February 2011


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We had a fabulous evening of stacking jars and launching on pillows.

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Dennis Clements, MD, PhD, MPH gave a lecture entitled “Global Health, the New Kid on the Block” to a class of 40 or so mixed discipline students (nursing, medicine, physical therapy) interested in exploring medicine on a global scale.  The presentation outlined the progression of global health since its true, documented introduction in 1997.  It offered a defense for the need of global health initiatives, the changing health picture of the world by region, and finally Duke University’s initiation into and current role in global health.  Dr. Clements delivered a concise, statistically-dense presentation on some of the current and projected challenges of the global health initiative.  He challenged his audience as soon-to-be licensed health-care professionals to get engaged in an area desperate for individuals seeking an “unconsummated desire for sacrifice and service”.

Dr. Clements opened his lecture with a humorous, nostalgic reminder of the cell phone, circa 1997, the same year “global health” got its real, documented start. The phone was big, bulky, and probably did not offer a fraction of the services that today’s wireless enterprise boasts.  The leaps and bounds technology has made well represents the developing world of global health.  The US spent over 63 billion dollars in the last 6 years on global health initiatives.  There are currently 270 Universities in the US that report some kind of Global Health Program; 158 of those universities offer Global Health concentrations, tracks or certificates, 70 have Global Health Centers, 49 offer degrees.  As technology continues to explode, international travel transpires in a matter of hours and life expectancy, even in underdeveloped countries, continues to climb, our global picture of health is radically different.  It demands an interdisciplinary effort to study, research and practice population-based interventions, clinical care/treatment, address trans-national health issues all in a hope to achieve some level of global equity in health.  To do so, and in an attempt to meet the UN’s Millennium Development Goals, Dr. Clements stated that global health care providers work on addressing infectious diseases, chronic diseases, environmental threats, social determinants and health system strengthening.  He expanded each of these challenges with specific examples.  Dr. Clements concluded his presentation with his personal plug on why we, his audience, should be joining the public global health enterprise.  He highlighted and bragged on Duke’s very new, but already highly effective program and offered resources for additional information and opportunities.

Dr. Clements presentation on global health synthesized chart after graph after projected trend from the CDC, UN, WHO, of the mounting healthcare challenges to provide a concise argument for the importance of a global health initiative.  “Global health will soon be simply, public health” he stated. In a strong, fluid manor, Dr. Clements easily captured his audience with his clear and thorough understanding of his content in addition to expertly adding personal anecdotal stories that offered compelling asides to his slides.  Considering the depth of available information and complexity of the topic, an hour worth of content just barely whet the pallet.  I left wishing his hour long lecture was just an introductory speech to a day-long seminar on a changing global climate and how we, as soon-to-be health-care professionals, could get involved and make a difference.    My only reservation about the lecture was the failure to address the huge ethical conversation that is tightly woven into any kind of international effort.  The challenges that face the health care community are so much bigger than just the health issues.  How does one deliver and execute interventions that address the various challenges within the scope of the global health problem in a culturally sensitive, sustaining way, invited way?

Phrases are intoxicating.

Like the song title: Where from Here.

It sounds so melancholy and thoughtful and resounds so clearly as I contemplate that very question.  Where from here?  Where from here?

I’ve been reading Donald Miller’s blog almost every day.  It reads like a daily administration of good advice, sound thinking, reaffirming motivation.  “Luck favors the prepared” he says.

“YES! Yes it does” I think to myself and nod along in agreement.

Life seems so full of truth and heart-evoking responses of late.  I wonder why.  Is it the approaching graduation date; is it the near end of the chapter I am living?  I feel this same way as I approach the end of a book.  You read with with a hesitation:  you want so desperately to finish the book; to find out what happens, to participate in some way with the conclusion of this story….

and yet….

the bitter sweetness of it envelops you as you close the back cover back upon the handful of pages you have just consumed. Its over.  You will never know more.  The road you have been walking has ended.

Where from here?

Its always another book.  Another story.  Another road.  Another lesson, another heartbreak…. but where? when? how? and who?

Graduation, YES!  and then…