By Natalia V. Galarza, MD and Kristina Diaz, MD
Global health has been identified as an increasing field of interest in medicine. As Koplan et al, mention, it can be thought as a notion, depending on current events. A definition for global health has never really been reached by consensus, and so it seems that global health can be adapted to the necessities of the location and time.
Many definitions touch on the fact that global health should improve health and achieve equity for all people and protect against global threats that disregard national borders.(1,2) It has deep connections with public health, blurring the boundaries between public health and global health. Within these connections, we have “border health” as a unique part of public health, with many characteristics being shared with the broader “global health.” For family medicine residency programs that are geographically located near the United States-Mexico border, the teaching of border health is embedded seamlessly in the medical resident education, so much that we tend to diminish its importance and gravitate toward other subjects of public and global health. It is easy to overlook the unique populations that we have in our own communities and focus on those that are more conventional and shared with other residency program or educational goals.
“Glocal medicine” is a concept recently mentioned in scattered medical literature which bases its definition on modifying the conventional way of educating about global medicine, to make it suit local needs. For example, this could include border health, refugee population, migrant farm workers, asylum seekers, and unique migrant communities. This concept can be used to help medical learners and providers understand that you don’t always have to travel far to practice global medicine—this can be done in our towns and with our unique patient populations. This concept is new and evolving and is a sui generis way of adapting to our patient needs and to the ever-changing education requirements of our medical residents.
The Yuma Regional Medical Center Family and Community Medicine Residency Program has introduced a unique experience for our residents. Our trainees are introduced to border health education and global health in a longitudinal curriculum created to address the singular necessities of our patient population and also some of the principles of global health and new ideas on what global/border health should be able to achieve. To provide some background, Yuma Regional Medical Center (YRMC) is the only hospital in Yuma County, a Health Professional Shortage Area (HPSA), and is located in the most southwestern part of Arizona on the Mexico and California border. Its population is 195,751, which includes 59.7% Hispanic, 20.9% below the poverty line, and 43.7% speak Spanish at home. This population has very different expectations and approaches to medical care compared with those which the conventional American health education system teaches.
Approximately 4 years ago, our program initiated binational grand rounds with family medicine and internal medicine residency programs at the school of medicine in Mexicali, Baja California, Mexico. Geographically this is the nearest medical school and medical residency programs. At each grand rounds, each program selects two residents to present two clinical cases in typical grand-round fashion, followed by a discussion of different diagnostic approaches and as well as health disparities as applicable. The event is followed by a tour of the individual hospitals and facilities.
Three important outcomes have been recognized from the above program. The first of these demonstrated an impact for our residents, where much to their surprise, Mexican medical health care was quite different than what they had imagined. Our residents realized that Mexican residents tend to focus more on clinical skills than on diagnostic imaging like MRI or CT scans. High quality research and academics are not exclusively happening inside the United States but is also very active and robust in Mexico. Another impact was that as medical providers, the participants were better able to understand our unique patient population and the relationship built with the medical school in Mexicali, as well as the possibility of expanding on this educational experience. Likely the most important and impactful lesson was that all participants identified that the language of medicine and passion to care for patients is a uniting and universal language extending much further than our borders.
To better understand and interact with this unique border patient population, physicians need to understand and appreciate the Mexican health care system and medical education. Historically, the idea that global health is only defined and guided by medical programs from developed countries that participate in short-lived medical missions that do not foster meaningful relationships does not meet the needs of our patients. Projects like the YRMC-Mexicali Program are important to improve the understanding of US-Mexico border patients, as well as border medical professional development. This is a unique way to truly customize care for distinctive patient populations around our own country, following the principles of public and global health. Providers don’t have to leave home in order to experience global medicine—they only have to serve their own community. Our program has come to refer this way of doing global health as “glocal” medicine. Let’s all go glocal.