McMaster's Department of Medicine is committed to excellence across the spectrum of clinical and academic service delivery. We are fortunate to live in a developed, “westernized” country and we acknowledge the debt we owe to the many people who are unable to live in such fortunate circumstances, both within Canada and in the wider world. A tangible way of addressing the disparities between ourselves and the less fortunate is for us to build strong educational and social ties with partner nations around the world. McMaster's Department of Medicine is committed to strengthening our educational and clinical commitment to the less fortunate through building a strong global health program. Our Global Health Program has three major directions: (1) Building relationships with developing countries through facilitating learners from such nations travelling to Canada for an extended educational exposure and returning to their home country with the ability to build capacity at home (this program runs predominately in concert with the St. Joseph Healthcare International Outreach Program); (2) Facilitating our learners experiencing healthcare in less advantaged locations through elective experiences; and (3) Developing strong relationships with McMaster's Global Health Program, led by Dr. Andrea Baumann.
Involvement in Global Health by the Department of Medicine has existed for some time now in Uganda. This includes academic, clinical, research, collaborative, and philanthropic activities. The Internal Medicine Residency training program in the Department of Medicine is the first program to offer a global health elective experience to the core residents in a developing country established in 2004. Three residents are chosen annually on a competitive basis to gain experience in Uganda. At the same time, we have McMaster faculty who go with the residents on a clinical and teaching capacity on a voluntary basis. The experience has been unequivocally outstanding from both the residents, our faculty, and the welcoming institution’s perspective. For many years now many Ugandan residents have been coming to McMaster to do electives in various subspecialties. We also have a memorandum of understanding between our two institutions, Makerere and McMaster. As a result of this, we are now training internal medicine residents from Uganda at McMaster in their subspecialty of choice at least for one year to become clinically competent in their area of training with the support of the St. Joseph’s International Outreach Program (IOP). In the end, they receive a McMaster certificate of training completion from the postgraduate office, which really helps capacity build in Uganda since there is no formal subspecialty training in Uganda. There is now also a formal university faculty cross-appointment process between the two institutions. We have also shared teaching rounds via the Internet despite the time differences. There are ongoing collaborative research projects also by the faculty and residents. Overall, the goal has always been to empower local health care providers and build global knowledge sharing.
During the pandemic, we have continued our collaboration by holding interactive virtual educational sessions in the areas of internal medicine, COVID-19 medicine, emergency medicine, radiology and pediatrics based on the needs and asks of the medical team in Uganda despite not being on site physically during this unprecedented time.
On a non-medical note, the Internal Medicine Residency program raises funds at a silent auction during the annual Winter Gala, which goes towards medical equipment, faculty development, resident education, and public-school support in Uganda. These funds also go towards supporting a rural 1º Care outpost to train nurses and other support workers to enhance the care of a rural population.
During the pandemic, we have also managed to raise funds and donations in the range of thousands of dollars to help support the procurement of PPEs, medical equipment, and other relevant supplies to help local health care providers and patients in Uganda. We have also advocated for several educational resources at a discounted or complimentary rate including UpToDate, McMaster Textbook of Medicine, and the McMaster COVID-19 Survival Guide.
McMaster University and the Department of Medicine have benefited from the global health initiative in many ways. This includes developing ties with less developed countries, promoting a broader sense of internal medicine education, and elevating the status of our institution on an international level. The initiative has also strengthened the training program and has made McMaster even more attractive to medical students applying for the CaRMS process in Medicine. Moreover, it has fostered humanitarianism and ongoing collaboration with institutions in less developed areas of the world in areas of research, teaching, and clinical work. This entails the concept of providing service to the less fortunate without expecting anything in return since this is a responsibility, not just philanthropy. Overall, the goal is to build capacity, promote bidirectional education and aim for sustainability in a culturally sensitive manner attentive to local resources.
The internal medicine training program was first established in Guyana at the Georgetown Public Health Corporation (GPHC) in 2013. McMaster collaboration was initiated with electives organized through nephrology and then other subspecialties in 2015. In 2016, Zara Khalid had to take on program directorship for the residency program when the local program director had to leave. The program so far has graduated 16 graduates and leadership has now transitioned to a graduate of the program, Melissa McDonald who is completing her Masters of Medical Education.
As a result of the McMaster- IOP- GPHC collaboration, the Guyanese internal medicine residents have been able to undertake 2-month electives in nephrology and other subspecialties in PGY3 year. The collaboration has also led to the successful completion of 4 graduates in Hematology, general internal medicine, respirology, and nephrology fellowship programs. The collaboration would continue to train the local graduates in subspeciality and would meet health care needs in Guyana.
Our focus would now also be more on the development of the department of medicine itself to mentor the new graduates to take on leadership roles to now function as a unified and productive department plus also building credibility within the surrounding communities. Over the last year, we (the Guyana graduates and residents and Dr. Khalid) have led the organization of a successful health fair educating the public scope of services offered at GPHC, secured WHO funding to establish 6 peripheral rural sites for telemedicine (training has been completed, equipment in place but uptake has been slow- this project was led by Arthur Wong and Zahira Khalid) and established collaborative projects with other departments- mainly surgery and Obs/Gyn (focusing on peri op medicine protocols and reducing maternal morbidity and mortality respectively)
Other than McMaster, the other collaborating partners are University of Calgary (online teaching provided by IM residents), University of Pittsburgh (visiting residents and fellows) and Vanderbilt (on-site and online neurology training) and Health volunteer overseas (visiting faculty)- This has allowed a lot of on-site functioning to operate sustainably.
McMaster University’s Department of Internal Medicine has been involved in teaching, research and administrative work within the Department of Internal Medicine at the University of Namibia in Windhoek, Namibia, for the past decade. This program was initiated by Dr. Christian Kraeker, Associate Professor at McMaster University, and is designed to help develop an undergraduate internal medicine curriculum and to support the local teachers and physicians in delivering this curriculum. The overall goal of this partnership is to support local staff, build a long-lasting, sustainable and mutually beneficial academic relationship all while educating Namibian medical trainees to the highest standards.
Many McMaster faculty and trainees have travelled to Namibia to develop curriculum, teach and to strengthen the relationship between the two partner institutions. Thus far the academic deliverables have been:
- A bedside clinical teaching curriculum
- A clinical simulation lab curriculum
- An undergraduate formal didactic course in internal medicine
- An undergraduate formal didactic course in medical pathophysiology
- A tuberculosis clinical curriculum and clinical rotation
- An HIV clinical curriculum
- Evaluative tools including written tests and structured observational exams (OSCE)
- Assistance in the development of student research projects
The reason this partnership is sustainable and viable due to Dr. Christian Hunter. Dr. Hunter is our local partner that lives in Namibia and works at the University of Namibia full-time where he is the Head of Department of both the departments of Internal Medicine and Physiology. He is also an Assistant Clinical Professor (Adjunct) at McMaster University. This partnership is quite unique within the realm of global health due to the fact that we have a stable partner working on the ground in the country at all times dedicated to training Namibia’s first locally educated doctors.
The ultimate success of this partnership was graduating the first class of medical students in Namibia. In total now the school has trained almost 300 doctors of which some are now working in the state healthcare system and contributing to the education of future Namibian doctors. The next step will be to build a postgraduate program in internal medicine.