Potential Benefits of Collaboration in Short-Term Global Health Learning Experiences

To the Editor: Rassiwala and colleagues1 provide a valuable overview of short-term global health learning experiences abroad, reviewing two differing models. We particularly appreciated the authors’ recognition of the potential harms to host communities related to the care provided, and welcomed their call to standardize global health education curricula. Despite their focus “on strategy for students […] rather than provision of care,” we believe our colleagues will agree that curricula standardization also needs to focus on the quality of care provided, and we draw on our own experience to suggest ways to achieve this. At present, the first short-term rotation model described by the authors has immense benefits for participating learners and sending institutions, while care provided (even with best intentions) has limited benefits and potential harms for the receiving community abroad.2 As these short-term models become popular, our research group believes that standards are needed to shift this “balance of benefits” more towards the intended service recipients (i.e., the community abroad) while retaining benefits derived by learners and sending institutions. Recognizing that isolated short-term global health learning experiences have limited community benefit, we are developing a “crowdsourcing” model that pools multiple visiting teams into a larger, coordinated effort addressing the root causes of ill health. More than 30 teams visit La Romana, Dominican Republic, annually, providing limited primary care in the form of mobile medical clinics over one to two weeks through a partnership with the local Good Samaritan Hospital. In isolation, these groups are hampered by duplication of efforts, mixed messages, and limited outcomes. Our pilot uses a collaborative model that links together visiting team efforts with those of local leadership in deploying longer-term development projects. Our premise is that multiple coordinated short-term teams could result in a more sustained, meaningful impact. For example, instead of having 12 teams going it alone and handing out assorted pills, could they instead provide a 12-week curriculum to host community providers and help develop local capacity—in essence, strengthening the local health care system by targeting upstream goals? A collaborative model is one example of putting the receiving community’s needs at the center of global health curriculum development, in the hopes of matching the intentions of these short-term learners with meaningful outcomes. Participation and interest in such efforts continue to grow among volunteers and institutions, given the learning, outreach, and advocacy benefits they derive. Realizing this, an informed discussion about models for short-term global health learning experiences is vital in ensuring such experiences also provide lasting benefit for the host communities. Lawrence C. Loh, MD, MPH Adjunct lecturer, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, clinical lecturer, University of British Columbia, Vancouver, British Columbia, Canada, and cofounder, The 53rd Week, Brooklyn, New York; [email protected] Henry C. Lin, MD Attending physician, Department of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, and cofounder, The 53rd Week, Brooklyn, New York.

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