Developing short-term medical experiences for long term impact: Global health education for community based primary health care in Nicaragua

While over 65% of incoming medical students express interest in international health experiences as part of their education, short term experiences in global health (STEGs) vary depending on the ability of both the sending and receiving agencies to offer learning opportunities. In this presentation, we describe the development of a framework for effective and impactful global health education in low and middle income countries (LMIC). AMOS is a non-profit organization based in Nicaragua which implements the strategy of community based primary health care (CBPHC) to decrease maternal and child mortality and morbidity in rural communities. Over the past ten years, we have received an increasing number of medical volunteers, students and teams. As a small non-profit, we face the dilemma of balancing passionate and committed volunteers (who need orientation and support to be effective) with the everyday programmatic implementation of CBPHC activities. With input from university partners, volunteers, AMOS program staff and community health workers (CHWs), we developed a global health education curriculum emphasizing: 1) Cultural humility, co-learning and critical self-reflection 2) Community based participatory research principles and practice 3) Principles and practice of CBPHC and CHW models for improving health, and 4) Processes to foster community empowerment and engagement. We hired and trained STEG staff who worked to integrate students and volunteers with existing CBPHC programming. Since implementing this framework, over 100 students have contributed to projects such as operations research on CHW performance, development of training materials and job aids for CHWs, and prevalence studies for childhood malnutrition and anemia -- all contributing to the long term community impact of our CBPHC program.  In our experience, STEGs can have long term impacts on students, volunteers, receiving agencies and community beneficiaries, but need to be supported by an adequate global health curriculum, staffing, community partners, budgets, and logistics.