Joseph Kolars, M.D.

Scott Soderberg, U-M Photo Services

 Michigan Answers

Full Circle

Medical missions, educational resources online, international research collaborations and cooperative clinical trials — globalism can take many forms, often with benefit right here at home. Joseph Kolars, M.D. (Fellowship 1989), the Medical School’s first senior associate dean for education and global initiatives, provides a big-picture look at a burgeoning trend among universities throughout the United States.

Q: What is globalism in today’s academic medical context?

A: Globalism as it relates to medicine and medical education concerns itself with improving health and achieving equity for all people worldwide. A lot of global health issues pertain to us in southeast Michigan by virtue of the fact that we have people from all over the world traveling here, living among us, enriching our communities. In turn, I believe that we’ll learn lessons that will help us to provide better care here in the United States.

Q: What is the spectrum of global activities the Health System and University are involved in?

A: The activities really cover the three big missions of research, education and service. A large number of research collaborations are growing between our faculty and faculty around the world; these are to mutual benefit. We recently went on an academic mission to China where we’re trying to forge collaborations. There’s tremendous interest among our students, residents, fellows, faculty and staff in learning and research and service experiences in other parts of the world. We want to help strengthen health care overseas so those countries can better serve their own communities.

Q: Are we a leader in globalism among higher education institutions?

A: Just about every institution is developing their global thrust; it’s very popular among universities right now. By virtue of the strength of our institution and our commitment in this area, we’re very much a global leader. Students today see that working globally is able to inform what we’re doing locally, and they want to be part of that process, they don’t want to be provincial and isolated. So a lot of the best students are attracted to institutions that are embracing global initiatives. It’s the same for our faculty and staff. We are a leader as an academic institution, so we see a duty to share that with other places. How can we partner and help strengthen them? In turn, I believe that we’ll learn lessons that will help us to provide better care here in the United States.

Q: What are the goals, short-term and long?

A: We’re trying to create growth opportunities for our own faculty and trainees, and to be a good global citizen. By strengthening the globe we strengthen ourselves. If we can use health as something that crosses boundaries, we can try to improve the economy of other places that can hopefully have a benefit to Michigan. Michigan as we know is very dependent on the global economy. When we’re looking at things as diverse as climate change, the impact of energy production, or epidemics, it’s very important to be part of the community that’s wrestling with these issues. We consider this to be a valuable academic and scholarly pursuit. It’s not just a fringe item, it’s pretty central to our values.

Q: Are there those who say “We need to care for our own; we can’t be saving the world,” and if so, what do you say to them?

A: We do have a duty to the people of Michigan, and we always have to keep that in the forefront. How can we pursue and invest in global health in a way that presents a value proposition to be doing this for the economy of Michigan? That’s very important to us, and that’s part of globalism.

By going into environments like Ghana or China, we get to see what the problem or opportunity is and how we can collaborate on a new structure to address that. It’s a bit of a green field — we don’t have to deconstruct silos, which is what we often have to do in our own environment. There’s a lot of danger in taking our way of doing things and saying this is what works. I think what particularly distinguishes our global approach is that we’re establishing charters of collaboration, in effect saying how can we set up a new way of approaching this?

Q: What determines which countries and foreign institutions we work with?

A: Because we’re an academic community, our collaborations are based on connections that faculty have with people in different settings, either because of their scholarly interests, research, education, or just personal ties to their home countries. Some of these evolve into multidimensional programs that extend beyond just one faculty member or one lab. We look at those almost as platforms. Some come together just out of convenience because of the strength of what started off as an individual collaboration.

One of the problems with international collaboration can be that people from other parts of the world come to train here and they don’t go back. I’ve never met anyone that didn’t intend to go back home, but our educational environment is very context-specific — after you spend three to five years here, you’re not trained to practice in the environment back home. This has contributed to a huge brain drain, depleting the most important resources for a lot of developing countries. Our ob/gyn department under Tim Johnson has reversed that, going to Ghana to train people. They’ve trained over 40 ob/gyns; all but one has stayed in Ghana. We also have people coming here but our success is measured not by what we do for people here, but what we’re doing for Ghana through training people there. The next step is for us to consider having one of our main courses or core rotations for medical students in Ghana. This would be the first time an institution has done that. Some of these learning opportunities we’re looking at in Ghana are becoming scarcer here, so it’s providing us a classroom venue that frankly we’re struggling to get in Michigan right now. Another thing that’s really challenging in the U.S. right now is identifying cohorts of patients to enroll in clinical trials to tackle some of the big questions. One of the resources that China has is quite a few patients just by virtue of their population, but they don’t have the depth and breadth of clinical research that they desire. They’re not used to doing clinical trials. They want to learn how to be able to do that. So there’s a nice marriage of goals. There’s a lot of ways to do this wrong. Places can go in and be exploitative, and say we just want to use your population to answer our questions. That’s the wrong approach, that’s not something that’s within the value system of the U-M. But because of these collaborations which are coalescing, China will be another of our platforms. Again it’s the coalescence of individual collaborations that are already taking place that we’re excited about.

Interview by Rick Krupinski