Students called to global service

WASHINGTON -- The number of graduates from US master's degree programs in international health has grown by 69 percent in the last decade as a part of an overall boom among students interested in saving lives in the poorest parts of the world.

The trend is also seen in heightened interest among undergraduates and medical school students in global health issues, particularly at Boston's two major centers of public health teaching -- Boston University and Harvard University.

More than 500 students attended a global health career forum at Harvard earlier this year. "Global Health Challenges" has been one of the most popular classes at Harvard College for the last three years, averaging 165 students. And the first two residents have just graduated from a new program at Harvard-affiliated Brigham and Women's Hospital that trains doctors in global health.

At Boston University's School of Public Health, enrollment in the Department of International Health has nearly doubled in four years, to 225 students from 120 in 2003.

"It's gangbusters, it's unbelievable," said Jonathon Simon , the department's chairman.

Sara Green , 31, who just finished her first year at the Harvard School of Public Health, said that helping AIDS orphans in Addis Ababa, Ethiopia, in 2003 made her think about global health as a career.

"It's an area where I could really make a difference, and making an impact is something that is important to me," she said. "I spent 10 years in communications, and it didn't feel nearly as significant."

Jim Yong Kim , chairman of Harvard Medical School's Department of Social Medicine, said just a handful of people in his Harvard Medical School class two decades ago expressed any interest in global health. This year, he said, roughly a third of the 130 first-year students petitioned him and Paul Farmer, with whom he was teaching a course on social justice in medicine, to put more global health material into their class.

The two professors added 10 seminars examining nitty-gritty subjects such as how organizations deliver syringes and anti retroviral AIDS medicines to remote villages in Africa.

Scott Lee , 25, said he led the peti tion drive because "many of us need something beyond" the class curriculum.

Health-related organizations also report a jump in resumes from young graduates. "We're seeing really good students who seem to have less concern about getting any job and more concern about having a job that is meaningful to them," said Joel Lamstein , president and co founder of John Snow Inc. , a Boston-based public health research and consulting firm that employs 1,000 people.

Around the nation, the number of schools of public health now stands at 38, up from 27 a decade ago, according to the Association of Schools of Public Health , based in Washington, D.C. In those schools, the association found the 69 percent increase in students studying international health.

Michael H. Merson , director of the six-month-old Duke Global Health Institute in Durham, N.C., founded with $30 million in seed money, believes that students are being drawn to international health for many reasons, including an increase in media coverage of such issues as the SARS outbreak and AIDS as well as a heightened awareness of foreign issues since the Sept. 11, 2001, attacks.

Merson also cited the increasing amount of money in the field and a greater number of health organizations. He singled out the Bill & Melinda Gates Foundation, which has given $6 billion to global health projects since 1999.

"The Gates Foundation has really mattered, and related to that is the celebrity factor. I admire Bono the most," Merson said of the lead singer of the Irish rock band U2. "But there are many others out there -- George Clooney with Darfur, Oprah with orphans in South Africa, Alicia Keys, Brad Pitt, Angelina Jolie. To our youth, that matters. The fact they have turned such devotion to such causes, many of them in Africa, makes it sort of a cool thing to do."

But transforming a desire into effective work overseas is not simple. For medical school residents, it can be costly and time-consuming and can require on-the-ground supervised training.

David Walton , 30, one of the first two Brigham graduates in the Howard Hiatt Residency in Global Health Equity program, needed to add a fourth year to the regular three-year residency program in order to complete his global health studies. In the last four years, he has spent half the year in Boston and half in Haiti. The Brigham program has grown to include 15 residents.

Walton said his education at Brigham was akin to being "at Disneyland and getting to go on all the rides. I had all the bells and whistles, all the tools, CAT scans, MRIs. If I needed an orthopedic surgeon, boom, I had one."

In Haiti, he had none of that -- and he had a much larger job. Based in Lascahobas , a two-hour drive north of the capital Port-au-Prince, Walton learned how to design a new hospital, order drugs for the pharmacy, and examine causes of disease by visiting patients in their homes.

"Part of what we fundamentally believe is that you can't just give people pills," Walton said. "You have to get them out of poverty to get at the roots of disease. With home visits, I can see if they need a new house, and if I need to do triage to see how we can do that."

Such skills take time to develop, requiring sensitivity to people's needs and traditions, said Farmer, whose work over a quarter-century in Boston, Haiti, and elsewhere around the world was chronicled in Tracy Kidder's book, "Mountains Beyond Mountains."

"The question is, how can you do this ethically and with dignity?" Farmer said, adding that US schools and nongovernmental organizations should work closely with authorities in poor countries to determine the mission of foreign doctors and other health workers. "You don't want to have a young doctor go over and . . . end up being a spectator to poverty."

But Walton said well-designed global health programs can both teach Americans and benefit a poor country. The ideal, he said, is when "Boston informs Haiti, and Haiti informs Boston."

John Donnelly can be reached at donnelly@globe.com