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TIE had its origin in
mid-1990’s activities undertaken
by the Utah Physician Assistant Program at the University of
Utah.
Support for training in International Health began in the mid-1990s
under the direction of Deborah Caswell, UPAP International Medicine
Coordinator. Ms. Caswell, with the support of Don Pedersen, the
UPAP Director, demonstrated tireless enthusiasm for giving direction
and structure to the newborn program.
Doug Barker’s involvement in the UPAP International Health
program began in 1996. In May of that year in New York City Doug
received the AAPA Paragon International Humanitarian of
the Year Award. In his acceptance remarks, Doug acknowledged
how much the PA profession had changed his life, and pledged
that he would give back to PA students some of the life-changing
experiences which became possible for him years before when he
embarked on a PA career in International Health.
| In the audience at the Paragon Awards were
friends Don and Kathy Pedersen from UPAP. Over the years,
Don had encouraged faculty initiatives in International Health.
After the Awards Banquet Don and Doug spoke
again about their similar interest in providing training
for PA students in International Health. |
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Over the next two years Don and Doug discussed
methods that might be practical to train PA students in International
Health, including discussions of the method most often used;
sending students on overseas International Electives. It was
the opinion of Doug  that
the benefits of electives could best be realized by promoting
two-way student exchanges; this enhances the whole educational
program rather than just one individual, and allows friendships
and learning to be widely shared with the greatest number of
people. But Doug's overseas experience also suggested
that exchanges were rarely sustainable; they quickly "die
on the vine" after one
or two exchanges. This was most often due to financial constraints
on one side or the other despite the persistence on both sides
of what was originally valued. As discussions continued, it became
clear that to take advantage of such undiminished value, the
best mechanism for sustaining exchanges would be to base them
on barter rather than dollars. It was subsequently proposed that
UPAP would (whenever possible) use barter in arranging exchanges
--discussing dollars only in relation to airfares. (This was
later to become somewhat problematic, since grant donors typically
do not fund air tickets!
| Doug and Don searched for a
suitable site for doing exchanges over the next year. Finally,
in February 1997 Chevron Niugini Company in Papua New Guinea
(PNG) initiated a PA Student Exchange program with UPAP.
This was, for an overseas subsidiary of an American petroleum
company, highly commendable. Don visited PNG, developed
a training curriculum, and finalized arrangements. |
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Don's trip to PNG was financed
by an International Medicine Committee interest group Don
had formed at UPAP. Arrangements were made for ‘State-side’ electives
for Chevron Niugini's Health Extension Officers (HEOs are
mid-level practitioners trained for three years in Clinical
Medicine before becoming deliverers of Primary Health Care
in rural areas of PNG.) Training for each HEO in Utah lasted
eight weeks while staying in an American PA's home. Classes,
conferences, and community experience were provided to
the HEOs and traded by UPAP for logistical support of PA
students in PNG by Chevron Niugini. PA Students traveled
to PNG for eight weeks orientation and training in International
Medicine. Funding for HEO economy airfares were provided
by Chevron Niugini, while PA students at UPAP wrote grants
and organized fund raising activities for the purchase
of tickets.
After an initial four exchanges, an AAPA Innovations in
Education grant allowed for more PA participation in exchanges.
PNG exchanges continued over subsequent years whenever participant
airfare could be raised through grants written by students
or through fund-raising by PNG HEOs. |
While the above exchanges continued, some UPAP students chose
the option of traveling overseas on one-way international electives,
studying in countries such as Ghana, Guatemala, Kenya, Samoa,
and Tanzania.
In February 2001 a UPAP International Student Exchange paper
was published by the International Health Medical Education
Consortium (IMEC) International Conference in Honduras, as
a case study of an "ongoing, successful partnership between
two or more countries, including one in the developing world".
Download a PDF of this paper.
Doug became the UPAP International Health Coordinator
in July 2001 after Deborah Caswell left UPAP to focus on innovative
methods of mobile care for Migrant and Minority workers.
Various UPAP faculty members participated in exchanges as enthusiasm
for such activity increased. Kathy Pedersen, UPAP Clinical Associate,
began involvement with UPAP International Health initiatives
in earnest in February 2001. She helped lead AAPA International
Health committee research into PA International Health activities
and curricula. The committee produced “A Report on
the Findings of the Ad Hoc Committee on International Physician
Assistant Education—October 2003”. Download
a PDF of this paper.
As exchanges and one-way international electives continued,
Don and Doug began to feel concern that some
of the realities of the international elective experience were
not meeting student expectations. One student might have a great
experience, but the next student would find no support whatsoever
due to the sudden departure of a motivated preceptor (caused
by a fight with a hospital administrator or some other local
crisis.) Students might visit a host country to learn broad topics
in International Health but instead see four or five hundred
cases of malaria and not much else. The occasional student would
return having learned very little. Doug, after twenty-five
years of overseas work, additionally began to worry that students
might be finding themselves in situations with attendant risks
of which they might not be aware. Increasingly high airfare for
travel to PNG was becoming prohibitively expensive for UPAP students.
In October 2003 Doug left PNG and with Don's encouragement
began to identify resources in Thailand to aid
in teaching the proposed TIE international health curriculum.
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