In a Chinese village, a man with emphysema receives life-giving oxygen from a respiratory therapist. In Ecuador, a woman receives trauma surgery after a fall. In Sweden, an elderly man recovering from a stroke gets help with his daily exercise routine from a young physical therapist.
What do these three patients have in common? All of them, without knowing it, are being touched by the outreach of the University of Alabama at Birmingham (UAB) School of Health Professions (SHP). At a time when the concept of “globalization” is a driving force in world affairs—from society to economics to politics—SHP is working to strengthen and expand its ties with health-care professionals in other countries, from underserved populations to innovators in high-tech treatment delivery.
“Our school has a long history of involvement in international health-care education,” says Harold P. Jones, Ph.D., dean of the School of Health Professions. “Our efforts began in the 1980s under the leadership of [former Dean] Keith Blayney, with partnerships in China and the Middle East, and have grown to include Eastern Europe, Scandinavia, South America, and other parts of the world. In fact, we were one of the first health-professions to become involved internationally. Now we’re refocusing our efforts to take advantage of new opportunities.”
Changes in China
SHP’s collaboration with West China Medical School, at a time when allied health had no foothold in the country, was “a truly incredible achievement,” Jones says. It spurred the development of China’s first professional training programs in those areas. The relationship with West China continues today, with faculty from West China currently visiting the school to improve their skills.
One of those professionals is Qing Jum He, one of the first graduates of her Chinese university’s nursing school and a teacher of respiratory therapy. “Medicine in China has changed dramatically in the past decade,” she says. “In the old times, nursing was strictly a matter of on-the-job training, so the transition to modern clinical medicine has been very hard at times. But now we have a master’s degree program, and graduates can get good jobs in hospitals and continue to grow professionally.”
“Because they don’t have insurance, they depend on the clinic, and they turn out in high numbers. They show so much appreciation for what we do for them—even seemingly small things like giving them a bottle of lotion for a scar.”
Howard Houser, Ph.D., professor in the Department of Health Services Administration (HSA) at SHP, has had an insider’s view of China’s recent transformation. He first did a sabbatical at Xian Medical University in the ancient capital of Xian City in 1984; in the years since, he’s made 21 trips to China, and has helped welcome more than a hundred Chinese students, scholars, and visiting dignitaries to UAB. On his 10th trip, he met the Chinese woman who would eventually become his wife and who would go on to earn two degrees of her own at UAB.
“The growth in health care in China has been incredible, as have the cultural changes over that period of time,” Houser says. “Starting in the early 1980s, the country basically began playing catch-up in everything from infrastructure to transportation to banking to health. Medical care has been greatly modernized, and medical schools have updated the content and rigor of their programs so that they’re highly competitive.
“China still has inadequate resources to supply all its citizens with health care, particularly in the rural areas, but the cost of health care goes with modernization, with drugs playing an increasingly important role. They’re responding by developing joint ventures and the ability to manufacture pharmaceuticals within the country, and are experimenting with various types of insurance. So it’s a challenging, and interesting, time.”
Health Care and Social Policy: UAB Goes to Sweden
It’s a long road from China to Sweden, but the Karolinska Institute in Stockholm has been another of SHP’s international partners since Karolinska’s faculty sought out a U.S. collaborator several years ago to help develop partners for the clinical education portion of its physical therapy curriculum.
The resulting exchange program has been an important window on the world for students from both Alabama and Sweden, according to Carolyn Sherer, PT, assistant professor in the UAB Department of Physical Therapy: “The experience of studying at Karolinska really broadens students’ perspective on health care and the different forms it can take in different societies,” she says. “One of the most important things they learn, I think, is how closely health care is tied to social policy.”
Sweden’s comprehensive health-care system does come at a price: In some parts of the country, sales tax is as high as 25 percent. But unlike Americans, Swedish citizens undergoing physical rehabilitation are supplied by the government with all the services they need for as long as they need them.
Little Things Mean a Lot: A Mission to Ecuador
A very different health-care environment greeted Stacie Porter, a student in the SHP Department of Occupational Therapy, when she joined colleagues on a medical mission trip to Ecuador in February. “It was a totally different world from any I’d ever seen, with major poverty,” says Porter, who graduates this December. Mission organizers chose her partly for her fluency as an interpreter, as she had grown up with Puerto Rican grandparents and minored in Spanish at UAB.
“Resources are in such short supply that they do small cost-saving things—recycling disposable gloves, for instance. Everything we used on our trip, from drugs to operating room monitors, was donated and shipped down on a plane,” Porter explains. “The mission is an annual event that’s been going on for 12 or 13 years, so people know it’s coming. Because they don’t have insurance, they depend on the clinic, and they turn out in high numbers. They show so much appreciation for what we do for them—even seemingly small things like giving them a bottle of lotion for a scar.”
Porter’s time in the southern half of her own hemisphere left her with two main impressions: “Mainly, it’s made me more appreciative of what we’ve got here in America. I don’t think most of us realize how fortunate we are.” But it also confirmed her ambition to practice her profession—occupational therapy with a special interest in pediatrics—in another country. “I’d like to get some experience here in the States first, and then work in Mexico,” she says.
Doctors Without Borders—Or Language Barriers
In fact, Jones says the Spanish-speaking populations of the Western Hemisphere—particularly Central and South America—represent a new frontier of opportunity for health-professions education that SHP will be pursuing in the coming years.
“The fact that the Hispanic population has grown to be the largest minority group in the U.S.,” says Jones, “has caused us to realize that we must educate professionals who are responsive to the needs of the Hispanic community. That realization, and the steps we take to respond to their needs, should help us to move past what’s been a major barrier so far in becoming involved with Central and South America—the language.
“If you don’t speak Spanish, working there effectively is difficult. As we train more students who are capable of delivering quality health care to Hispanic populations, it makes sense to offer some of our programs bilingually, and that will open up new opportunities in our own hemisphere.”
Turning Health-Care Professionals Into Ambassadors
“Through international programming, we have the ability to serve as a valuable resource to other countries, while providing opportunities for our students and faculty to learn and develop through experiencing the diversity of other cultures and health-care systems.”
“Programs in health-related professions and clinical laboratory sciences have recently undergone significant expansion, offering accreditation in other countries around the world,” says Skrinska. “There are clearly many differences in the way health care is organized and delivered from culture to culture, and it’s important for our students today to understand those differences—especially as we approach a global set of academic standards for many of those institutions.
“Exchange programs give the institutions, as well as the students, great experience in how the standards of different countries compare, and they equip students to work in a global academic environment.”
Jones agrees: “As the world’s major superpower, we often receive mixed reactions to the things we do. But one thing the world looks to America for is the export of our educational system and our knowledge about the delivery of quality health care. This sharing of intellectual capital is some of the best foreign aid we can offer. Through this exchange, we can influence the hearts and minds—as well as the economic development—of other countries.
“Through international programming, we have the ability to serve as a valuable resource to other countries, while providing opportunities for our students and faculty to learn and develop through experiencing the diversity of other cultures and health-care systems. Everybody’s perspective is broadened, and everybody wins.”