By Stephen C. Shannon, DO, MPH A
AACOM President and CEO
n epidemic—a disease or illness that often starts as an isolated outbreak, yet has the potential to grow into a pandemic if not properly controlled. There are many ways that epidemics are spread, each depending on the type of illness and the environment in which the outbreak occurs: through food and water supplies, sexual contact, blood transfusions, close contact with infected individuals, etc. Because of its complexity and ever-evolving nature, the threat of wide-spread disease is something that physicians and public health experts are constantly work to mitigate. Today, however, many of the most dangerous health threats we face as a global community are not contagious.
While death rates from infectious diseases such as malaria and tuberculosis are decreasing, we in the health community see a growing number of deaths caused by noncommunicable conditions such as heart disease, stroke, and injury. According to recent statistics from the World Health Organization (WHO), non-communicable diseases are responsible for roughly 63 percent of deaths worldwide—that is double the number of deaths from infectious diseases, maternal conditions, and nutritional deficiencies combined—and are projected to account for seven out of every 10 deaths worldwide by 2020.
This issue is exceptionally difficult to manage for the many developing countries who have limited resources to fight the spread of infectious diseases and noncommunicable conditions, while also mitigating environmental health risks. Information from the U.S. Department of State identifies the major known causes of death from noncommunicable diseases as tobacco use, poor diet, physical inactivity, and harmful alcohol consumption—all detrimental lifestyle factors that could be preventable with proper continuity of care.
The ideal continuity of care scenario—an interprofessional care team working with patients to ensure ongoing effective health management—is a recognized standard of patient care in most developed countries around the world, and the total health approach is a foundation of osteopathic medical practice. Unfortunately, many developing regions lack the resources to accommodate even basic access to patients. Short-term medical missions run by various organizations all over the world provide an immense amount of support in the instances where acute conditions are the primary problem (such as a village in a war-torn region), but for areas where the people are suffering from enduring conditions such as chronic pain, diabetes, and mental health issues, effective treatment requires continuity.
DOCARE International, an osteopathic medical outreach organization that provides health education and care to medically-underserved areas around the world, is a leader in creating this necessary continuity of care in at-risk regions. Two of DOCARE’s clinics, located in Guatemala and Nicaragua, respectively, are permanent health clinics that care for local communities while also serving as a home base for missions in nearby regions. The permanent location of these clinics means that patients have a place to return to or send family/friends to when care is needed. It also means that those with chronic illnesses or conditions can expect a certain level of continuity of care, including ongoing examinations and access to necessary medications.
In response to the growth in global health issues, international health care has become an expanding area of learning in osteopathic medical curriculum, inside and outside of the classroom. In addition to keeping students informed of current events in medicine and their impact on the global health landscape, many of the nation’s COMs work with DOCARE or individually to incorporate mission opportunities into their curriculum.
Many COMs have also established continuity of care clinics in developing countries, providing underserved areas with ongoing access to quality care and enabling opportunities for research and hands-on clinical experiences for health professionals, residents and students. These schools include the Edward Via University Colleges of Osteopathic Medicine (VCOM), with clinics in El Salvador, the Dominican Republic, and Honduras; the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine (KCU-COM), with clinics in the Dominican Republic and Guatemala; and the Michigan State University College of Osteopathic Medicine (MSUCOM) International Center for Excellence in Malaria Research (ICEMR) in Malawi.
Another pillar of osteopathic medicine that positions DOs to lead positive change on many global health issues is the use of holistic forms of treatment (in addition to the entire scope of medicine) and a belief in the body’s self-healing abilities. A year after the eruption of the Ebola epidemic in West Africa, the WHO published a detailed look at the many factors that contributed to the undetected, rapid spread of the virus in the region. Of these factors, community resistance, reliance on traditional healers, and cultural beliefs were named. These factors were only amplified by a lack of effective communication and education from the local governments and health care workers, which served to further scare communities away from non-traditional medical measures. In instances such as this, taking holistic and patient-centric approaches to care can be effective in building trust with patients and the broader community, especially in countries unfamiliar with or resistant to modern clinical and public health practices.
Osteopathic manipulative medicine (OMM) is one of these forms of holistic treatment, and can be performed to address a variety of ailments in almost any setting without the use of tools and medications. In April, The DO published a story highlighting the work of DOs and osteopathic medical students at permanent DOCARE clinics in Guatemala and Nicaragua. One of the students interviewed for the article described how in areas where a large segment of the population are laborers, OMM proved to be an effective treatment for chronic work-induced pain. In addition, OMM doesn’t require medication or tools, meaning it is a relatively cost-effective treatment that can be safely used in tandem with other forms of treatment, such as pain medications, if necessary.
It is my belief that physicians graduating from OME programs today are uniquely prepared to serve as leaders in the international health care community, both because of their innate and growing interest in the global health arena, as well as and the core skills they developed through their osteopathic medical training. Therefore, it is up to us as osteopathic medical educators to ensure that we maximize our student, resident, and practitioner access to training opportunities that adequately equip them for the challenges of providing health care in international settings. This means ensuring that they have the skills to practice as a member of a global team, each practitioner looking beyond the patient to find the person within in order to break down cultural barriers and establish open communication and trust.
AACOM’s International Collaborative (IC) is one way that the Association is facilitating educational efforts focused on global health and student exposure to health care in international settings. Through its community, the IC works to connect individuals interested in promoting, practicing, and being involved with global health. However, there must be a greater effort to work with our international counterparts to influence health policies in the United States and abroad. By forging partnerships that help create positive changes in international health, osteopathic medicine can continue to position itself and future DOs as leaders in the effort to combat illness and promote health and wellness on the global stage.