Haiti and the United States was forged with the objective of implementing an emergency response skills curriculum at a medical school in Port-au-Prince. The effort sought to assess the validity of a near-peer, bidirectional, cross-cultural teaching format as both a global health experience for medical students and as an effective component of improving medical education and emergency response infrastructure in developing countries such as Haiti. Method: Medical students and emergency medicine (EM) residents from a North American medical school designed and taught a module on emergency response skills in PAP and certified medical students in basic cardiac life support (BLS) over 2 consecutive years. Five-point Likert scale self-efficacy (SE) surveys and multiple-choice fund of knowledge (FOK) assessments were distributed pre- and postmodule each year and analyzed with paired 't'tests and longitudinal follow-up of the first cohort. Narrative evaluations from participants were collected to gather feedback for improving the module. Findings: Challenges included bridging language barriers, maintaining continuity between cohorts, and adapting to unexpected schedule changes. Overall, 115 students were certified in BLS with significant postcurriculum improvements in SE scores (2.75 ± 0.93 in 2013 and 2.82 ± 1.06 in 2014; 'P' < 0.001) and FOK scores (22% ± 15% in 2013 and 41% ± 16% in 2014; 'P' < 0.001). Of 24 Haitian students surveyed at 1-year follow-up from the 2013 cohort, 7 (29.3%) reported using taught skills in real-life situations since completing the module. The US group was invited to repeat the project for a third year. Conclusions: Near-peer, cross-cultural academic exchange is an effective method of medical student–centered emergency training in Haiti. Limitations such as successfully implementing sustainability measures, addressing cultural differences, and coordinating between groups persist. This scalable, reproducible, and mutually beneficial collaboration between North American and Haitian medical trainees is a valid conduit for building Haiti's emergency response infrastructure and promoting global health

Chronic political instability and HIV/AIDS response in Guinea-Bissau from 2000 to 2015: The intersections of politics and epidemiology

The primary objective of this thesis is to explore the role of chronic political instability on the response to the HIV/AIDS epidemic in Guinea-Bissau. The first sub-objective was to understand to which extent political instability and its manifestations have been considered in research conducted during this period on the country’s HIV/AIDS epidemic. The second sub-objective was to understand local stakeholders’ perceptions of the effects of instability on the HIV/AIDS response during the MDG period. We hypothesize that chronic political instability has served as a major barrier to an effective HIV/AIDS response in Guinea-Bissau. Results – The Viewpoint article reminds the global health community that political and social environments count in the design and implementation of public health programs. As the case of Guinea-Bissau showed, our systematic review identified 122 published journal articles about HIV/AIDS in Guinea-Bissau, and we found six articles containing a specific reference to the country’s political instability. The literature on the HIV/AIDS epidemic is largely biomedical in nature with limited research conducted to date situating the country’s higher HIV/AIDS disease burden in the context of its history of political instability. Our qualitative health research fills this gap and suggests that key stakeholders perceive that the country’s political instability has served as a substantial barrier to the country’s efforts to mount a successful response to HIV/AIDS. Various themes emerged from key informant interviews, such as, the phenomenon of “starting over,” the effects of instability rippling from central level throughout the health pyramid, vulnerable populations becoming more vulnerable, and the emergence of grassroots coping mechanisms at community level. Conclusion – Building on the themes of the Viewpoint article, the two articles on Guinea-Bissau are the first research to explicitly examine the effects of chronic political instability on the HIV/AIDS disease response in Guinea-Bissau. The systematic review found a heavily biomedical literature on the HIV/AIDS epidemic in this country. Yet the qualitative health study suggests that key informants are eager to discuss the effects of chronic political instability on the HIV/AIDS disease response. It is critical for researchers, funders, and other global health practitioners to account for countries’ overarching political contexts when designing and implementing public health programs.</p

Chronic Political Instability and the HIV/AIDS Response in Guinea-Bissau from 2000 to 2015: A Systematic Review

Guinea-Bissau suffers from political instability and an unusually high HIV/AIDS burden compared to other countries in the West Africa region. We conducted a systematic review on the HIV/AIDS epidemic in Guinea-Bissau during the Millennium Development Goals (MDGs) period (2000-2015), which dovetailed with a period of chronic political instability in the country's history. We searched published works on the HIV/AIDS epidemic in Guinea-Bissau for references to chronic political instability. Six databases and the grey literature were searched, informed by expert opinion and manual research through reference tracing. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search yielded 122 articles about HIV/AIDS in Guinea-Bissau during the MDG years. Biomedical, clinical, or epidemiological research predominated public health research production on HIV/AIDS in Guinea-Bissau in this period. Six articles addressing themes related to chronic political instability, including how political instability has affected the HIV/AIDS disease response, were identified. The results suggest the importance of considering a broader political epidemiology that accounts for socio-political aspects such as governance, human rights, and community responses into which any national HIV/AIDS response is integrated

Chronic political instability and HIV/AIDS response in Guinea-Bissau: a qualitative study

The Republic of Guinea-Bissau in West Africa has a high HIV/AIDS disease burden and has experienced political instability in the recent past. Our study used qualitative methods to better understand key stakeholders' perceptions of the effects of chronic political instability on the HIV/AIDS response in Guinea-Bissau from 2000 to 2015 and lessons learned for overcoming them

From "learning from the field" to jointly driving change

The theme of the 8th edition of the Geneva Health Forum (GHF) was Improving access to health: learning from the field. While ‘the field' often denotes people,patients, communities, and healthcare workers, we challenge the notion and its usage. A group of like-minded conference participants set up a working group to examine the term ‘the field' and look at questions related to language, power, participation, and rights. By highlighting deficiencies of existing terms and jargon, we explain why language is a form of power that matters in public health. We describe global, regional, and national case studies that facilitate full participation to achieve more equitable health outcomes. By concluding with concrete recommendations,we hope to contribute to these shared goals: to correct power imbalances between health authorities and the people that they intend, and are expected, to serve. The authors are all members of the working group