Global health

Fostering a passion for global health

UofSC students travel to developing countries to understand and tackle global health issues

Senior Stephanie Hirth says she’s known since freshman year that she wanted to go into medicine. But it was her trip to Nicaragua with the Capstone Scholars program that inspired the exercise science major to consider a career in pediatrics and international health care.

“I never really considered pediatrics, but I fell in love with the kids,” says Hirth, who returned to Nicaragua as a student leader on this year’s spring break trip and who will attend medical school at the University of Cincinnati. “My dream would be to serve in Central America. I feel really connected there. I feel the heart of their culture.”

Hirth and about 40 other Capstone Scholars participated in “International Healthcare: Service Learning in Nicaragua,” this month. The course introduces students to skills and topic areas including psychology, social work, education, medicine, nursing and other health professions. As a service-learning course, it offers a solid base for students interested in a career working in developing countries. Of the students on the Nicaragua service-learning trip, all but one are interested in health sciences careers; the other hopes to join the Peace Corps.

“I want to always remember there are people who are desperately in need. I want to actively serve those people,” Hirth said. “You can’t change a whole country in one week. But you can take small steps. And then I hope to go and do that for a career.”

Olivia Albanese made the trip to Nicaragua for the third time this spring. She said the relationships she’s made with the people there and the impact she feels she makes keep calling her back. During her gap year before graduate school she is considering an invitation from a Nicaraguan doctor to work in the clinic there.

“Global health is such a burgeoning field,” she says. “My experience was so impactful to me. The people and places and institutions in my life have given so much to me. I want to give back to them.”

Making a difference

For Patrick Hickey, a clinical associate professor of nursing and the faculty principal for the Capstone Scholars program, international health care has been a passion for most of his career. During three year-long backpacking trips in Europe, around the world and Central America, he says he was confronted with the depth and breadth of the issues in developing nations, particularly in the area of health care.

“We saw a lot of poverty and challenges and issues with access to health care,” he says. “When I came back in 1993 after a year in Latin America, I knew I wanted to help Hispanics and I knew I wanted to go back to school.”

He was already a nurse, but enrolled in graduate school in public health at Carolina, where he earned his master’s and doctorate, and did research on barriers that Hispanics face in accessing health care. “Even in my hospital here, I saw Hispanics walking around who were scared to death. There was no signage; nobody spoke Spanish. It got me passionate about international health care and the need to break down those barriers,” Hickey says. “Just because they speak Spanish doesn’t mean we can’t provide them the same level of health care. They’re here, they’re sick, we help them.”

And he never forgot what he saw in rural parts of Central America, knowing he wanted to return and take students with him. “I thought, ‘Why not take our future docs and nurses to see what I’ve seen and become as passionate as I am about international health care?” he says.

At Carolina, he started organizing medical mission trips years ago. His spring break course in Nicaragua with his Capstone Scholars allows students to explore the impact of national and international policy decisions on the health and well-being of individuals and communities. 

“It’s been my experience, these trips for students confirm that they want to be involved in health care, and, for a lot of people, international health care,” Hickey says. “We’ve been able, through this course, to expose 300-plus students to the opportunity to make a difference in global health, which is very, very exciting.”

We’ve got the best minds in the world to solve some of the problems that exist. That’s why the university should be involved in global health.

Deb McQuilkin, the director of Global Health Initiatives in the College of Nursing

Along with working in hospitals and clinics in rural Nicaragua, the students take donated medical supplies along with them on the trip. This year, 25 bags of over-the-counter medication — everything from Tums to Advil — made the trip with Hickey’s group. “Children’s vitamins are gold down there,” he says. Students also donated their own scrubs to the nurses and health care providers in the local hospital.

In addition, the students kicked in some cash — about $1,000 — to purchase nearly 200 large mosquito nets for families in rural areas where mosquito-borne diseases such as the zika virus and dengue fever are common.

“All families should have mosquito netting, but, because of poverty, they don’t. Or the nets have big holes in them. We worked with a doctor in one of the rural areas to buy the nets. The doctor wept when we gave him the nets,” Hickey says. “Because of this, 200 families are going to be able to sleep at night with mosquito netting.”

A certificate of thanks for the netting, written in English and Spanish, will hang on the clinic wall.

“Students walk away, saying, ‘Wow. That’s what I want to do. This confirms I want to be a doc.’ Then they are hungry. They come back and take school much more seriously. They say, ‘I can see where my purpose is, I can see where my future is.’ That’s an exciting part about the trip,” Hickey says. “And my trip is just one little piece of the puzzle we have here at USC called global health.”

A university mission

Deb McQuilkin, the director of Global Health Initiatives in the College of Nursing, serves on the university’s Global Health Initiative, a group of faculty members from several schools and departments across the university’s five health disciplines. The group collaborates in research, education and service in global health and works to identify and solve complex global health problems and disparities while training the next generation of global health leaders.

“We’ve got the best minds in the world to solve some of the problems that exist. That’s why the university should be involved in global health,” says McQuilkin, a clinical associate professor.

“What I tell students is it’s not just how I relate to my patient face-to-face. That’s important and I don’t want to negate that, but that’s just a piece of the puzzle,” McQuilken says. “That patient is in an organization, that organization is in a health system, which then is in a state system, which is then in a national system, which is then in a global system.

“One in three Americans is born outside the United States. What happens in Indonesia in terms of sanitation and health and water impacts what’s going on here. We get immigrants from everywhere. Plus, we’re going everywhere. The world is small.”

Researchers in public health, medicine, nursing, social work and pharmacy are involved in global health research, looking at topics as diverse as health disparities and immigrant health to infectious and chronic disease management in middle- and low-income countries. In service, there are a variety of areas covered, including hosting a symposium on global health each semester. The speakers present a public lecture, and meet with researchers to stimulate the research agenda and then discuss strategic goals across the university with the Global Health Initiative steering committee.

“I’ve asked the provost what she would like this committee to be. She said she’d like for us to be known in global health like we are in international business. Our work is to get us there,” McQuilkin says.

Along with the Capstone Scholar’s trip to Nicaragua over spring break, public health, pharmacy, medical and nursing students also were in the country, working in an interprofessional primary care clinic. The experience gives students an experience of life in another culture.

“They gain an understanding of how people can live in dire poverty and yet live well. That’s an experience many of our students have not seen, that kind of poverty. But they also have an opportunity to hone their own clinical skills separate from an American health system. You have to be creative sometimes and adaptive.”

Along with studying in developing countries, McQuilkin also points to the importance of health care students going to countries with better health outcomes than the U.S., such as Germany and Australia.

“It gives us a chance to say, ‘Teach us about your health system, what makes it work, why are your outcomes better, how do you do nationalized health care well and what works within that system,’ ” she says.

While it is unclear if short-term experiences bring strong health care outcomes, McQuilkin says the key is getting students interested in global health.

“There’s also a theory that the more cross-cultural exposure you have, the more you want. The more you want, the more you’ll go after and get. The more you get, the more you’ll be changed,” she says. “I buy into that system. In the long run, that changes our students. It makes them world citizens.”

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