Category — Publications

The newest project out of the UBC School of Journalism’s International Reporting Program (IRP) has been published as a two-part series for The New York Times. The IRP explores how Brazil’s economic interests clash with efforts to protect the environment and preserve ancestral aboriginal land. As a result, many people have been killed, put on death lists or chased off their land.

The entire series is available on http://www.internationalreporting.org/landbrazil.

Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer LJ, Ueffing E, Macdonald NE, Hassan G, McNally M, Khan K, Buhrmann R, Dunn S, Dominic A, McCarthy AE, Gagnon AJ, Rousseau C, Tugwell P; Canadian Collaboration for Immigrant and Refugee Health, Assayag D, Barnett E, Blake J, Brockest B, Burgos G, Campbell G, Chambers A, Chan A, Cheetham M, Delpero W, Deschenes M, Dharamsi S, Duggan A, Durand N, Eyre A, Grant J, Gruner D, Harris S, Harris SB, Harvey E, Heathcote J, Heidebrecht C, Hodge W, Hone D, Hui C, Hum S, Janakiram P, Jivani K, Jurcik T, Keystone J, Kitai I, Krishnamurthy S, Kuhn S, Kutcher S, Laroche R, Logie C, Martin M, Massenat DE, Matthews D, Maze B, Menzies D, Munoz M, Murangira F, Nolen A, Plourde P, Sandoe A, Sears J, Rousseau H, Ryder AG, Schwartzman K, Stauffer W, Thombs BD, Topp P, Toren A, Torres S, Ullah A, Varghese S, Vissandjee B, Welt M, Wobeser W, Wong D, Zelkowitz P, Zhong J, Zlotkin S. Evidence-based clinical guidelines for immigrants and refugees. CMAJ 2011 Jul 27.

Introduction

There are more than 200 million international migrants worldwide, and this movement of people has implications for individual and population health. The 2009 United Nations Human Development Report suggested that migration benefits people who move, through increased economic and education opportunities, but migrants frequently face barriers to local health and social services. In Canada, international migrants are a growing and economically important segment of the population (Table 1A).

Immigrants to Canada are a heterogeneous group. Upon arrival, new immigrants are healthier than the Canadian-born population, both because of immigrant-selection processes and policies and because of sociocultural aspects of diet and health behaviours. However, there is a decline in this “healthy immigrant effect” after arrival. In addition, compared with the Canadian-born population, subgroups of immigrants are at increased risk of disease-specific mortality; for example, Southeast Asians from stroke (odds ratio [OR 1.46, 95% confidence interval [CI] 1.00–1.91), Caribbeans from diabetes mellitus (OR 1.67, 95% CI 1.03–2.32) and infectious diseases (e.g., for AIDS, OR 4.23, 95% CI 2.72–5.74), and immigrant men from liver cancer (OR 4.89, 95% CI 3.29–6.49). The health needs of newly arriving immigrants and refugees often differ from those of Canadian-born men, women and children. The prevalence of diseases differs with exposure to disease, migration trajectories, living conditions and genetic predispositions. Language and cultural differences, along with lack of familiarity with preventive care and fear and distrust of a new health care system, can impair access to appropriate health care services. Additionally, patients may present with conditions or concerns that are unfamiliar to practitioners.

Many source countries have limited resources and differing health care systems, and these differences may also contribute to health inequalities among migrants. In these guidelines, we refer to low-and middle-income countries as “developing.”

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By Jeremy Snyder, Shafik Dharamsi, Valorie A Crooks

Abstract

Background

Medical tourism is a global health practice where patients travel abroad to receive health care. Voluntourism is a practice where physicians travel abroad to deliver health care. Both of these practices often entail travel from high income to low and middle income countries and both have been associated with possible negative impacts. In this paper, we explore the social responsibilities of medical tourists and voluntourists to identify commonalities and distinctions that can be used to develop a wider understanding of social responsibility in global health care practices.

Discussion

Social responsibility is a responsibility to promote the welfare of the communities to which one belongs or with which one interacts. Physicians stress their social responsibility to care for the welfare of their patients and their domestic communities. When physicians choose to travel to another county to provide medical care, this social responsibility is expanded to this new community. Patients too have a social responsibility to use their community’s health resources efficiently and to promote the health of their community. When these patients choose to go abroad to receive medical care, this social responsibility applies to the new community as well. While voluntourists and medical tourists both see the scope of their social responsibilities expand by engaging in these global practices, the social responsibilities of physician voluntourists are much better defined than those of medical tourists. Guidelines for engaging in ethical voluntourism and training for voluntourists still need better development, but medical tourism as a practice should follow the lead of voluntourism by developing clearer norms for ethical medical tourism.

Summary

Much can be learned by examining the social responsibilities of medical tourists and voluntourists when they engage in global health practices. While each group needs better guidance for engaging in responsible forms of these practices, patients are at a disadvantage in understanding the effects of medical tourism and organizing responses to these impacts. Members of the medical professions and the medical tourism industry must take responsibility for providing better guidance for medical tourists.

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An Educational Resource Kit created by the Ethics of International Engagement and Service-Learning (EIESL) project at the University of British Columbia.

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An article in Medical Teacher, 2010, Vol. 32, No. 12 , Pages 977-982, by Shafik Dharamsi, Mikhyla Richards, Dianna Louie, Diana Murray, Alex Berland, Michael Whitfield, Ian Scott

Abstract

Background: Medical students are expressing increasing interest in international experiences in low-income countries where there are pronounced inequities in health and socio-economic development.

Aim: We carried out a detailed exploration of the international service-learning (ISL) experience of three medical students and the value of critical reflection as a pedagogical approach to enhance medical students’ conceptions of the Canadian Medical Education Directions for Specialists (CanMEDS) Health Advocate Role.

Method: A phenomenological approach enabled us to study in considerable depth the students’ experience from their perspective. Students kept reflective journals and wrote essays including detailed accounts of their experiences. The content of the students’ journals and essays was analyzed using the critical incident technique.

Results: Students noted an increasingly meaningful sense of what it means to be vulnerable and marginalized, a heightened level of awareness of the social determinants of health and the related importance of community engagement, and a deeper appreciation of the health advocate role and key concepts embedded within it.

Conclusion: This in-depth phenomenological study focused on the detailed experiences of three students from whom we learned that social justice-oriented approaches to service-learning, coupled with critical reflection, provide potentially viable pedagogical approaches for learning the health advocate role. How this experience will affect the students’ future medical practice is yet unknown.

The full article is available for download at: http://informahealthcare.com/doi/full/10.3109/01421590903394579

Naeem Mawji knew that many of his fellow Tanzanians did not have access to electricity. But, it wasn’t until he got to UBC and investigated the matter that he realized the extent of the problem.

Read this story in UBC Reports.