Using Photovoice to Encourage Reflection in Health Professions Students Completing a Short-term Experience in Global Health

Abstract

Objective. To engage health professions students in a photo and caption sharing methodology to stimulate reflection and inculcate principles related to global health at a formative time in training. Methods. Undergraduate and graduate students from multiple colleges enrolled in a course that would prepare them for an in-country global health experience. As part of the course, participants took photos to illustrate one of three topics: global health ethics, interprofessional practice, or social determinants of health. The iterative and participatory photovoice process was used for students to analyze, discuss, and reflect on their work in country and upon return. Final photos with captions were displayed online. Researchers analyzed photos and captions using content analysis to identify unifying themes. All students were required to complete the photovoice assignment, but only those who gave informed consent were included in the qualitative analysis. Results. Twenty-six students were included in the analysis. Two overarching themes emerged: revelation and adaptation. Revelation encompassed novel elements that surprised the students, including differences and similarities between the United States and Ecuador. Coded segments related to adaptation discussed participants' resourcefulness while challenging work environments, and how they would apply this new perspective to their future practice in the United States. Conclusion. This global health photovoice project provided a unique medium for reflection for health care trainees. This project enhanced our understanding of the learners' perspectives and this new means of expression offered the learners a greater opportunity for deeper reflection. The assignment also revealed gaps in learning related to social determinants of health and areas of concern related to solidarity and privilege.

Keywords: education abroad; global health; medical mission; photovoice; reflection.

Figure 1.

Kolb’s Experiential Learning Theory as Applied to the Short-term Experiential Learning in Global Health (modified from Kolb, 1984)

Figure 2.

In this photo, there is a chicken running wild in the pharmacy. This was in the pharmacy that was set up on our second clinic day on the porch of a Tsachila community member’s home. We didn’t have room to spread out the medications, all we had were the suitcases. In this picture, a chicken got up on the porch and was running around and actually climbed up in one of the suitcases full of medication. I took a picture of this because it displays how there are numerous animals running wild in and around their homes, and how this is a common occurrence in Ecuador. It wasn’t just the chicken that the pharmacy got a visit from, we also had cats and dogs that came over to see what we had in the suitcases. This picture also provides a perspective of how we set up the pharmacy on 3 out of 4 of our clinic days. We didn’t have room to work or even a large amount of supplies to work with like we’re used to back home. We had to be flexible every day and work with what we had. This picture reminds me of the importance of being flexible, not just in my career, but in my everyday life. It’s important to remember that everything might not be going how we want it, but we need to work with what we have and remember how fortunate we are to have the opportunities that we do here in the United States.

Figure 3.

In this picture, an MD/MPH student, is blowing bubbles for children who had come to a community center in Santo Domingo seeking medical care. All around her, children were jumping to catch bubbles while other providers, nurses and students were laughing and blowing bubbles as well. I took a picture of this specific moment because it shows no matter where you are in the world, all children are the same; they all enjoy playing with bubbles. On the brigade my eyes were opened to the vast differences in living between my city and Santo Domingo. The dirt floors and concrete walls that lack glass in the windows is not a common sight at home, but in Santo Domingo, this is normal. Children are still the same: happy-go-lucky with no care in the world, in both places. This picture speaks volumes to the differences in the social determinants of health in different communities, cities, and countries.

Figure 4.

While on the medical brigade, I felt very inspired by the passion the Ecuadorians had for learning about healthcare. I was stationed as a fluoride provider and I had the opportunity to teach the children how to floss, brush their teeth, and have good oral health. For my picture, I chose to do the theme of social determinants of health. My picture is focusing on a mother and son and there are many colors within the picture that provide a beautiful contrast. Within my picture is a mother holding her young toddler son while he gets treated with fluoride by a dentist. I took a picture of this scene because it was truly beautiful to see how caring the mother was about her young son and her smile is visible within the photo. This picture portrays how I learned how eager the Ecuadorians were to learn about healthcare and get treated. Within the United States this picture teaches me to never judge a book by its cover and to always give 100% while giving services.

Figure 5.

While on the Shoulder to Shoulder brigade, I learned a great deal about how to be flexible and creative when dealing with limited resources, while also maintaining patient safety. This photo shows the sharps container made from a wet wipes container used by the nursing team for a majority of the brigade. Although our team did not have access to the typical sharps containers that are used in the United States, we had an ethical obligation to ensure that our sharps were disposed of safely in order to prevent accidental injury and disease transmission. This sharps container, although unconventional, offered easy access to dispose of sharps and prevented their removal from the container, which are the functions of traditional sharps containers. This image captures the resourcefulness used by brigade participants to adhere to their ethical responsibility to provide safe care despite resource limitations.