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Global program helps doctors break down barriers and learn from other cultures

This article first appeared in the St. Louis Beacon, Sept. 25, 2012 - As a third year resident in internal medicine at Washington University, Dr. Fatima Karaki is accustomed to having access to plenty of high tech tools and other resources to give patients the best care possible. But she’s learning that the world of medicine can look a lot different on the other side of the globe or even in certain parts of St. Louis.

Karaki, who just turned 27, is learning to view medicine from different perspectives after being part of the university’s Global Health Scholars in Internal Medicine program. It chooses 10 scholars each year and gives them an opportunity to learn from experts in international medicine. Under the guidance of physicians associated with Washington University, the scholars also practice medicine abroad for a month in Guatemala, Honduras, India, Bhutan, Eritrea or Japan. In addition, the medical students gain experience by treating refugees and immigrants in St. Louis at Family Care Health Centers, Casa de Salud, and other sites.

The program's work is highlighted during Global Health Scholars Week, which runs through Thursday in Hope Plaza, just outside BJC Institute of Health. Activities there include health screenings, performances by a Jewish choir and a Japanese dance group, ethnic food and a marketplace for local artists to sell merchandise. Part of the proceeds go toward supporting the Global Scholars program.

A native of Michigan, Karaki is a graduate of the University of Michigan Medical School. After she completes her residency here, she hopes to work a year or two to gain more international experience, with an ultimate focus on cardiology.

“The program offers me a global perspective on health care,” Karaki says of her Health Scholars experience. “It helps us think outside the box because many times we’re in under-resourced settings where we don’t have the medical technologies available.”

An example, she says, was her four-week experience of treating indigent patients at Ramakrishna Mission Hospital in Haridwar, India. When a patient suffers cardiac arrest, Western-trained physicians might assume that their peers around the world can step in and take action.

“If somebody comes here (BJH) with a heart attack, I can send them straight to cardiac catheterization. They can get a stent put in to open the blockage. But if you’re working in a poor country, a lot of times, you don’t have those resources.”

That scenario, Karaka says, “forces you to review what are the most effective treatments and the most efficient ways for using the resources that you have.”

The experience at the hospital in India opened her eyes in other ways. After a patient went into cardiac arrest at the hospital, Karaki and others realized that many indigenous physicians there were unfamiliar with proper CPR techniques, not because the training in India is inferior but because that nation's approach to medicine is different. Karaki and others taught the doctors how to do CPR in ways that didn’t appear condescending.

“That’s the good thing about going to different countries,” she says. “The medical education is very different. In India, for example, a lot of physicians are trained in traditional or holistic medicine rather than allopathic medicine, which is the kind of medicine that we learn here. They (doctors in India) use a lot of herbs, for example. So there was a lot of knowledge sharing and teaching going on. They can teach us, and we can teach them.”

In addition to working with one another, the scholars engage in dialogue with people in other university disciplines, including public health, nursing, physical therapy, social work and engineering.

“It’s a way for all of us to come together and collaborate," Karaki says. "In addition, we want to increase community awareness of global health and why it’s important.”

Basia Najarro, co-director of the Global Health Scholars program, says participants learn much from working “overseas in an environment in which they lack resources to perform certain exams and must sharpen their skills” and learn to communicate effectively with patients.

“We hope that by traveling to these sites, they are challenged, that they can think differently and strategically and bring that back to their work here in St. Louis,” she says. Many of the scholars come away enlightened by the experience, she says, grateful for resources they have at home but grateful, too, for the knowledge they gain from interacting with peers and serving patients from other cultures. In the process, scholars break cultural barriers, so that the patients “accept you, trust you." Such situations "inspire and empower” the scholars and “make them think on their toes,” Najarro says.

Although the program remains an elective, she says, “We are becoming a globalized world. It’s imperative that our doctors are training doctors who know how to work in this type of setting.”

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.