In the southern Africa country of Zambia, progress over the past few years has been gauged by the reduction of traffic jams. In this case, traffic jams caused by the staggering number of deaths --- and the ensuing slow-moving, road-clogging funeral processions --- as a result of HIV/AIDS.
Nearly 100,000 people in Zambia died from HIV/AIDS in 2005, according to the 2006 United Nations report on the global AIDS epidemic. More recent data are not yet available, but University of Alabama at Birmingham (UAB) nutrition scientist Douglas C. Heimburger, M.D., says the smoother traffic flow is an indicator that the situation is improving.
“Death rates from AIDS are decreasing,” says Heimburger, who spent six months in Zambia in 2006 and has made two other visits to the country. “The traffic is better because there are not as many funerals. People can get their kids to school on time and get in to work. There are a lot of really good things happening over there.”
The UAB School of Health Professions (SHP) is becoming increasingly involved in what is happening in Zambia and several other countries, including Ukraine and India. The school’s global presence is due to an effort by the SHP and Dean Harold Jones, Ph.D., to increase the school’s international involvement.
“We’re trying to coordinate and encourage our faculty to get involved in a variety of different international activities,” says SHP Professor Stephen Collier, Ph.D., who chairs the school’s international task force. “About a year ago, as part of our periodic strategic planning for the school, we got together and looked to reevaluate where we were, and we identified two areas that we wanted to emphasize over the next few years. One was research, and the other was the international area. That’s why the dean has been encouraging people to get involved.”
The school’s biggest involvement so far has been in Zambia (visit our Zambia Flickr page to see photos). In 2006, Heimburger received a Fullbright Scholar grant to lecture and conduct research at the University of Zambia. Since then, he has spearheaded the SHP’s efforts to complement the work already being done in Zambia by UAB.
“The Zambia picture for UAB is very big,” Heimburger says. “It is probably the place where there has been more concentrated international effort for UAB as a university than any other country. And it’s all around HIV/AIDS treatment and research.”
On the strength of national grants from the President’s Emergency Plan for AIDS Relief (PEPFAR) and local funding from the Sparkman Center for Global Health, UAB has been able to dramatically increase the number of people receiving AIDS treatment in Zambia. Heimburger says UAB’s group in the Zambian capital of Lusaka was treating about 1,000 people for HIV/AIDS in 2004. By the beginning of 2008, that number had risen to more than 120,000.
“It’s a real partnership with the Zambian Ministry of Health that continues to be absolutely fabulous,” Heimburger says. “Their health workers in these clinics are the ones who deliver the care. But it’s underwritten in an enormous way by PEPFAR and by UAB’s expertise, providing protocols, training, accountability and prospective data gathering. In order to treat those patients, UAB is employing 500 people in the city of Lusaka. About 95 percent of those are Zambian. They’re working right alongside Zambian Ministry of Health people.”
Such self-reliance by the Zambian people is the long-term goal of the school. Now that HIV/AIDS treatment is becoming established in the country and the mortality rate is dropping, Heimburger says the SHP is exploring ways to provide educational or service delivery support.
“The way the School of Health Professions may fit into this the best is in figuring out ways we can help the Zambian health care system build its own capacity to take care of its people,” Heimburger says. “There are opportunities developing for departments within the school to come alongside the Zambian health care education and training system and help them design and operate a health care system that really takes them into the 21st century. That’s where the focus is going. We hope this will be something where the school can really shine and have a great impact.”
A similar opportunity might be unfolding in Ukraine, where the situation is not as dire as in Zambia, but the health care problems are still severe. After years of operating under authoritarian Soviet rule, Ukraine is struggling to make the transition to offering health care in a capitalistic environment. There are a limited number of people in the country who have experience in health care administration and few established programs to train such administrators.
Robert Hernandez, Dr.P.H., an SHP professor in the UAB Department of Health Services Administration, attended a series of meeting in Ukraine this past April to discuss establishing a two-year program in the country that would offer a graduate degree in health care management.
“Currently, the only training that people who are running the health care system receive is a course where they meet for 20 hours a week for a month, then they take a test at the end of that period, and that’s it,” Hernandez says. “Whereas in the United States, it’s a two-year academic program to prepare people to assume leadership positions. This would be a much more intensive management-education program, so that these folks would have a better understanding of how one would provide leadership to an organization through command-and-control.”
But this is much more serious than a simple managerial problem, Hernandez says. As the health care system in Ukraine has become increasingly disorganized, Ukranians are increasingly skeptical that the democratically elected government can provide basic services like health care in an effective manner.
“You can have all the treatment options going in, but if you can’t organize the workers to provide the services in an adequate way, then it’s all kind of moot,” Hernandez says. “The issue in Ukraine is making sure the leaders in the health care system understand how to manage and can do it effectively, so they can make better use of the resources they have available.”
That is important, because the health care resources in Ukraine are limited. Hernandez points out that Ukraine spends only about 3 percent of its gross domestic product on health care, compared to approximately 16 percent in the United States and 8 to 10 percent for most developed countries.
“They don’t have adequate resources, so they have to be efficient with what they’re delivering in terms of services,” Hernandez says. “That’s the focus of what we would be doing, providing management training for health care leaders. There are a whole host of things that UAB can do. We are the initial entry in there, and as things go well in our program, we hope to broaden the base of improving the professional nature of health care deliver in Ukraine.”
The SHP also is looking to expand its presence in several other countries including:
There are several potential projects for India and the subcontinent for the SHP. First, as a part of an ongoing relationship with major private universities in India and Sri Lanka that have a substantial involvement in health-professions education, there are discussions for collaborative arrangements with counterpart programs in the SHP or providing assistance to create new programs in those institutions.
The second potential initiative in the country involves a group of investors who would like to develop several area hospitals to accommodate India’s growing middle-class population. The investors want to create a training institute to provide staffing for the hospitals, and they wish to seek SHP assistance in creating the training program.
With the Hispanic population growing in many areas of the United States, including Alabama, the SHP is interested in developing a partnership with the University of Puerto Rico (UPR) to conduct research and education related to genetics in Hispanic populations.
The SHP already is developing a master of science program in genetic counseling, is continuing research in the UAB Department of Nutrition Sciences, and has close connections with the UAB School of Medicine’s Department of Genetics. A partnership with UPR would provide an area of focus for these programs and could potentially lead to additional external funding.
Plans are underway to have an SHP faculty member act as a mentor for students in UPR’s multidisciplinary graduate program in clinical investigation as a first step in a more involved collaborative research relationship.
With the development of the School of Health Professions’ Executive Master of Science in Health-Administration Program, officials are participating in several trips to Great Britain (and possibly other European countries) to observe and analyze the health-delivery systems there. The SHP is also exploring the possibility of establishing an international master’s degree in health administration with a major university in the United Kingdom, perhaps as soon as next year.
Collier says he hopes these initiatives are simply the beginning of steady international expansion by the SHP. He says the school’s faculty has long been involved in international projects, but other than substantial efforts a number of years ago in China and Saudi Arabia, it has usually been on more of an individual basis rather than as an official school program.
“What we’re trying to do is take that individual faculty activity and move it into more of an organized program activity,” Collier says. “We’re trying to move to how the school can relate to another schoo, or how a program within our school can relate to another program or institution. For example, in Zambia, we’ll work with the main university there to see if they need a physical therapy program. Basically what we’re trying to do is increase our level of international activity. There is a real need there, and schools of our kind have not been very involved in activities outside of the U.S. We want to coordinate these activities, but not control them. That’s what the international task force is doing. It’s trying to find a way to mobilize that interest, and it has representatives from each of our departments.”
“We want to make a real important contribution to the ability of that country to deliver good health care. We’re helping them to do a better job where they are. But it’s never a one-way kind of thing. We benefit just as much by that experience as the people we try to help.”
“We have an expectation of this enriching our programs and our faculty by giving us a broader perspective as we teach our own students,” Heimburger says. “We definitely hope it will create training opportunities where we can invited students or professionals to come over from the developing countries for continuing education, and then possibly have our faculty and students spend some time overseas and develop some long-term strategic partnerships.”
But in the end, the primary motivation could best be described as simple altruism -- the desire to help developing countries improve their quality of health care, and in the process improve the lives of the people.
“Dean Jones wants to do this for multiple reasons, and the biggest one is that it’s the right thing to do,” Heimburger says. “If we have really substantial expertise, as we do, then we need to be generous and let it flow over to others who might benefit from it. There are a number of faculty within the school who are really interested in getting involved internationally. It would be good to have some additional venues, and maybe our expertise can be of help to developing countries who have been hampered partly by a lack of vision and a lack of adequate training. Maybe we can really help them make a difference.”
Collier agrees, saying he hopes the positive results from Zambia encourage others within the SHP to pursue additional international initiatives.
“People usually go into a health profession because they have a sense of mission. They usually want to serve other people,” Collier says. “This is a way for them to be able to get that kind of experience. Plus, if they have an international experience, it really improves their perspective of health care here. They get to see another way that things operate, and it really develops a greater appreciation for what they’re doing here. Students often go on medical mission trips, and those are really good humanitarian efforts. That is a good experience. We’re trying to take that and do it on a more ongoing basis. We want to make a real important contribution to the ability of that country to deliver good health care. We’re helping them to do a better job where they are. But it’s never a one-way kind of thing. We benefit just as much by that experience as the people we try to help. It helps broaden the perspective of the faculty and the students. We really want to give people a broader and bigger experience.”