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International Child Health for the Practicing Pediatrician. Section on International Child Health November 3, 2003 David P. Norton, MD FAAP. International Child Health. Why get involved? Where to find opportunities Preparing for doing medical work abroad Challenges Returning Home.

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International Child Health for the Practicing Pediatrician

Section on International Child Health

November 3, 2003

David P. Norton, MD FAAP


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International Child Health

  • Why get involved?

  • Where to find opportunities

  • Preparing for doing medical work abroad

  • Challenges

  • Returning Home


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Why get involved?

  • Children and Health Care

    • Where are most of the world’s children?

    • Child health issues – US vs. Global

    • Disparities– developed world vs. developing



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Under-five mortality rate trends (per 1,000 live births)

Source: UNICEF



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Child Mortality, US

Leading causes of Death in Children, ages 1-4 years.

  • 1 Accidents (unintentional injuries)

  • 2 Congenital malformations

  • 3 Malignant neoplasms

  • 4 Assault (homicide)

  • 5 Diseases of heart


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Total Number of Immigrant Visas Issued to Internationally Adopted Children by Year

Source: US Dept State


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“Why we do it”– UNICEF –for the Children Adopted Children by Year

  • Children have rights

  • The world has set goals for children

  • Children demand a voice

  • Poverty reduction starts with children

  • The people of the world say 'Yes' for children

  • Children should not be dying from preventable causes


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Why get involved-- other reasons Adopted Children by Year

  • Moral/ ethical– personal need to give back

  • Sense of Adventure

  • Language skills, interest in other lands and cultures

  • Previous international experience – personal/ family ties

  • Broaden one’s educational horizons


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Requirements Adopted Children by Year

  • Idealism and a sense of hope!

  • Resilience

  • Flexibility

  • Open Mind

  • Cultural Sensitivity and Awareness

  • Sense of humor


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Other Factors to Consider Adopted Children by Year

  • The home scene / family life

    • Family– bring them or leave them?

    • Involve them!

  • Job –

    Who’s covering and how happy are they?

  • Money

    • Access to support for your work

    • Loss of income

  • Time off– vacation/ CME/ leave of absence

  • Personal Health


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How to get involved -- abroad Adopted Children by Year

  • Short term work with volunteer organizations

  • Longer term– with NGO’s, governmental agencies, universities

  • Types of work-

    • Clinical Care / Service

    • Medical Education

    • Research


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How to get involved– at home Adopted Children by Year

  • Donation programs-

    • Books and Journals

    • Recycling Medical Supplies –”REMEDY”

  • International Adoption and Caring for Immigrant Populations

  • Travel Clinics


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How to get involved– at home Adopted Children by Year

  • Sponsoring/ working with visiting physicians, nurses here for education

  • Political Action– advocate for children!

    • UN Convention of the Rights of the Child

    • Where your tax dollars go

    • Other issues– land mines, child labor


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International Child Health-- on the Net Adopted Children by Year

  • Consulting from afar- “e-mentoring”

    • Doctors of the World-USA

  • Foster knowledge access and exchange with colleagues across the globe.

  • List serves– method to collaborate on international projects–

    • Yahoo group– Honduras Hospitals

  • International Pediatric Chat


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Volunteer Opportunities– Resources Adopted Children by Year

  • SINCH Website

  • SINCH list serve

  • IHMEC

  • IMVA

  • Religious Organizations

  • Journal Articles- JAMA

  • Word of mouth/ Network with colleagues

  • Make contacts while traveling


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Things to consider- Adopted Children by Year

  • Context

    • Alone or with a team/group

    • Secular or religious NGO

  • Type of work

    • Education, service, combined

    • Physically demanding

    • Personal experience/ training


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Things to consider– cont’d Adopted Children by Year

  • Safety

  • Logistics

    • Travel

    • Climate

    • Altitude

  • Local medical community

    • How welcoming?

    • Teaching opportunities

    • Pediatric colleagues


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Challenges Adopted Children by Year

  • Overwhelming Need– How can I possibly make a difference?

  • Lack of Resources

  • Language

  • Cultural Differences

  • Food, Housing

  • Health of the Volunteer

  • Emotional Challenges


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Preparation– What to learn Adopted Children by Year

  • Job Description– figure out what you will be expected to do!

    • Specific tasks expected– patient care, teaching, procedures, administrative

    • Update PALS, NALS

    • Range of medical problems

    • Work hours and time off.

    • Who are your colleagues?

    • Connect with previous volunteers


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Preparation– What to learn- Adopted Children by Year

  • Language – even a little bit helps, and is appreciated

  • Research the area– geography, culture, ethnic groups

  • Health information – what kinds of health problems are you likely to see?


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Preparation – What to do Adopted Children by Year

  • Medical – for the volunteer

    • Travel Immunizations

    • Malaria prophylaxis

    • High Altitude meds

  • Supplies

    • Medical Equipment/ Tools

    • Medications

    • Books

    • Teaching – slides, teaching kits (PALS)


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Preparation-- teaching Adopted Children by Year

  • Consider topics-

    • What may be interesting or useful for your professional colleagues?

    • What are you comfortable teaching/ what can you prepare for?

  • Who will you be teaching? – physicians, students, residents, nurses, lay health care workers…


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Preparing -- teaching Adopted Children by Year

  • What kind of teaching– lectures, rounds, discussion groups

  • What tools can you use?

    • Slides

    • Handouts

    • Overheads

  • Language issues with teaching


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Packing Adopted Children by Year

  • Traveling Alone or with a group?

  • Personal Items

    • Documents—passports, visa, copies of everything!

    • Personal Medications

    • Sunscreen, insect repellent

    • Appropriate Clothing – acceptable in the local hospital or clinic


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Packing – Medical Supplies Adopted Children by Year

  • Really depends on what you will really be doing!

  • Tools you need to do your job.

  • Bring only supplies that are useful and can be maintained, not dependent on advanced technology.

  • Heed customs regulations– vary from country to country.


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Packing – Medical Supplies Adopted Children by Year

  • Containers– zip lock bags, small plastic bottles

  • Disposable gloves, masks, gowns, eye protection.

  • Antiseptic hand wash/ consider n-95 masks

  • HIV prophylaxis

  • Electrical equipment- may need transformer if electricity is different voltage.


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Medications– what to bring Adopted Children by Year

  • Never bring expired meds.

  • Be selective – what is really needed?

  • Obtaining meds-

    • Samples– sometimes useful, but often lots of package for not much med.

    • Many pharmaceutical companies have donation programs– will donate larger amounts of medications to volunteers.


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Medications– what to bring Adopted Children by Year

  • Antibiotics – stick to the basics.

  • Analgesics and Antipyretics

  • Avoid–

    • Meds that don’t actually do much– cough/cold preps

    • New meds unfamiliar to local docs, especially if there are any significant side effects or risks.


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Cultural Issues Adopted Children by Year

  • Beliefs, customs related to health, disease and the medical community – where does your work fit in?

    • Level of education

    • Role of physicians vs traditional medicine

    • Medical advise vs. what really happens

    • Integrating your work with local colleagues


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Cultural Issues, cont’d Adopted Children by Year

  • Language and Translation– Getting your message across….

    • Use of appropriate terminology

    • Talking to the right person!

    • Use of translators

    • Literacy issues/ use of pictograms

  • Make an effort to speak – a few words go a long way!


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Cultural Issues, cont’d Adopted Children by Year

  • Other important issues—

    • Local dress- what is appropriate for physicians?

    • Local hospital political scene

    • Interactions outside the medical setting


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Returning Home Adopted Children by Year

  • Cultural re-entry can be challenging

    • Return to “opulence” of our health care

    • Relative lack of medical need here vs. there

    • Patients/ parents here may seem demanding.

  • Volunteer may be physically and emotionally drained upon return.


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Returning Home- cont’d Adopted Children by Year

  • Sharing your experience may not be easy--

    • Most people don’t really want to know much.

    • Hard to communicate your experience.

    • Criticism of the home scene may not be well-received.


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Returning Home– Integrating the Experience Adopted Children by Year

  • It may be easier to share with colleagues with similar experiences.

  • Direct your enthusiasm about a trip into talks or slide shows– for interested audiences.

  • Become active in the planning and administration of the organization that sent you.


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Returning Home– the gains Adopted Children by Year

  • You’ve learned a lot!

  • Flexibility- new definition

  • Ingenuity & Innovation

  • Appreciation of the resources at home

  • Charged batteries– remembering why you became a pediatrician!

  • You had the opportunity to just practice medicine.


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The Pediatrician’s Gift Adopted Children by Year

--- To touch the life of a child…


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