THANK YOU HARMONY for posting the information on your trip. If you did not get
it I
have made a copy. Can you tell us more. The cost of the trip, the lenght, what
you did
etc......

Harmony: I did an international rotation with Child Family Health International
They were very organized and are familiar with the use of PA's
although the rotation sites may be unfamiliar and in need of
experience with PA's. I went to Mexico and my classmates to Nepal and
the homestay experience was very comfortable and safe. Check it out!

WE SHOULD AD THIS LINK TO OUR WEB PAGE
http://www.cfhi. org/program_ intro.php4

THIS IS THE ARTICLE WE SHOULD HAVE ON OUR WEB SITE
http://physician-assistant.advanceweb.com/common/EditorialSearch/AViewer.aspx?
AN=PA_07sep1_pap46.html&AD=09-01-2007

Vol. 15 •Issue 9 • Page 46
PAs GO GLOBAL
While part of a uniquely American profession, physician assistants now practice
worldwide.
Find out how U.S. PAs are caring for patients in countries around the globe.

By Terri Schaefer

The physician assistant concept no longer is exclusive to the United States by
any means.
Right now, American-educated PAs are providing medical care though humanitarian
missions in countries around the world, from Sudan to Haiti. And, the exported
U.S. PA
model also is allowing PAs who have been educated in their own countries to
treat
underserved international populations.

"We want to provide some of the little free time we have to provide care for the
people in
desperate need," says Cyril F. Thomas, PA-C, RRT, who is vice president of
Physician
Assistants for Global Health (PAGH) and an emergency medicine PA in San Diego.
"At a
time when everybody is discussing what a PA should be called, I think I would
like to say
simply that PA probably stands for 'poor advocate.'"

American-educated PAs are practicing in countries such as England and Scotland
through
pilot programs designed to determine whether the PA concept can help the
countries'
health care needs. And foreign-educated PAs already have graduated from programs
in
Canada and the Netherlands, and more likely will graduate in the future from
programs in
England, Taiwan, Australia, South Africa and other countries.

"There have been PA-like providers long before there were PAs, all across the
world," says
Richard C. Rohrs, PA-C, administrative director of hospital medicine at
Northwest Hospital
Center in Randallstown, Md., and past president of the American Academy of
Physician
Assistants. "Were we the first to formalize it? Possibly. Maybe we've expounded
upon it
more than anybody else. It's not a new concept; the structure and formalization
is what's
new."


U.S. PAs and Humanitarian Work

PAs who travel around the world on humanitarian missions stress that PAs are in
a perfect
position to provide care in impoverished or underserved areas.

"PAs are diverse in their education and background," says Folusho Ogunfiditimi,
MPH, PA-
C, who is president of PAGH, the founder of Public Health and Education in
Nigeria
(PHENIG) and a PA at the Henry Ford Hospital's Vattikuti Urology Institute in
Detroit. "This
diversity helps them with some of the challenges faced when practicing medicine
outside
of the confines of the Unites States. Also, PAs are trained with the mentality
of providing
care in rural centers where most other providers would rather not go?this
experience and
mindset fits well into the humanitarian concept."

Ogunfiditimi visits his home country of Nigeria for about two weeks every year
through
PHENIG to participate in community development programs and health and education
awareness programs.

Thomas, who was born in Madagascar, an island nation off the southeast coast of
Africa,
returned there for his first humanitarian trip in 1993. During that first trip,
Thomas made
many connections—often the case for PAs providing care in other countries—which
allowed him to participate in further missions to other countries, including
Haiti, Nepal,
Ecuador, El Salvador and Mexico.

Thomas's work overseas usually is surgery—providing cleft lip and cleft palate
surgery, for
example—and treating burns. His trip to Haiti, though, was his first nonsurgical
mission;
he attended as part of a disaster medical assistance team.

"It was a lot of yellow fever, dengue fever, malaria, wound care, tetanus
infection,
malnutrition and parasitic infection," he says.

Catherine Hoelzer, MPH, PA-C, since 2006 has overseen community health workers
in
several clinics in Sudan, having worked previously with other health programs in
Iraq,
Afghanistan and Chad. She developed a 32-week medical training program for the
Sudanese community health workers who, she says, often are the sole medical
providers in
remote rural regions of southern Sudan.

"I train them in the morning for about an hour, and I also go out into the
villages and do
outreaches such as immunization programs, health education and treating
diseases,"
Hoelzer says. "Where we live, there are no roads, no cars, no nothing. The last
place I went
to was 19 miles round-trip by foot."

Hoelzer, the AAPA's 2007 Humanitarian PA of the Year, says that she is the
person with
the most medical training in her region and, along with her husband, is one of
only two
Caucasians. She also stresses that PAs' training in obtaining excellent
histories and
physicals works well in Sudan, because laboratories often are limited or not
available in
the clinics. In fact, she says, "That's why I'm training our health care workers
to take an
excellent H&P, so they can make a good diagnosis and provide the right treatment
to
patients who often have to walk several hours to reach our clinics for care."

Hoelzer says her experiences in Sudan are rewarding, challenging and thrilling.

"And other times, it's just like working here in the states, except I happen to
work in a
mud hut with a grass roof on top, with snakes, scorpions, chickens and dogs
running
around. And a few goats here and there," she says. "I'm appreciative and very
thankful for
the experience, and my one desire is to see more PAs get involved in
volunteering in
underserved countries."


Opportunities for PAs

PAs who have participated in humanitarian trips emphasize that while any PA who
wants to
get involved often can find organizations through a simple Internet search, PAGH
(www.pasforglobalhealth.org) is a prime resource for PAs interested in
humanitarian trips.

The group initially was known as PAXI, or Physician Assistants for
Cross-Cultural
Involvement. At first, Thomas says, "We wanted PAs to understand that they
needed to be
involved in providing free care to people, really get volunteer work in their
frame of mind."

But, Ogunfiditimi says, "We have evolved from that (initial) concept and tried
to focus on
acting as a resource or clearinghouse for information for all PAs interested in
global
health. There are a vast amount of PAs interested or who have participated in
global health
outside the borders of the United States. PAGH looks to harness that information
and
provide it for anyone interested."

The AAPA also maintains an international PA development Web page (www.aapa.org/
international/index.html).


U.S. PAs and Pilot Programs

England is one of several countries that has used or is considering pilot
programs using
U.S.-educated PAs, including Marilyn Harms, PA-C, RN, CNP, who practiced for two
years
in the country at Heart of Birmingham Teaching Primary Care Trust.

Harms worked with a mostly immigrant population at the intersection of three of
Birmingham's inner-city boroughs. She was in the clinic most days from about
7:30 a.m.
until 5:00 or 6:00 p.m.; in addition, she held a minor surgery outpatient clinic
once a week
and performed examinations for the well baby clinic once a week.

Medical care practitioner was the original title proposed for the American PAs
in England,
but after much discussion, that name has reverted to physician assistant, says
William H.
Fenn, PhD, PA-C, a professor at the Western Michigan University PA program in
Kalamazoo, Mich., and chair of the AAPA's International Affairs Committee.

Similar to when PAs started practicing in the United States, no regulations for
PAs yet are
in place in England. "There is no credentialing, since they didn't know what we
were or
how to use us until we could demonstrate what we could do," Harms says. "They
found us
to be a valuable asset to the clinic and were disappointed when we did not
choose to stay."

Despite that, like Harms, some of the U.S. PAs in England have returned
stateside, Fenn
estimates that 40 to 50 PAs still practice in England and Scotland, but that
number is
unlikely to increase much, if at all.

"This was always designed as a pilot, to make sure the program worked there, as
an
introduction, a way of jump-starting the project before (England) could produce
their
own," Fenn says. "It's going to be a segue into British-trained PAs."


PAs in England

A number of universities in England, including the University of Wolverhampton,
the
University of Birmingham and the University of Warwick, have PA education
programs in
place, and some already have enrolled students. Classes could begin as early as
January.

Fenn says that because of England's worsening shortage of junior doctors
(similar to a
resident in the United States), along with the success of the pilot programs,
PAs would fit
well into the health care system there.

"Legality has never been a huge issue, partly because the entire British health
care delivery
system is much more focused on competency rather than specific credentials," he
says. "So
the idea of this person who's not a doctor taking on roles previously performed
by doctors
is not quite as alien there as it might be here."

Rohrs also has visited England and reported physicians at the University of
Birmingham,
for example, were grateful for the U.S. PAs' help.

"They were very happy about not only the expertise, but the spirit of the
American PA, and
how much that helped them," Rohrs says. "Even though our technical expertise
doesn't
always translate to their health care system, and they can't do it exactly the
way we do it,
or choose not to do it that way, certainly the enthusiasm we have for
nonphysician
providers to be able to work within the more traditional health care system was
encouraging to them."


PAs in the Netherlands

The first PA program in the Netherlands—the University Medical Center in
Utrecht—
graduated its first class of five PAs in September 2004. Rohrs was there to
deliver the
commencement address to the first PAs to graduate in Europe.

"It was very rewarding, because you saw all the efforts, that they had taken to
heart a lot of
the information that we had given them," Rohrs says. "They had incorporated a
lot of our
suggestions and modified some of them, but had really come out with a product
that fit
the needs of their health care system, and they seemed to be very happy about
it."

All of the graduates of the Utrecht program had health care experience, and
became PAs
as a second career, which is a trend among internationally educated PAs.

"It was a little bit of an older group, very similar to early American PAs,
where many were
either medics or nurses or EMTs," Rohrs says. "And it wasn't as contingent upon
the
academics as it is now at some (U.S.) programs."

A number of programs in the Netherlands now are graduating PAs, and Rohrs
estimates
that about 100 students likely are in the Dutch pipeline. PAs there aren't
certified in any
manner, but neither are the country's physicians. There is a sense of trust of
graduates
from accredited universities in the Netherlands, Rohrs says. The PAs are working
under a
temporary practice act.

"There's still a long way to go there, but I think that they have the excitement
and
enthusiasm, and that they're producing the results that'll probably help them
get to that
final stage of being a fully recognized health profession in their country,"
Rohrs says.

PA students in the Netherlands do not pay for their education; instead, a
student's costs
are subsidized by individual employers in return for a period spent working for
that
employer after graduation.


PAs in Taiwan

Because of the demand for health care in Taiwan, that country already has many
PA-like
medical personnel. Roderick S. Hooker, PhD, PA-C, associate professor and
director of
rheumatology research at the Veterans Affairs Medical Center in Dallas, recalls
that the
demand started in 1996.

"Overnight, with the new first freely elected president, they created universal
health care,"
he says.

Rohrs also has visited Taiwan, and he says that hospitals there can have
thousands of beds
and also see thousands of outpatients each day.

"People lined up as far as they eye could see," he says. "Three people in an
exam room at a
time, like an assembly line to get in."

Fooyin University in Kaohsiung is the first school in Taiwan to formally educate
PAs. But
Hooker says that the concept has met with some opposition from the nursing
profession,
and as a result the name—but not the role—may change.

"For all practical purposes, they are PAs in the roles in which they were
functioning," he
says.

No matter what the title, Taiwan has a clear need for a midlevel provider, and
PAs in the
United States can provide guidance.

"We were very pleased," Rohrs says. "I think they have an excellent training
model, they
have enthusiasm for the concept, and if they want to call them advanced nurses
or clinical
nurse specialists, if that's where they're going to get the majority of their
applicants from,
then they should go that route."


PAs in Australia

Hooker says that at least two Australian institutions—the University of
Queensland and
James Cook University—are interested in starting PA programs. Two American PAs
already
practice in Australia, and more might be recruited to start a pilot program to
assess the
potential role of PAs.

James Cook University has a social mandate to recruit and educate indigenous
people—
Aborigines and Torres Strait Islanders—to become health workers.

"Not all people have a strong university education," Hooker says. "And they may
not do
well when they are away from their homelands for extended periods. The
challenges are to
provide quality education while addressing their cultural needs simultaneously."

Another challenge is the hesitancy of the government in Queensland—Australia's
second
largest state? to welcome a new health care worker because of a bad experience
with a
physician trained outside the country. A surgeon who recently had been imported
to
alleviate a health care shortage in a town in Queensland was "apparently working
beyond
his level of competence," Hooker says. More than a dozen people in the foreign
physician's
care died.

The Australian military has expressed great interest in the PA concept. "They
want to
obtain places at the University of Queensland if they open up a PA program,"
Hooker says.
"But if not, then (the military) may consider sending some of their medics and
corpsmen to
an American or Canadian program."


Terri Schaefer is on staff at ADVANCE for Physician Assistants.


For more ADVANCE articles about international PA practice, visit
www.advanceweb.com/pa
and click on "Global PAs" in "Online Extras."