Letters to the Editor  |   June 2013
Author Affiliations
  • Sidney Coupet, DO, MPH, MSc
    Founder and Chief Executive Director, Doctors United For Haiti, Robert Wood Johnson Foundation Clinical Scholar, Department of Internal Medicine, University of Michigan, Ann Arbor
Article Information
Imaging / Medical Education / Osteopathic Manipulative Treatment / Graduate Medical Education
Letters to the Editor   |   June 2013
The Journal of the American Osteopathic Association, June 2013, Vol. 113, 448-449. doi:
The Journal of the American Osteopathic Association, June 2013, Vol. 113, 448-449. doi:
I appreciate the evaluation1 by Zachary Comeaux, DO, of my December 2012 article on strengthening graduate medical education through the use of international health electives (IHEs).2 I want to thank Dr Comeaux both for his comments and for his dedication to his vision of merging IHEs with opportunities for exposure to international osteopathy. However, I believe that to build a global understanding of osteopathic medicine, US-trained osteopathic physicians will be required to become players in global health through actively participating in the delivery of international health care services, academia, and policy making. 
Osteopathic physicians trained in the United States have integrated osteopathic manipulative treatment (OMT) into westernized medical practices, which have become the framework for the delivery of osteopathic medicine. When US-trained osteopathic physicians, residents, and medical students volunteer for international medical missions and rotations, they expose the international community to OMT, thereby shaping the osteopathic medical profession in a global context. These osteopathic physicians practice within their specialties while incorporating osteopathic principles and practices. I believe that practicing in low-resource countries such as Haiti has the potential to bring the osteopathic palpatory techniques of our physicians to the forefront. Because access to expensive imaging modalities and advanced therapeutics is limited in such countries, US-trained osteopathic physicians have the opportunity to revisit the diagnostic and therapeutic advantages offered by OMT. Participation in international health care workforce capacity-building programs such as Doctors United For Haiti offers US-trained osteopathic physicians just such an opportunity.3 
Academic approaches (including teaching and research) will also help develop a better understanding of our practice of osteopathic medicine in international settings and establish new opportunities for expansion of the osteopathic medical profession. In my view, in a predominantly agrarian country like Haiti the use of OMT has potential not only as a diagnostic and therapeutic intervention but also as a means of building trust among Haitians. Because of their traditional ethnomedical practices, Haitians may be more willing to work with westernized medical practitioners who are using the laying-of-the-hands (high-touch) approach of OMT.4 I believe that these benefits of OMT reinforce the need for US-trained osteopathic physicians to be leaders on the front lines toward improving health care in developing countries like Haiti around the world. For some, this stance may be a bit of a leap; however, I believe that with appropriate academic support and financing, we can build an osteopathic medical school in Haiti, with the goal of establishing this school as a research institution. Haiti would be a favorable site for such a project in light of the ethnomedical beliefs of its inhabitants and its proximity to the United States. 
Involvement of US-trained osteopathic physicians in developing inter national health policy is paramount. The Institute of International Health at the Michigan State University College of Osteopathic Medicine is currently supporting this vision of global involvement by developing an IHE in the city of Mérida in the Yucatán state in Mexico. After diligently studying the Yucatán population, the Institute of International Health identified an urgent need to establish a department of OMT in a training hospital in Mérida. The local government and the Yucatán State Department of Health have provided strong support for this initiative. In a joint effort, the Michigan State University College of Osteopathic Medicine and the American Osteopathic Association were able to secure medical licensing rights for US-trained osteopathic physicians who wish to practice osteopathic medicine in the state of Yucatán. The IHE currently is in the first phase of development, with the Michigan State University College of Osteopathic Medicine working to establish a permanent osteopathic medical clinic, both to serve the health care needs of the people of Yucatán and to provide clinical training to US osteopathic medical school undergraduates and postgraduates. If this IHE is established successfully, it can serve as a model for developing similar initiatives in other countries around the world. 
Although Dr Comeaux's recommendation to merge IHEs with opportunities for exposure to the international osteopathic medical profession could impact our professional identity on a global scale, I believe that it is only through the actions of osteopathic physicians in global health through the delivery of international health care services, academia, and policy making that we will help enhance the global reputation of osteopathic medicine. 
Comeaux Z. International health electives: strengthening graduate medical education [letter]. J Am Osteopath Assoc. 2013;113(6):446-447. [PubMed]
Coupet SC. International health electives: strengthening graduate medical education. J Am Osteopath Assoc. 2012;112(12):800-804. [PubMed]
Coupet S, Nassiri R, Aliu O, Coppola C. A long term building capacity model that prepares for effective disaster relief. Int J Disaster Risk Reduction. 2013;4(6):10-14. doi:10.1016/j.ijdrr.2013.02.003. [CrossRef]
Coupet S, Howell JD, Ross-Lee B. An international health elective in Haiti: a case for osteopathic medicine. J Am Osteopath Assoc. 2013;113(6):484-489. [PubMed]