The Role of Communal Living in Global Health

There is a community of the spirit.
Join it, and feel the delight of walking in the noisy street and being the noise…
Open your hands, if you want to be held…
Why do you stay in prison when the door is so wide open?…
Move outside the tangle of fear-thinking…
Flow down and down in always widening rings of being.
-Jalāl ad-Dīn Muhammad Rūmī

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Maijd Sadigh, M.D., Trefz Family Endowed Chair in Global Health at WCHN and Director of Global Health at UVMLCOM, and Mitra Sadigh, Writer/Editor for the WCHN/UVMLOM Global Health Program

When in an unfamiliar environment, small, unexpected events easily become unmanageable obstacles, and simple problems overwhelming. A global health elective brings a wealth of unfamiliarity in the culture, clinical settings, surroundings, and daily lived experience. Students, especially those who are traveling to a place different from their home for the first time, may feel isolated in the plethora of feelings that arise- among them confusion, frustration, helplessness, and loneliness. To help process these feelings, it is crucial that students be embedded in a network of support with fellow medical students, residents, and physicians with whom to share experiences and discuss thoughts. This way, each student has the insight of fellow students who are simultaneously undergoing similar experiences, and that of those well-versed in the challenges of global health. With the aid of a diversity of perspectives, students are more likely to reach a comprehensive point of understanding.

To help facilitate the shaping of this supportive enclave, we send junior medical students with a resident and faculty member to international sites together as a team. By working, living, dining, and socializing together over the course of the elective, members learn about and support each other as the group becomes unified. With a strong support system, students are more likely to feel comfortable, confident, and curious, a strong foundation from which they can immerse in and engage with an unfamiliar culture, people, and way of life. Thus, this communally-centered support system is not intended to recreate the home environment as to avoid the unfamiliar, but to encourage a diving into the unknown. Furthermore, this group dynamic challenges the concept of “private space,” the overturning of which will help medical students better adapt and integrate into host communities that so highly value communal living- and ultimately prepare for future global health experiences that will likely require the sharing of space and resources.

But why do students need to live with residents and physicians? You might ask. Why is the time spent during work hours at the hospital not sufficient? Global health is not just about working at a hospital in a different country. It requires work that extends far beyond the clinical experience. If a working knowledge of global diseases was enough to navigate the field of global health, any able physician would be a good candidate. But global health calls for a much taller order: to learn how to care for patients within a different cultural landscape, context, and medical system. Medical conditions are not standalone, but deeply enmeshed in a convoluted web with social context, political history, cultural beliefs, and economic forces at its vertices.

This is why we call for complete immersion in the host country. The idea of the elective is not to go to the hospital, focus on patient cases, and return home to decompress by disconnecting from everything that felt challenging. The idea is to completely overturn one’s  idea of reality and be open to a new way of life. This is the only way to truly understand the circumstances and reasons that drive certain health problems and inequities. Clinical knowledge is not enough.

A global health elective can be quite challenging. Without the support system provided by communal living, students may be so overcome with fear and anxiety that the entire purpose of the elective may be lost on them. Communal living is needed to dissolve the barrier between physician and medical student and develop trust without which supervisors would be unable to truly support students. Communal living is needed to encourage students to remain engaged with their experience and growth process, rather than disconnect from it the moment they leave the hospital premise. With the support of a team, students can have the encouragement needed to transform obstacles into growth experiences, push themselves through difficulties, and emerge as more compassionate, culturally sensitive, adaptable humans who may someday be leaders in global health.

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