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Global Health Careers and Issues to Consider

Carlos del Rio MD, Jyoti Mathad, MD, MSc (appreciate Charlie Van Der Horst’s help!)

 

1. Personal Issues

  1. What do you want to do:
    1.  Research
    2. Implementation/ public health
    3. Clinical care
  2. What are your strengths and interests?
  3. What are other considerations: children, sick parents, financial debt, spouse’s happiness and job?
  4. Talk to people who are living the life you want
  5. Establish professional and peer mentors (within and outside of ID!)
  6. Consider filling out a Personal Development Plan (PDP) or Individualized Development Plan (IDP) (https://www.bmj.com/content/351/bmj.h4603, http://myidp.sciencecareers.org/)

2. Where?

  1. Places with existing administrative, laboratory, clinical, regulatory infrastructure (Hint: Look up sites with US-funding such as NIH/Fogarty, CDC, USAID, PEPFAR, etc).
    1. Clinics and hospitals are important as you can’t do implementation science or clinical research without infrastructure to deliver services
  2. Language issues: learning a second language, depending on your area of interest (Asia, Africa South America) is a huge benefit. It also makes you more marketable in the global health world.
  3. Safety: Have an in-country and US-based plan, especially for women or if working somewhere where you don’t “blend in”

3. Time overseas: commute vs. full time?

  1. Full time: A 2-3 years (or even 1) overseas stay is critical for new individuals embarking on a global health career. You need that time to learn what it’s like to live and work overseas; it also allows you to build the necessary long-term relationships for success.
    1. Expatriate support for faculty abroad is not well defined at many US academic centers. Negotiate up front as they’ll take advantage of you: schools for children, housing, guards/security, trips home, academic track, local transportation, health insurance, evacuation insurance
    2. Maintaining certification: If full time, how will you maintain certification and skills in internal medicine and infectious diseases (return to attend)?
  2. Commute: Many feel that even if you want to commute, it is essential to spend a few years overseas initially, if you are interested in a long term US based research position that involved international research.  You need a realistic understanding of the health care/research infrastructure or lack thereof to be able to design, implement and oversee global health studies through the “commute” method.  You can’t mentor others in country and build their capacity if you don’t understand their challenges.
    1. You also need support of Department Chair and Division Chief as who will cover in clinic when you are going back and forth?
    2. Need a strong local team if trying to do it remotely.
  • Need evacuation and health insurance that will cover you.
    1. If pregnant, verify how long insurance covers you abroad
  1. Through collaboration: For certain skill sets such as health economics, basic or translational science, biostatistics, you can work on global health without travelling if you have a strong overseas collaborator

4. Research:

Consider dedicated training in research (coursework or Masters/PhD in Epi, Clinical Research, Biostats, etc). Primary areas include basic science, clinical research, implementation science or “translational.”

  1. Post docs (PhD or MD)
    1. Fogarty Global Health Fellows D43 Program: One year of post-doctoral funding plus up to $15,000 for research, travel, health insurance https://www.fic.nih.gov/Programs/Pages/scholars-fellows-global-health.aspx
    2. Fulbright US Scholar: Country specific, usually not longer than a year, often focused on teaching but you can search here: https://www.cies.org/program/core-fulbright-us-scholar-program  
  • T32’s focused on global health-these are institutional grants but as they are usually combined with clinical training, they offer limited time overseas
  1. Individual global health research grants to US faculty that you might be able to get a post-doc on. Many NIH institutes have global health portfolios relevant to ID physicians including NICHD, NIAID. The Fogarty portfolio is here: https://www.fic.nih.gov/Programs/Pages/default.aspx
  2. Non-NIH funding https://www.fic.nih.gov/Funding/NonNIH/Pages/postdoctoral.aspx There are a lot of non-NIH career development award funders in particular areas that seem open to international work. Many cancer foundations (Komen, ASCO, ASH, etc.), Thrasher for peds
  3. Burroughs Wellcome Fund: http://www.bwfund.org/grant-programs/biomedical-sciences/collaborative-research-travel-grants Collaborative Research Travel Grants (open to young faculty and post docs-$15,000)
  1. Early Career Grant Opportunities
    1. NIH IRSDA (K01): 3-5 years, $75,000 for salary and $30,000 for research. Spend 50% of grant time overseas, at least 3 months/year. Due March 2019, 2020, 2021. http://grants.nih.gov/grants/guide/pa-files/PAR-17-002.html
    2. Standard NIH K awards: https://researchtraining.nih.gov/programs/career-development
  1. Burroughs Wellcome Career Awards for Medical Scientists $700,000 over 5 years to bridge advanced fellows/early faculty (similar to the NIH K99/R00 grant) http://www.bwfund.org/grant-programs/biomedical-sciences/career-awards-medical-scientists

5. Public Health

Many clinicians are not geared for this right out of training. Public Health requires a different skill set-focused on implementation and training, less on the clinical issues you are used to facing:

  1. Post-doc-
    1. CDC Epidemic Intelligence Service (2 years post doc): https://www.cdc.gov/eis/
    2. USAID Global health Fellows II Program: 2-4 years in Washington or overseas. Salary dependent on experience, degree https://www.ghfp.net/
  1. Career:
    1. USAID Bureau of Global Health: https://www.usaid.gov/work-with-us/careers/vacancy-announcements?field_bureau_io_nid=1864&field_career_type_value=All&field_career_eligibility_value=us
    2. CDC Global AIDS Program-internal and external positions: http://www.cdc.gov/globalaids/global-hiv-aids-at-cdc/jobs.html
  1. NGOs such as ITECH (http://www.go2itech.org), FHI360 (https://www.fhi360.org/about-us) and INTRAH (http://www.intrahealth.org/ )

6. Service/clinical

This is difficult as a long-term, full time career, but easy for shorter stints overseas. Full time clinical positions can lead to burn out quickly due to poor health systems, limited supplies, high rates of complications, etc.

  1. Peace Corps Global Health Service Partnership: https://www.peacecorps.gov/apply/global-health-service-partnership/
  2. Peace Corps Medical Officer: https://www.peacecorps.gov/returned-volunteers/careers/career-link/peace-corps-medical-officer/
  3. Partners in Health http://www.pih.org/pages/employment
  4. Medecins Sans Frontieres (MSF or Doctors without Borders) -9-12 month assignments http://www.msf.org/en/work-msf
  5. Smaller NGOs such as Last Mile Health, http://lastmilehealth.org/
  6. Texas Children’s Global Health Corps: Renewable 1 year contracts, salary $45,000 - $60,000 depending on the location, housing stipend, health insurance, http://www.bipai.org/health-service-corps/  
  7. Religious groups such as Partners in Hope in Malawi, part of Serving in Mission (Charlotte based evangelical group) http://pihmalawi.com/

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