Meet Michigan Medicine: Global REACH
The first-ever kidney transplant procedure in Ethiopia was performed by Michigan Medicine surgeons a little more than a year ago. In 2016, a university in India, in partnership with the U-M Medical School, launched that country’s first-ever masters-level Health Professions Education course aimed at teaching doctors to be better instructors for residents and fellows.
In Brazil, where end-of-life care is not commonly taught in medical schools, the University of Sao Paulo has recently begun sending residents to U-M’s academic medical center to learn palliative care. And nations across Africa, including Liberia, Cameroon, Malawi and others, have adopted OB/GYN residency training programs modeled after a very successful initiative that UMMS helped launch in Ghana more than a decade ago.
In short, the work that originates from Michigan Medicine doesn’t stay here. Rather, it reaches countries — and countless lives — in nearly every corner of the world, and the division responsible for fostering much of that international work is Global REACH. Read on to learn more about a small Michigan Medicine department with a huge geographic footprint.
Founded in 2001, Global REACH (Research, Education, and Collaboration in Health) is an office within the medical school that fosters international collaboration among faculty, as well as learning opportunities and exchanges for medical students, both those at Michigan Medicine and those visiting from abroad.
There are hundreds of UMMS faculty engaged in collaborative research with colleagues and counterparts overseas in nearly every country. The places with the largest concentrations of international partnerships include China, Brazil, Ghana, Ethiopia and India — countries where Global REACH is especially active. Global REACH helps faculty connect with counterparts abroad who share a mutual research interest and in some cases offers small grants to help kick-start new collaborations. One such grant recipient was Assistant Professor of Physical Medicine Mark Peterson.
Last summer, Peterson garnered a $10,000 award from Global REACH to start a new project with researchers in China, a country where he had no prior professional connections. Today, he and a Chinese colleague have a finished project, a publication, and have laid the groundwork for a long-term partnership comparing the burden of age-related disabilities and disease on the U.S. and Chinese health systems.
“I had never collaborated with anyone in China, but I had this idea to harmonize information from large data sets that I knew were already available in both countries,” Peterson said. “At times it can be difficult to garner external funding for new ideas. Seed grant opportunities like (those offered through Global REACH) can really jump-start preliminary projects and lead to much bigger things.”
In the 2015-16 academic year, more than 50 UMMS students traveled abroad for educational experiences, engaging in clinical electives and research projects across more than a dozen countries. Global REACH sponsored the vast majority of those experiences. With the department’s support, students studied the links between diet and fibromyalgia in Kenya, staffed pop-up health clinics in the jungles of Peru, and helped treat Syrian refugees in Jordan, to name a few.
These students not only learn about medicine in an entirely different (and often resource-scarce) setting, but they also discover things about themselves, lessons that follow them into practice no matter what type of medicine they ultimately pursue or where they pursue it.
“It made me realize that many of the differences I witnessed in practice are a result of systemic influences, especially insurance and primary care infrastructure,” said Janet Ma, an M4 who spent a month last summer doing rotations in various units at Peking University Health Science Center, UMMS’ partner medical school in Beijing. “This has prompted a greater personal interest in public health and policy and how it may affect my daily practice.”
Not all of the students who participate in a global health experience in medical school find themselves working internationally down the road, but most come away better doctors, said Joseph Kolars, senior associate dean of education and global initiatives and longtime proponent of global health education.
“One of the reasons I like advocating for global experiences is the personal growth that comes from having to navigate issues in a new context; you become more in touch with your assumptions that often limit the way you see the world,” said Kolars, who traveled to Nepal as a medical student. “I know of a number of people who focus on domestic health equity who were first ignited or turned on to these issues by a global health experience.”
Visiting students, scholars
The exchanges run both ways. Even as UMMS sends learners abroad, it hosts a growing number of foreign students and scholars as well; Michigan Medicine welcomed nearly 300 visiting students and scholars from overseas in 2015-16. Global REACH supports many of these exchanges, helping visitors find everything from housing and transportation to their way around the grocery store. (Really! The first-day orientation typically includes a chaperoned trip to the neighborhood supermarket.)
Titus Beyuo, a Ghanaian physician, spent three months at Michigan Medicine in 2016 observing with colleagues in the OB/GYN department. “The whole fellowship experience was fantastic,” Beyuo said. “I expected to observe, but I’ve felt like an active participant in the academic discussion, so it exceeded my expectations.”
Such exchange programs have accelerated medical and scientific advances around the world and are an integral part of top-tier academic medical centers like Michigan Medicine. Chair of Internal Medicine John Carethers, writing with several colleagues from peer institutions, made this very case in a piece published last month in the New England Journal of Medicine.
“Over the past 50 years, the U.S. biomedical research enterprise has benefited greatly from the ideas, creativity, ingenuity, and drive of international medical graduates and other non-U.S. nationals engaged in biomedical research. It is well known that a large proportion of the most talented and productive research trainees come from abroad,” Carethers and co-authors noted. “Before the mid-20th century, professors from U.S. medical schools often traveled to Europe to gain new knowledge that they could bring back to their students. Today, international collaborations are the bedrock of many of our most important scientific endeavors, from genomics to drug development.”