In countries where residents are supposedly entitled to free health care, what explains that individuals from specific groups still face challenges in accessing basic healthcare services? The so-called “neglected populations” are those populations whose socio-economic, cultural and legal conditions deny them opportunities available to the rest of society. Inequality in accessing healthcare services can be observed through the discrepancy in the life expectancy that exists between populations of the different neighborhoods on the island of Montreal, Canada. This discrepancy can be as high as 9 years between the territories covered by different clinics. For the neglected communities, who have specific needs and are already facing prejudice, the lack of access to healthcare services sets them in a vulnerable position. Situation is further aggravated by a lack of coordination of the services offered, and by the insufficient understanding of these populations and their needs. All these factors contribute significantly to the aggravation of accessibility problem these already very vulnerable populations face.
Because of a lack of exposure to the neglected communities during their training, healthcare providers can fail to grasp their context and these populations may therefore face significant stigma. The latter can then lead to a delivery of lower quality care to these patients. Future healthcare providers, including medical students, must therefore benefit from a better exposure to the vulnerable populations in their own community to prevent these issues.
In line with promoting access to health and tackling the lack of exposure of medical students, the Standing Committee on Human Rights and Peace of IFMSA Québec has implemented an immersion program in local neglected communities, in 2011, for preclinical medical students. The latter is called the INcommunity project. As students, we should get involved with these communities and get to know them, as we will have to work with them during our future medical practice. The earlier we start working with individuals in vulnerable settings, the better we can grasp the reality of life conditions and context and the more efficient we will be in breaking any potential prejudice.
The vision of INcommunity is aligned with a more social approach to medicine. The latter aims at taking medicine practice beyond the purely biological causes of diseases approach and help students realize the importance of a more holistic approach to the health and prepare them to use it with their future patients. Through our 4-week extra-curricular summer immersion in one of the five target populations, participating students gain an early exposure to the social conditions and medical particularities in some communities. This program aims to increase the awareness of future doctors with respect to the reality of neglected groups of our population here in the province of Quebec. The benefit of this program to students is multifold, as it will: (i) help stimulate their interest in working with the above discussed groups; (ii) emphasize their interdisciplinary work; (iii) increase their awareness of resources available for vulnerable populations.
Each year, INcommunity participants take part in this one month immersion, in June or July. Program will offer immersion in one of five different populations: Migrants, Indigenous, Inner-city urban setting, Law offenders, and Women in vulnerable settings. As we wish to encourage and emphasize interdisciplinary work, we work with more than 50 partner organizations to give a variety of immersion settings such as clinics, hospitals, organisms, shelters, rehab centers, etc. During their daily immersion, students will be offered the opportunity to interact with various professionals and increase their knowledge of the various resources that exist.
To complement the immersion, we use various learning methods to further engage the participants in the program. Participants, first, receive a pre-immersion training to give them information on vulnerable populations. This year, participants finished their training on May 19th, 2018, and are ready for their immersion. Workshops are then organized to allow participants to reflect on issues, faced by theses populations, and to prepare for what they may experience during their immersions. During the immersion, we facilitate discussions around the issues faced by the communities through weekly readings, debriefings with other participants and mentorship sessions with doctors to encourage students to reinvest their learnings and consolidate them. Finally, participants have to produce a final report, based on a logbook they have to keep throughout the internship. In the report, the participants must answer the reflection questions provided to them at the end of the immersion and share their experience and lessons learned. This report will help the INcommunity team to improve the program and assess its benefits on participants.
Since 2011, more than a 100 students were given the opportunity to take part in the INcommunity immersion program. At the end of their immersion, participants often mention their intention to maintain their involvement with the target populations and even pursue a medical career in organizations or clinics that work with these populations. The partner organizations and partner professionals of the program also appreciate the initiative and interest of medical students to be exposed to these communities. Some of our current partner physicians are past participants of the program who want to transmit their passion to the new participants each year.
The next step for the program is to increase the number of partner organizations. When achieved, we expect this to allow a higher number of participants, and ultimately help implement a monitoring program of the participants to better measure the long-term impact of the project. Finally, one of the most significant results of the program is its adaptation, just two years after its creation, into a mandatory clerkship week called Social Engagement in 2013 at University of Montreal. This achievement not only illustrates how student initiatives and leadership spirit can influence the medical curriculum, but also gives us the motivation to continue this important effort as SCORPions!
By Imane Benaskeur, IFMSA-Quebec
John Etietop Ebong, Program Coordinator on Dignified and Non-Discriminatory Health Care