Why is Global Child Health important? – with Dr Erva Nur Cinar

Dr Erva Nur Cinar (ST1) has been heavily involved in global child health since being a medical student. Here, she talks about her experiences and how they have shaped her clinical work, research and teaching, and emphasises the importance of considering a holistic view when talking to patients / their parents.

My name is Erva, and I am currently an ST1 Paediatric Trainee in EoE. I am also an MSc student in Public Health at LSHTM (London School of Hygiene and Tropical Medicine).

I completed my medical degree in Istanbul in 2020 and subsequently worked for approximately eight months in Gaziantep, a city located on the Syria-Turkey border.

Throughout my time in medical school, my interest in inequalities and health politics grew steadily. I got involved in various voluntary and professional activities related to global health. Many of these activities were led and centred around youth involvement.

I collaborated with youth organisations like IFMSA (International Federation of Medical Students’ Associations), UNMGCY (United Nations Major Group for Children and Youth), as well as UN organisations such as UNFPA (United Nations Population Fund). I worked with humanitarian organisations as well – MSF (Médecins Sans Frontières/Doctors Without Borders) and CARE being among the prominent ones.

I now still continue addressing / working on these pressing issues.

What is Global Child Health?

Global child health – the term refers to a practice and advocacy to promote the wellbeing of children worldwide. When using the term, you have to think of the physical, mental, and social health of children by emphasising on addressing the unique health challenges faced by them in different geographical, cultural and socioeconomic contexts.

It basically involves a broad range of areas and determinants of health and covers the effort to reduce the health inequalities – it covers preventive healthcare, nutrition, immunisation, infectious disease control, access to clean water, education, early childhood development, things related to maternal health, and most of the time, health politics and systems as well.

What got you interested in Global Child Health?

I think my interest began to develop around my 1st or 2nd year of medical school. During that time, our medical school had a program where we were assigned to various clinics to observe and become familiar with the hospital’s routine and clerking, history taking etc. in general. My observations took place mainly in internal medicine, where I had the chance to see many patients with diabetes, obesity, and heart failure… My medical school was the oldest in the country and located in the oldest part of Istanbul, so the population in that area and the patients coming to our hospital were primarily patients from socioeconomically disadvantaged backgrounds. Witnessing how these patients struggled to make lifestyle changes due to their economic circumstances and lack of education, and how their health did not improve significantly without proper preventive measures, deeply impacted me.

I remember one particularly striking moment on a placement was when the doctor running the clinic prescribed a patient the first line treatment, but the patient could not use it because they couldn’t afford it. This left the doctor speechless. And this was a moment that I will always remember, and what led me to thinking more about public and global health.

Furthermore, the time around the beginning of my med school coincided with the ongoing Syrian war, and the area of the city where I lived / studied had a large population of Syrian refugee communities. Observing the impact of the war on their lives, the inequalities they faced, and the impact on their health made me think about these issues a lot as well. I remember making readings about those issues especially around these times. 

 Then, the turning point was the summer break after my first year of medical school when I had the opportunity to attend an IFMSA International workshop on refugee health and rights.

Can you tell me more about your experiences with the IFMSA and other organisations?

My initial experience was with IFMSA – International Federation of Medical Students’ Association. I worked with them and took some international leadership positions (e.g. International Child Health Programme Coordinator), and ran the advocacy campaigns for child health all around the world with medical students. I also became one of their Human Rights Trainers and organised so many international workshops/sessions on Child Health and Rights for medical students all around the world, visiting many countries including Tanzania, Egypt, Austria and the US.

I then worked with some UN agencies for local projects in Turkey, mainly on delivering SRHR educational sessions to young refugee women. As a global lead for humanitarian affairs in UNMGCY, a youth-led organisation, I advocated for policy changes at the international level to support individuals affected by humanitarian crises.

During my medical school years again, I participated in an MSF project aimed at organising training sessions and improving a guide for health interpreters. The goal was to enhance their understanding of the healthcare system in Turkey.

While practising medicine on the border, I collaborated with CARE International, delivering various health-related sessions to young refugee groups.

How has your experiences impacted your clinical work and research?

My experiences definitely expanded my perspective and understanding of the social determinants of health.

I started considering not only the immediate medical needs of a child but also their social, economic, and environmental factors that influence their health.

Child health advocacy should emphasise the importance of preventive care and early intervention. It makes it your routine practice to cover all the potential circumstances, environmental factors that are making the child ill, and I started to consider all the potential measures that can be taken to prevent the child from becoming ill. I think it certainly made me put these important key aspects to my daily practice. For example, if a child comes down with a recurrent asthma attack, you can’t send them back home without considering the main question – what is actually making them so ill? – Is it the air pollution, smoking at home, parental lack of information on how to use medications etc. ?

It makes you see that individual perspective as well, and you easily start assessing each patient considering their unique socioeconomic circumstances.

It’s hard to find time for it, but when you do and try to be more holistic when talking to the patient or parents, there will be a couple of patients per month where you fell like you’re really making a difference.

On another note, I learnt so much from my experiences with leading workshops and training peers, and I still use the interactive methods in my teaching sessions today when leading journal sessions or delivering teaching sessions to medical students.

What are your future goals?

In terms of subspecialty, I am interested in community and endocrine, I will probably pursue a future career in those 2 subspecialties. Recently, I am really interested in childhood obesity, I think it is one of the most important public health issues.

The main thing I know is that I always want to advocate for global child health and equal access to healthcare services for every child, every individual.

Any advice for medical students and clinicians for getting more involved / aware of global health?

I think gaining that vision for global health, public health, and inequalities while studying medicine will really make a difference in your practice, and if you want to be a researcher, in your research as well.

I would say, if you are interested, the first advice I would give is just read about the inequalities, what global health means, what public health and social determinants of health means (see Useful Links below for suggestions!). Once you start learning and understanding, you will have a practice where you always keep those things in the back of your mind and have a holistic approach towards your patients.

The other thing might be, speak to the people who has similar interest, listen to their experiences and if you really want to do some work in that field, build up your own network. Email people. Attend conferences, courses – RCPCH has workshops during their conference! Youth led organisations might also be a good start. (See below for links!)

Useful links:

Marmot Review (2020) – a slightly long, but comprehensive read, about health equity in England: https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on

International Child Health Group Podcasts: https://www.internationalchildhealthgroup.org/podcasts

RCPCH Global Child Health: https://www.rcpch.ac.uk/work-we-do/global-child-health/our-approach-global-child-health

Webpages of organisations mentioned above:

IFMSA (International Federation of Medical Students Associations): https://ifmsa.org/

SRHR (Sexual and Reproductive Health and Rights): https://srhr.org/

UNMGCY (UN Major Group for Children and Youth): https://www.unmgcy.org/

MSF (Médecins Sans Frontières / Doctors Without Borders): https://www.msf.org/

CARE International: https://www.careinternational.org.uk/