Innovation in Laos
U of C doctors help improve medicine in Southeast Asia and gain new perspectives on health care in return
By Grady Semmens
Fresh from finishing her hospital residency last summer, Cristin Fitzgerald, MD’04, did something you wouldn’t expect from most newly minted psychiatrists. She packed her bags, flew to the other side of the world and spent a month working on basic hospital medicine in one of the world’s poorest countries.
As a graduate of the U of C’s Faculty of Medicine, Fitzgerald knew her visit to Laos would be spent sharing her up-to-date medical knowledge and practices with colleagues in a developing country. What she didn’t anticipate is how much she would learn by working in hospitals that are decades behind by North American standards and often lack even the most basic medical equipment.
“I have always been interested in experiencing other cultures and giving something back to the international community,” Fitzgerald said. “What I found really amazing was how thirsty Lao medical students are for information and how adaptive they are in managing health with so few resources. They showed me how you can manage with less.”
Fitzgerald’s experience neatly summarizes the philosophy behind the U of C medical school’s ongoing involvement in the landlocked and culturally-isolated nation known officially as the Lao People’s Democratic Republic. Since 1994, dozens of Calgary physicians, medical researchers, public health experts and medical students have travelled to Laos to spend between one week and four months immersed in the country’s health-care system as part of the Lao Human Resources for Community Health program. Currently, about 25 volunteer participants return to work in Laos each year. The program evolved through work by U of C medical professor Dr. Clarence Guenter as an official partnership between the U of C’s Faculty of Medicine, the medical school of the National University of Laos and the Lao government’s ministries of health and education. It aims to modernize and improve the training of doctors and health-care workers in Laos, which is among the 25 poorest nations in the world and was virtually sealed off from the rest of the world during the 1970s and ’80s. After more than a decade of collaboration, the project has worked with Lao teachers to produce an entirely new med school curriculum based on the country’s most pressing health issues and is expanding to look at how health care can be best delivered to the vast majority of the country’s 6.5 million people who live in remote farming communities and often rely on traditional healing remedies for their ailments.
“The most important activity for us has been to spend time with the Lao people and understand how they would like to improve,” said Guenter, who retired early from his medical academic career to devote himself to international health.
“It took years for them to develop trust in us, and for us to really understand what they need and how to achieve it in the long term,” he said. “It’s taken thousands of hours to come up with everything that should be in a curriculum for doctors-in-training in a poor country and it includes a lot of things we don’t teach here in Canada.”
Guenter was drawn to Laos after being involved in similar initiatives in Nepal, Thailand, China and the Philippines in the 1980s and early 1990s. The Lao government invited the U of C to help update its health-care system, which Guenter said required a long-term partnership in order to be successful.
“At that time, they had just come out of a 25-year period when their doctors and medical students had no access to medical information from the outside world,” he recalled. “They were using European textbooks that were 30 years old, and were only spending a few hours learning about malaria, even though it’s one of the biggest health issues facing the country.”
With the new curriculum in place, emphasizing the Lao health needs, and a new postgraduate family medicine training program, the country’s new doctors and government officials are getting a better understanding of health-care needs in rural areas where villagers’ knowledge of modern health care is extremely limited, basic infrastructure is lacking and families live a subsistence farming lifestyle.
“Every medical student now has to spend a month working in a rural area where they go from household to household talking to mothers about their children and working on basic things like separating the water ponds for humans away from the ponds for animals,” Guenter said. “They are experiencing what conditions are like outside of the capital city so they can understand what the situation is and what the needs are.”
Assistance from the Canadian International Development Agency (CIDA) through the Association of Universities and Colleges of Canada is expected to last until 2010, with the next phase focusing on improving the services provided by rural hospitals and clinics. Guenter also envisions an expanded role for U of C professors, researchers and medical students who can help improve health care in Laos while expanding their knowledge of tropical medicine and health care in the developing world.
Laos’ Minister of Health Dr. Ponmek Dalaloy has requested the U of C continue and expand its role in his country’s medical system, explaining that the partnership has made great strides in improving health-care for the Lao people.
“The professional teams from Canada are greatly appreciated because they respect Lao realities and work by coaching our students and involve them in learning by doing,” Dalaloy said. He added that the U of C’s involvement has also helped start a new nationwide family medicine plan that will see new doctors become leaders of multidisciplinary teams working on prevention and primary health care projects around the country. “This will be the key to bringing improved health to our rural people,” Dalaloy said.
Fitzgerald said she hopes to return to Laos to continue working with doctors in the small provincial hospital in the city of Paxse. She also hopes that she can use her expertise to improve care for patients with mental illness.
“Psychiatry doesn’t have a lot of lab tests or cures, so it’s not a huge jump for it to be developed as part of their hospitals and health-care system,” she said. “Right now there are only two psychiatrists in all of Laos and mental health is mainly dealt with using traditional medicines.”
Guenter said that while the project may come to an end, the relationship between U of C and the Lao people will likely continue indefinitely.
“Personally, I’ve had so many wonderful experiences and learned an incredible amount about everything from Buddhism and Hinduism to tropical medicine and nutrition,” he said. “To me, this kind of work is what a university should be all about. We’re sharing information and leaving behind knowledge and training that will hopefully go on and improve without us.”
Six Months in Laos
A Calgary Family's Adventure
In the village of Phatang, deep in the humid heart of Laos, there’s a new generation of children doing something that was unheard of until last year: swimming in the local river for fun. Credit for this new form of entertainment can be given to an eight-year-old Calgary boy, Oliver Buchner, who did what came naturally to him in the tropical heat of southeast Asia. And now that it has caught on with the kids of Phatang, there has been no keeping them away from splashing around in their favourite swimming hole.
It’s one of the many unexpected cross-cultural experiences for U of C PhD student Denise Buchner, BEd’91, and her two children, who lived in the remote rice-growing community from January to June 2007.
“There was a lot of culture shock initially, especially for my kids, but once they learned some of the language and began to fit in, we really became part of the community,” Buchner said. “In Oliver’s case, he wanted to stay longer because he was having so much fun being the king of the river. He really surprised the local people because they had never seen anyone play with such abandon in the river before.
Buchner brought Oliver and her six-year-old daughter Eleanor along for her fieldwork examining how illness and disability is understood in developing countries. Some might consider it a bold family experiment, but it just made sense to Buchner, after she was accompanied by her husband and small children for previous fieldwork in Africa.
“It’s such an amazing learning experience for everyone,” she said. “In fact, I’ve found that having my kids with me helped my fieldwork because we were seen as another family in the village, which wouldn’t be the case if I had come in alone as a foreign researcher.
Neighbours gather to say farewell to U of C PhD student Denise Buchner and her children Oliver and Eleanor, at the end of their stay in the village of Phatang in 2007.
Buchner’s work in the Interdisciplinary Graduate Program is focused on the rural health clinic that serves about 300 households in Phatang and trying to uncover why the clinic is seldom used by villagers who have a wide range of illnesses and disabilities associated with injuries, birth defects, developmental disorders, and diseases like diabetes and cancer. Her study is part of the Faculty of Medicine’s ongoing program of helping to improve and modernize the health-care system in Laos. Much of Buchner’s time was spent interviewing local families about their health issues and dealings with the local clinic.
“It’s fascinating because disabilities aren’t something people talk about very much in developing countries and they’re viewed very differently than we view them here in Canada,” she said. “There’s a very different concept of what it means to be ill.
Buchner also found that the clinic is under-utilized because villagers can’t afford to pay doctors the informal fees expected of their services.
“There’s a belief that rural people don’t go to the clinic because they don’t believe in Western medicine, but that’s not the case at all,” she said. “People want to be healthy but they don’t see a doctor because they can’t afford it or they feel uncomfortable going to an official government building because they don’t know what to expect.
Results of her study will be used by the United Nations World Health Organization and the U of C s Lao Human Resources for Community Health program to try and increase access to health care in rural areas of Laos.
In the meantime, Buchner said their time in Laos has changed the way she and her children look at their village of Redwood Meadows, just west of Calgary.
“It’s amazing to think that Phatang is the same size as my neighbourhood because you see so many people with serious health problems there that you don’t see here,” she said. “It’s really eye-opening to see what a community with virtually no modern health care is like.”
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Top Row: A group of children gather to greet visitors to their small village on an island in the Mekong River. |
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