By - April 04, 2022
Global health work, in which health organizations in well-resourced countries engage in outreach to under-resourced countries, has traditionally been a largely “in-person” experience, says Dan Milner, MD, Chief Medical Officer for ASCP. Before the pandemic, traveling to other countries to build relationships on the ground, particularly in “high-context cultures” such as Africa and Southeast Asia, was a necessary part of the work. Virtual global health work was simply not very common or successful.
“Prior to the pandemic, maybe for the past 20 years, if you wanted to do a project, such as go to a village and do a survey or build a new facility, you had to physically go there. You had to meet with village elders, have a meal with people, a personal conversation, a handshake, and meet them in person,” Dr. Milner explains. “They had to understand why you were there for completely different reasons.”
In Southeast Asia, for example, cultural context and societal organization is important, he says, such as understanding respect for elders and the way businesses are structured. In Africa, anti-colonialism drives relationship building, since people there can be suspicious, having had resources stripped away. “They want to know who you are and want to know you’re invested,” Dr. Milner says.
But in 2020, when the pandemic hit, in-person global health work was no longer possible in many cases, or discouraged.
“Pre-pandemic we did not really embrace virtual work. We felt very compelled to be in person,” says Jeannette Guarner, MD, Professor and Vice Chair of Faculty Affairs, Department of Pathology and Laboratory Medicine at Emory University. “Yet the technology was there, we just did not explore it. The pandemic has pushed us into using it,” she says.
If the pandemic had happened five or even 10 years ago, Dr. Milner points out, virtual global health work would have been next to impossible in places such as Africa, where internet access and basic power infrastructure were not up to the task. Fortunately, progress has been made in providing access, though it is not without problems, such as power outages and slow internet bandwidth.
“Now, people are much more willing to have virtual interactions and much more excited to have educational content delivered that way,” Dr. Milner says.
Even in cultures where relationship building is a priority, the pandemic has enabled them to see the benefits of virtual global health work. The first benefit is the ability to reach a greater number of people at once through virtual training or courses, Dr. Milner says. What makes this successful is adding in an asynchronous component, so that course recordings can be viewed offline at the participants’ availability. “If you can watch it in your own time and do your homework and tests, think about them for three days and come back with helpful questions, it’s much more impactful than if we tried to go in person and do the same course,” Dr. Milner says.
Another benefit to the organizations providing the outreach, according to Kenneth Landgraf, Director of the ASCP Center for Global Health, is saving money on travel. “We’re able to get people from regions of the country who usually wouldn’t be able to travel,” he says.
Young mothers also benefit from virtual work, notes Dr. Guarner. “If you’re a young mother, it’s hard to travel. So, they’ve benefitted from [being able to] do lots of conferences and speaking and creating things. They have the drive and the interest.”
Dr. Guarner notes that one unexpected, positive result of going virtual was that the resident program at Emory was able to interview people from all over the world, including Qatar, India, Lebanon, and Colombia. “In other words, virtual interviews—which we were not doing before the pandemic—have allowed us to go global. As all of the candidates do not have to travel for interviews, they are placed in the same level playing field and we have expanded the pool of applicants.”
Of course, where much is gained, much is lost. “By doing virtual work, you end up not really meeting the people,” Dr. Guarner laments, as well as missing out on the richness of experiencing a country up close, first-hand.
This impacts the places where new relationships are being established the most, Dr. Milner says. Virtual work is most successful where relationships have already been built in person.
“Because of ASCP’s reputation and what we had done prior to the pandemic, when we moved to a virtual format with our colleagues, even new colleagues in Africa, they were okay with that because they knew who we were, and they trusted us. But I don’t think someone who’s never done global health can start zooming with Africa and have an impact,” Dr. Milner says.
Another problem is that language barriers can be exacerbated by virtual exchanges. “When you’re in a room with someone, you can see their mouth moving and know the context of what they’re talking about, which is easier to follow,” Dr. Milner explains. “But when they’re on video and mumbling, or looking the other way, you might have trouble hearing or understanding.”
Mr. Landgraf added that simply trying to read through a deck of PowerPoint slides virtually, “is a very quick way to lose people. You need to make things more engaging.”
And of course, while internet may be improved in some countries it is still a problem in others. “The biggest downside depends on the bandwidth,” Dr. Guarner says. “Sometimes the internet may not be very good in certain parts of the world. In the U.S. we don’t think about it because we mostly have good internet.”
So, what impact has the switch to virtual had on patient care? Dr. Milner says it’s impossible to separate out the effect of the pandemic and the switch to virtual global health work, both of which have been “massive.” He adds, “However, what I can say is that we have been able to make progress with implementing changes and programs. Is that translating to better care in the setting of COVID? It’s unclear.”
When it becomes safe to travel again, Mr. Landgraf feels that the future of global health work will likely be a hybrid approach. “Particularly the people funding global health are always looking for efficiencies, and international travel is expensive.”
Dr. Milner adds that the education component is particularly conducive to a hybrid approach. “You can deliver education very effectively in a virtual format, and we have to be accepting of that.” Additionally, he sees the popularity of telehealth—including teleradiology, telepathology, and telemedical consultation only growing.
While virtual global health work may not be as comprehensive as in-person work, it fills in necessary gaps and ensures that organizations can keep supporting patient care in the countries that need it most.