US-EU-MEE program gives three students a new perspective on health care

Since 1998, HMS has sponsored the United States-European Union-Medical Education Exchange (US-EU-MEE), a multinational medical student exchange program that promotes comparative analysis of health care delivery systems in Europe and the United States. This spring three students completed the program.

Tariro Makadzange

Each spring HMI selects two or three students from a consortium of five medical schools for a one-month clinical training rotation at a partner institution across the Atlantic. The US-EU-MEE students follow the course of one of the host faculty’s patients through the health care system in that country, from the hospital to other health care facilities and services such as ambulatory, long-term, and home care. The students develop a case study of the health care system’s response to the selected patient's health care needs. In this context, the patient’s care is viewed as a broadly interconnected system of health care delivery rather than as a narrowly clinical treatment of a disease. The case studies promote critical reflection on the health care delivery systems in which the students will practice and encourage thoughtful exchange of information and ideas about the health care systems in Europe and the United States.

The partner institutions involved in the consortium are Harvard Medical School (Boston, MA, USA), Weill Medical College of Cornell University (Ithaca, NY, USA), Ludwig Maximilians University (Munich, Germany), King’s College in London (UK), and the University of Copenhagen (Denmark).
Tariro Makadzange, a native of Zimbabwe who is a student at Harvard Medical School, spent a month in the Department of HIV and Genito-Urinary Medicine at King’s College in London. Under the mentorship of Dr. Phillippa Easterbrook, Makadzange followed the difficulties of an HIV-positive Zimbabwean man, and observed how public policy—and public perception—regarding immigration can impact the care of individuals. “The time I spent at King’s College enabled me to gain amazing insights into the complexities of the National Health Service (NHS) and HIV care and management,” she said, and was “one of the most pivotal experiences of my medical education.”

Malte Rieken

Makadzange pointed out that the UK saw a 10 percent increase in new HIV cases between 2002 and 2003. Individuals from Zimbabwe accounted for a large number of those new cases, a fact that has helped to place the issues of HIV and African immigration at the forefront of political discourse and fed the perception among the UK’s citizens that immigrants who receive medical care for HIV are “health tourists” draining resources from an already overburdened systems. Last year, the UK introduced a new policy that would forbid those ineligible for full NHS care (i.e., immigrants) from receiving treatment for HIV. Makadzange speculated that this could have adverse effects on public health, as immigrants may be less likely to seek diagnostic testing and counseling services (which are still available) and therefore remain ignorant of their HIV status.

Malte Rieken, a student at Ludwig Maximilians University, completed his program at the Freedom Trail Clinic, an affiliate of the Schizophrenia Program of Massachusetts General Hospital. Under the tutelage of Dr. Oliver Freudenreich, Rieken followed the case of a middle-aged man diagnosed with schizophrenia. His case, he said, “demonstrates the complexity of the mental health system in the United States.” This complexity stems from a number of factors: the tangle of agencies responsible for providing care and making sure that this care is paid for; the financial situation of the patient, whose condition makes steady employment difficult if not impossible; and his mental state, which causes him to receive special attention to fully understand his situation and options.

Line Holst

Line Holst, a sixth-year medical student at the University of Copenhagen, worked closely with Dr. Robin Joyce for four weeks at Beth Israel Deaconess Medical Center (BIDMC) in Boston. Her goal was to examine how patients with Hodgkin’s lymphoma disease are managed in the United States health care system. “It was a unique opportunity for me to see the American system from the inside, but also to gain a better understanding of our own system in Denmark, ” said Holst.

Observing the care of her subject, a 22-year-old collegestudent, and others at BIDMC prompted Holst to consider how health care providers in Denmark might adapt a more service-oriented approach. She reflected on two aspects of the care at BIDMC that impressed her. “First, the schedule of care was well planned for the patient, and second, the way he was treated enabled him to understand the situation. I think that when these two factors are established, it helps promote better compliance on the part of the patient because he feels better informed and is met by professionalism from all sides: from the doctors, staff, system, and hospital.”

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