Teaching Africa: A Guide for the 21st-Century Classroom

21 Beyond the Biologic Basis of Disease: Collaborative Study of the Social and Economic Causation of Disease in Africa

225 21 Beyond the Biologic Basis of Disease Collaborative Study of the Social and Economic Causation of Disease in Africa amy c. finnegan, Julian Jane atim, and Michael J. Westerhaus introduction On a dry, hot friday afternoon in January 2010 in northern Uganda, medical students from Uganda, holland, and the United States gathered in a large circle and reflected on Paul farmer’s book Pathologies of Power: Health, Human Rights, and the New War on the Poor (2005). excitedly, the students shared inspirations, critiques, and real-life experiences in response to the issues raised by the book. One Ugandan student, captivated by the concept of structural violence, expressed how he had seen corruption, gender inequality, and poor governance ruin the lives of sick patients, but he had not previously known what to call it. a student from the United States with experience working in central america expressed concern about the sustainability of the sorts of resource-intensive health solutions for the poor that farmer advocates for in the book. another student beamed with the hopeful message of the book. and one other commented that she now sees that solutions for the global health challenges facing our world today rest on forming networks and building “togetherness.” The engaged conversation that afternoon symbolizes the interactive and collaborative classroom dynamics that characterized Beyond the Biologic Basis of Disease: The Social and economic causation of illness, a social medicine course taught in gulu, Uganda, from January 18 to february 12, 2010. The course brought together 21 medical students from around the world—12 from different regions of Uganda, 8 from the United States, and 1 from holland.1 Through patient case discussions, bedside clinical teaching, didactic lectures, group discussions and interactive activities, and field visits, 226 | Application of Approaches the course merged the teaching of clinical and social medicine to provide a unique immersion into global health in the Ugandan context. The course originated in response to swelling global health interest over the past decade among aspiring medical students. The factors propelling this increase include enhanced media networks that regularly confront us with troubling stories about poverty and disease (Boltanski 1999), the implementation of community-based models of care with demonstrated efficacy for reducing health inequities (farmer 2005), and reinvigorated calls for social justice and primary care to form the basis of new initiatives (Lancet 2008:863). for these reasons, dramatically increased numbers of medical students are venturing abroad and facing the ethical, emotional, social, and clinical challenges of health-care delivery in resource-limited settings (hurt 2007; Panosian and coates 2006; roberts 2006). given cautionary historical precedents in which biomedicine drove the adverse objectification of africans (Vaughn 1991), the practice and study of global health in africa warrants meticulous attention to questions about its origins, logic, values, and intentions. in what ways can global health education steer away from sole reliance on objective, positivist biomedicine as the dominant paradigm for understanding disease in africa? how can curricula be created that juxtapose medical, social, political, economic , cultural, and historical understandings of illness in africa? can global health immersion experiences maximize collaborative learning and partnership by welcoming african and foreign students into the same classroom? and, in such settings, how can instructors mindfully attend to the economic and power inequalities in the classroom to ultimately build unity and cohesion? The experience and pedagogy of Beyond the Biologic Basis of Disease offers an opportunity to engage these critical questions. This chapter argues that the design and pedagogy of this course offered a creative and rich opportunity for teaching global health in africa in the 21st century built upon reflexivity, partnerships, and empowerment . Through personal confrontation with privilege and power both in the classroom and in the world, careful scrutiny of global and local relations, and concurrent teaching of clinical and social medicine, the course replaced customary, stereotyped teachings of africa with personalized, self-critical, and contextual understandings of global health in Uganda. in this chapter, an overview of the course pedagogy, objectives, and content is first provided. Second, experiential narratives from the perspectives of previous participant instructors and students are shared in order to demonstrate how the unique curriculum fostered collaboration and partnership. This discussion is followed by a presentation of the course’s limitations and opportunities for growth. The chapter concludes with a discussion on how novel approaches to teaching global health can inspire social change. Beyond the Biologic Basis of Disease | 227...