ABSTRACT
The global health exchange program between the University Teaching Hospitals (UTH) of Lusaka, Zambia and the University of Maryland, Baltimore (UMB) has been operating since 2015. As trainees and facilitators of this exchange program, we describe our experiences working in Lusaka and Baltimore, and strengths and challenges of the partnership. Since 2015, we have facilitated rotations for 71 UMB trainees, who spent four weeks on the Infectious Disease (ID) team at UTH. Since 2019 with funding from UMB, nine UTH ID trainee physicians spent up to six weeks each rotating on various ID consult services at University of Maryland Medical Center (UMMC). Challenges in global health rotations can include inadequate preparation or inappropriate expectations among high-income country trainees, low-value experiences for low- and middle-income country trainees, lack of appropriate mentorship at sites, and power imbalances in research collaborations. We try to mitigate these issues by ensuring pre-departure and on-site orientation for UMB trainees, cross-cultural mentored experiences for all trainees, and intentional sharing of authorship and credit on scientific collaborations. We present a description of our medical education collaboration as a successful model for building equitable and reciprocal collaborations between low- and middle-income countries and high-income countries, and offer suggestions for future program initiatives to enhance global health education equity among participants and organizations.
Subject(s)
Global Health , Health Education , Humans , Universities , Zambia , Hospitals, TeachingABSTRACT
Resumo Este ensaio aborda a importância da descolonização da saúde, fundamentada no referencial teórico das epistemologias do Sul de Boaventura de Sousa Santos, e aponta para uma ecologia de cuidados a ser produzida no campo da saúde coletiva, abordando saúde e doença, sofrimento e cura, agravo e cuidado por formas de luta que emergem no enfrentamento das dinâmicas capitalista, colonialista e patriarcal. O processo de biomedicalização tem se produzido na emergência de uma monocultura de concepções dominantes do saber biomédico que define as condições de validade do conhecimento e das intervenções sobre saúde, doença, cuidado e cura. Esta análise aponta para a importância de pesquisas colaborativas e não extrativistas que partem do reconhecimento dessa diversidade de saberes, práticas e experiências, da sua copresença e dos seus encontros, das lutas pela justiça social e cognitiva e das múltiplas e diversificadas lutas pelo acesso à saúde e aos cuidados de saúde. As relações entre a saúde coletiva e os saberes e práticas do cuidado e da cura que fazem parte da experiência e do mundo dos povos indígenas aparecem como um exemplo importante para o aprendizado de um pensamento e de um agir ecológico em saúde.
Abstract This essay focuses on the importance of decolonizing health care, based on the theoretical framework of the epistemologies of the South proposed by Boaventura de Sousa Santos, and points to an ecology of care to be produced in the field of public healthcare, approaching health and illness, suffering and healing, disorder and care through struggles that emerge in facing capitalist, colonialist and patriarchal dynamics. The process of biomedicalization emerges within a monoculture of dominant conceptions of biomedical knowledge that define the terms of validity of knowledge and interventions on health, illness, care and healing. This analysis points to the importance of collaborative and non-extractivist research projects based on the recognition of the diversity of knowledges, practices and experiences, of their copresence and their encounters, of the struggles for social and cognitive justice and of the multiple and diverse struggles for health and access to medical care. The relations between collective health and the knowledge, care, and healing practices that are part of the experience and of the world of the indigenous peoples emerge as an important example of how to learn to think and act ecologically in the field of health.
