Letters to the Editor
In Reply to Blaise and Carter:
We agree with Dr. Blaise and Mr. Carter that it is important for visiting faculty to be familiar with the health challenges of Haiti or any other country where they will teach. We stress to our medical school trainees that they must recognize and understand the political and social determinants of poor health affecting our global community so that they can begin to address these.
The authors have raised an equally important issue regarding the quality of medical education in the resource-limited communities in which we visiting faculty work. In particular, they provided advice on how foreign medical educators can improve their teaching of Haitian medical staff and trainees. It is not unreasonable to expect visiting professors to significantly edit their presentations for Haitian audiences. In addition, visiting professors should encourage their Haitian colleagues to drive the learning agenda and help them prepare material to be presented. This will ensure that lectures are relevant.
We agree that medical students, residents, and faculty all over the world deserve an innovative, interactive, and stimulating environment in which to learn. Unfortunately, in many low- and middle-income countries, a chronic lack of resources has resulted in the inability of their ministries of education and health to effectively build comprehensive medical education programs. This lack of adequate and relevant training capacity, as well as poor working conditions and meager salaries, has directly resulted in the “brain drain.” Clinicians should also be advocates for the support of these ministries so that medical education programs throughout Haiti and other developing countries can be either built or strengthened.
In addition to Dr. Blaise and Mr. Carter’s helpful suggestions, we also encourage use of the clinical accompaniment model, in which visiting medical educators would work alongside and share ideas with their Haitian colleagues to improve quality of care. Instead of focusing only on lectures or taking the lead on morning rounds, the accompaniment model would emphasize Haitian leadership that is supplemented by expertise from visiting faculty.
Ultimately, we all would agree that Haitian health care practitioners deserve an education system that does not depend primarily on visiting medical educators. In our experience, most seasoned Haitian clinicians have tremendous experience and knowledge in the illnesses and conditions that afflict Haitians. We as an international community should increase our focus on providing tools and resources so that our skilled Haitian colleagues can train Haiti’s next generation of health practitioners.
Natasha M. Archer, MD
Associate physician, Department of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; narcher@ partners.org.
Phuoc V. Le, MD
Assistant clinical professor, Internal Medicine and Pediatrics, University of California, San Francisco, San Francisco, California.