CHAPTER 17

Global Health Sources

MEGAN VON ISENBURG AND MELLANYE LACKEY

The phrase global health refers to “health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions.”1 It is a relatively new label for international health and tropical medicine and includes several factors: an increased globalization in education, an “international connectedness,” a greater awareness of “common vulnerabilities” in communicable diseases, and a “discomfort” with health disparities in the disease burden of rich and poor countries.2 Further, different institutions define and contextualize global health to meet their own goals. For example, some institutions may stress the interdisciplinarity of research, or the inclusion of local communities to solve health disparities, while others may have a stronger clinical or educational focus.

Interest in global health is increasing, and global health academic programs, institutes, centers, and partnerships are on the rise. A review of accredited, MD-granting U.S. medical schools found that nearly half boast some kind of global health program or office, and this number is surely higher today than when the review was done five years ago.3 A recent count of members of the Consortium of Universities for Global Health includes seventy-four North American members and twenty-nine international (developing world) members.4 A new European association, the European Academic Global Health Alliance has fifty-five full, associate, or affiliated members with partnerships in seventy-one developing world countries.5

Librarians are supporting the growing number of students and faculty in global health subject areas in both traditional and innovative ways. Informally, our colleagues at academic health sciences libraries attest to more reference questions and consultation requests in global health topics. Librarians are also partnering with global health researchers through embedded librarianship, work on grants, service projects, and international partnerships.

In this chapter, we address considerations for providing global health reference services. We also describe reference sources for working with researchers and students who are teaching, studying, and researching global health issues in the developed world. Because of the growth of international partnerships between developed and developing world institutions, we highlight resources for working with researchers and information professionals in both the developed and developing worlds.

Providing Reference Services in Global Health Contexts

Librarians can support global health research, education, and clinical efforts in a number of ways, from locating a statistic for a paper to traveling with a medical mission team to international locations. Given the increasing need for transparency, accountability, and evaluation to demonstrate the value of libraries and librarians to an organization, it is critical to consider how to measure the success and impact of any service or interaction. Librarians may need to justify supporting reference questions from global patrons, as opposed to those from one’s home institution.

Supporting Global Health from the Home Institution

Virtual Reference Service

Many libraries have virtual reference services that include e-mail and chat reference. This service can also assist patrons who are traveling, even while the librarian remains at the home institution. Time differences may make synchronous reference assistance difficult, but e-mail can certainly bridge the divide. If synchronous reference service is possible, consider using Skype or Google Hangout for free or low-cost phone, video, and desktop sharing. Some institutions may have Elluminate or other technologies that they prefer to use because of firewall and security issues.

Librarians may also want to offer additional services such as free scanning of print articles or book chapters from the library collections to patrons who are working in the field and cannot access the library’s physical materials. The librarian could scan chapters or articles into a PDF which can be e-mailed to the user.

Measuring the success and impact of a virtual reference service for global health can follow the metrics for a library’s other reference services. Traditionally this includes statistics, but could also include patron testimonials. Be sure to clarify how services using new technologies, such as online synchronous desktop sharing, should be counted in statistics collection.

Subject Guides/​LibGuides

One of the most familiar ways in which librarians can simplify research for a group or specific discipline is to create a subject guide highlighting the most important and commonly used resources. In global health, subject guides should include key literature databases and statistical sources, and may also include information to support field research, such as research methodology or even language learning. The Health Sciences Library at the University of North Carolina at Chapel Hill has created a Global Health Toolkit (http://guides.lib.unc.edu/​globalhealthtoolkit). The toolkit focuses on supporting the research of faculty and students working in global settings with pointers to helpful databases, datasets, and selected resources by topic. The guide does list some free or low-cost resources for global partners without institutional access. The toolkit also highlights creative and innovative ways that librarians can partner with researchers to improve global health.

Additionally, subject guides can also support the international partners of the home institution. For example, at Duke University Medical Center Library, the “Global Health International Partners” subject guide (http://guides.mclibrary.duke.edu/​internationalpartners) highlights freely available resources (including most of those detailed in this chapter’s final section, Working with Health Librarians and Researchers in the Developing World). It features site-specific information for the largest partner projects, based on feedback from both Duke and international faculty. This guide seeks to decrease the digital divide when Duke faculty and students are working side by side in the field with their international partners who do not have access to the Duke library collections.

Subject guides offer Web analytics to enable librarians to monitor the number of page views, hits, broken links, and popular links. LibGuides software, available from Springshare, offers built-in statistics that can simplify measuring the impact of the guide. Although it may be difficult to establish what number of clicks constitutes a successful guide, tracking usage patterns and popular links can help librarians keep the guide relevant.

Outreach

Most reference librarians participate in outreach activities to their institutions or liaison groups. Outreach activities typically take the perspective of the patrons rather than the library and can include holding office hours outside the library, sending e-mail updates with discipline-specific library news or table of contents alerts, and participating in discipline-specific activities.

In global health, additional outreach opportunities may include joining institutional global health interest groups, volunteering in activities to send medical supplies overseas, and monitoring and sending out notice of funding opportunities. Major sources of global health research funding include the Fogarty International Center (http://www.fic.nih.gov/) at the National Institutes of Health, the Bill and Melinda Gates Foundation Global Libraries program (http://www.gatesfoundation.org/​libraries/​Pages/​global-libraries.aspx) or the Elsevier Foundation Innovative Libraries in Developing Countries (http://www.elsevierfoundation.org/​innovative-libraries).

Measuring the impact of outreach activities and virtual reference can be difficult. In addition to capturing simple metrics on numbers of e-mails sent, etc., one may also want to investigate whether outreach leads to increased consultations, instruction opportunities, new partnerships, or other requests for library help. A pre/​postsurvey of awareness of library services may enable some quantitative measurement of the outreach activities.

Purchasing Specialized Materials

Global health activities may benefit from the library’s selection and purchase of specialized collections of materials. For example, if the home institution develops a field site in a foreign country, there may be numerous faculty, staff, and students looking for language instruction books, CDs, or software. Books or other materials on specific cultures or about cultural diversity in general may also prove helpful to those working with international partners, whether home or abroad.

Global health resource collections can be evaluated for strength and utility of collection using similar methods to most other collections. Resources should be evaluated for currency, applicability to specific situations, cultural relevance, and usability to judge collection strength. These particular qualities are especially important if the physical collection consists largely of donated print or media materials, as it is very common for overenthusiastic donors to gift outdated or irrelevant books. Usability and utility can be evaluated by considering any print circulation or internal use, interlibrary loan or online usage statistics if available, and library user feedback. As global health collections can vary from being part of a large academic library in the developed world to small collections of books and pamphlets in a clinic in the developing world, useful and appropriate metrics will vary widely.

Pretravel Instruction

“Preflight” workshops for faculty, health-care practitioners, and students traveling internationally can preemptively solve many potential problems that patrons may encounter in the field. Workshops could include help on how to connect to the library’s resources from off campus and tips on searching for articles in the project’s research areas, if applicable. Librarians have also conducted specialized searches on very specific topics to give users PDFs of articles to save on their computers. Another option is to save PDFs in the cloud using document storage applications (like Dropbox.com which has offline usage options) before researchers go into the field. The advantage of saving PDFs in these spaces is that the researchers can still access them in locations with low or no Internet connectivity (or during long plane rides!).

Additionally, librarians can also offer information on HINARI, an online digital library available through the World Health Organization (WHO) to qualifying countries (described in 17.23), or other free resources mentioned in the next two sections of this chapter. This training allows the traveling patron to become something of an ambassador for the resources to which his or her international partners will have access.

Patrons planning international field work may also have questions about what vaccinations they need. This information could be part of a preflight workshop or provided to the departments or individuals as needed. Here are some recommended sites for this information:

The U.S. Centers for Disease Control (CDC) keeps an active list of travel vaccinations needed for visiting many countries. The page also addresses special health concerns such as pregnancy or traveling with children. An interactive map details vaccination requirements (http://wwwnc.cdc.gov/​travel/​page/​vaccinations.htm).

Vaccinations for travel abroad are available at specialized travel clinics. The CDC lists some (http://www.nc.cdc.gov/​travel/​page/​travel-clinics.htm), including these:

To evaluate these workshops, maintain attendance records and follow up with patrons after they return from the field to determine how the workshop helped them and what additional information they may need.

Supporting Global Health from the Field

Is there a role for librarians out in the field? Based on an increasing number of recent conference presentations from librarians who have participated in global health field work, our answer is, “Yes! There are many roles for librarians in the field.” Librarians have traveled with physicians to Uganda, Ghana, and other countries. While overseas, many librarians lead training sessions on HINARI, PubMed, or other databases and search portals. Taking the HINARI “Train the Trainers” online course offered by the Medical Library Association (MLA) and taught by Lenny Rhine is excellent preparation for teaching a HINARI session. Course materials and talking points are available (http://www.mlanet.org/​resources/​global/​lwb_trainthetrainers_ce.html) to help in getting started.

Librarians have also conducted information, education, and library needs assessments at international partner institutions. Findings of the assessments can suggest and help plan improvements for the institution’s library and knowledge management services if one exists. If a library does not exist, these assessments can help determine if a library should be established at the global site. The authors suggest taking an approach that recognizes the assets of the current environment such as appreciative inquiry or strengths-based assessment.

Connectivity

Continuous electricity may not be available in global health field sites. In sub-Saharan Africa, for example, only 24 percent of the population has access to electricity, and industry experiences an average of fifty-six days without electricity.6 Anecdotally, in Tanzania and Uganda, the authors have experienced daily brownouts where power was cut off regularly for several hours at a time. Political unrest can also impact the availability of electricity.

Similarly, Internet connectivity is not always available. WiFi access at institutions is sometimes accessible in common areas, such as libraries, but is dependent on electricity. Many individuals use USB modems to connect to the Internet, thus providing individual Internet access that runs off a laptop battery. This is a good solution for librarians working in the field, as it provides some computing and Internet access even when power and Internet are not available. These modems are available for purchase such that a certain number of gigabytes of data are available for a specific amount of money.

Apart from service disruptions, bandwidth is often low and variable, and that can result in delays to e-mails and lost connections during database searches. If planning to teach a session, it’s always a good idea to bring backup slides with screenshots as a potential substitute to conducting live searches. When we as librarians create subject guides with links to PDFs, streaming tutorials on how to search, or other dynamic content, we must accommodate for these limitations. PDFs can sometimes take hours to load. Drop-down boxes that fill in as users type may not auto fill when the connection is too slow. Streaming videos are often unusable altogether. Low-bandwidth alternatives include providing transcripts of the tutorials, simple HTML webpages, and links to HTML rather than PDFs if possible. IT specialists or librarians in partner countries may be able to recommend alternative formats that are suitable for low-bandwidth computing environments.

The following three websites can help when designing webpages for areas with low bandwidth: Web Design Guidelines (http://www.aptivate.org/​webguidelines/​Home.html) offers practical tips on how to make webpages more usable in low-bandwidth environments. The Web Page Analyzer (http://www.websiteoptimization.com/​services/​analyze) will calculate the size of a page and the sizes of specific components of a page. After it analyzes a page, the site will offer suggestions for improving the load time. Finally, the Low Bandwidth Simulator (http://www.loband.org/​loband/​simulator.jsp) will load a page at the same speed as it would in a low-bandwidth environment, then tell the amount of time the page took to load (in case one wasn’t keeping track). The wait can seem maddening, but it really helps to understand what users in low-bandwidth settings experience as they surf the Internet.

We speak broadly of connectivity issues here. Not all locations will have slow Internet connections. And, just because a site is not in the developed world, does not mean that it will not have fast Internet. Connectivity also varies between rural and urban settings.

Mobile devices, including feature phones, are on the rise in emerging markets, especially sub-Saharan Africa.7 Feature phones can send text messages and can connect to the Internet, but without the display touchscreen and expensive data plans of smartphones. Librarians might leverage the widespread use of feature phones to provide reference services via text. In fact, the Ask-a-Librarian service offered through Springshare’s LibGuides product offers a text service, helpful for answering users’ reference questions.

Time Zone Differences

Librarians who support global health researchers working in different time zones should expect time delays in responses to e-mails or text messages. For example, the end of the work day for researchers working in sub-Saharan Africa, India, or Asia may fall in the middle of the night or at the start of the day for a librarian in the Western Hemisphere. This may not be the case for librarians in Europe, nor for librarians in the Western Hemisphere supporting their users in South and Central America. Regardless of where the librarian works, he or she should be mindful of the time zones of the researcher and how that may affect communications.

Cultural Considerations

In the months and days leading up to a site visit in another country, there are many tasks to complete. We highly recommend that all travelers take time to educate themselves about some of the cultural practices and courtesies of the places they will visit.

In fact, a very useful role of the librarian is to collect information about the culture of the place where the team will visit. Knowing about the place, the habits, and the motivations of a group of people can impact the success of conversations and collaborations. Seemingly simple questions such as, “What do you specifically need from us?” and “Can you show me how your group has spent the money from the grant?” may offend, fall flat, and cause misunderstandings between the parties. Time spent learning about the cultural practices of a place can greatly boost the potential for success of a project.

Resources for Global Health Information and Research

This section details some of the resources that include global health or international health information. The list includes peer-reviewed, scholarly databases, datasets and statistical sources, and grey literature sources.

Scholarly, Peer-Reviewed Databases

Global Health is a public health database containing information from serials, books, conferences, patents, theses, and electronic publications from more than 150 countries. Subject coverage includes international health, biomedical life sciences, noncommunicable diseases, public health nutrition, food safety and hygiene, occupational health, toxicology, health services, and maternal/​child health. This database offers global coverage of both the developing and developed world with more than fifty languages translated into English. (Subscription)

Global Health Archive is fully compatible with the Global Health database (see 17.1) and can be searched alongside it for records from 1910 to the present day. Together they provide a global, historical picture of international health research. (Subscription)

MEDLINE offers access to high-quality health research. MEDLINE is a bibliographic database with citations and links to an ever-increasing number of full-text articles in a variety of subjects, including global health. Citations may include links to full-text content from PubMed Central and/​or publisher websites. (Free or subscription, depending on vendor)

Embase is strong in a variety of health topics including drug research, public health, and clinical medicine, among others. Some content in Embase overlaps with that in MEDLINE, but Embase does contain about 30 percent unique material. The advanced search option allows users to eliminate MEDLINE-only records, reducing the number of duplicates. (Subscription)

All of the previous databases use controlled vocabularies and subject thesauri to assist searchers in finding information. Help using these thesauri is available from each database.

Stay updated, free articles. Join our Telegram channel

Join