From Tourism to Solidarity

Abstract

Background and Problem Statement:

As Erasmus MC develops the ErasmusArts 2030 curriculum, the institution faces an ethical challenge regarding the international student exchange program. It is currently viewed as a tool to encourage global citizenship. But, the current model of internationalisation is filled with systemic inequities. This advisory report identifies three major failures in the current approach.

1. The persistence of colonial power dynamics, where the Global North extracts learning experience at the cost of the Global South without giving back.
2. The medical emission paradox. The amount of travel we do to support our current model contributes significantly to the climate crisis which disproportionately harms our host communities.
3. A lack of reciprocity. In the current model, an exchange is a privilege reserved for wealthy students from the Global North.

Analysis:

Based on personal experience and academic literature, this report analyzes how the current practices perpetuate ‘epistemic injustice.’ By prioritizing the learning goals of Dutch students over the needs of our host institutions. While failing to recognize local knowledge as equal to Global North medicine. The current system reinforces historical power asymmetries. Furthermore, the carbon footprint of the current International Student Exchange Program is no longer compatible with the principles of Planetary Health.

Advice and Recommendations:

To align the new curriculum with the values of equity with our Global South partners and sustainability, the Committee on Internationalisation advises the board to transition from a model of ‘tourism’ to a model of ‘solidarity.’ The advice is structured into two tiers:

1. Sustainability and Equitability Framework:

• Institutionalize Reciprocity: Replace short visits with three plus months visits and establish a Global Health Advisory Board with veto power for our Global South partners to ensure collaborative decision making.
• Climate responsibility: Implement a ‘carbon budget’ to limit unnecessary travel and invest in local carbon offsetting projects in host countries for all necessary air travel.
• Reciprocal funding: Establish a ‘Reciprocal Exchange Fund’ to cover all costs for incoming Global South students and teachers. This will eliminate the financial barriers for bi-directional exchange.

1. Restructuring the International Student Exchange Program:

• Phase 1 virtual & inclusive: Implement mandatory Collaborative Online International Learning (COIL) assignments and a ‘Global Classroom’ taught by Global South doctors. This ensures all students gain global competence without flying.
• Phase 2 Selective Physical Exchange: Reserve physical exchanges for selected, well-prepared students for longer durations (3+ months) in order to ensure meaningful contribution and cultural integration.
• Local Alternative: Create a ‘Global is Local’ internship course within Rotterdam's diverse communities for students who can not travel.

Conclusion:

By adopting these structural reforms for the new international student exchange program, Erasmus MC can become a leader in decolonized, sustainable Global Health Education and make sure that the doctors of ErasmusArts 2030 are trained in true partnership with the world, while sustaining the environment.

Introduction

As the ErasmusArts 2030 curriculum is being developed, we are faced with a difficult question: Does our current way of teaching Global Health Education and our current model of internationalisation still align with our values? Student exchanges are often immediately seen as beneficial in the Global North, because they tend to promote ‘’global citizenship’’ and cultural competence; these types of exchanges are also often looked at and marketed to students as an exotic vacation. However, in the context of ‘’decolonizing global health’’ and the climate crisis, we should look at these exchanges more critically than before. Are we actually helping the Global South, or are continuing with a program that is benefiting us at their expense?

Global Health education shows power imbalances, I experienced this first hand when I visited Polokwane, South Africa. At the end of the day I was the major winner in terms of what knowledge and experiences I gained from my exchange program, while the students and doctors in Polokwane gained very little from me being there. My experience is also not unique, admission criteria favour students from high income countries, and student practicums can cause unintended harm in low- and middle-income countries (1).

We also need to talk about ‘community harms.’ This is a concept where medical students often practice medicine in a way that is beyond their current training in the host country. Because of the short period of stay, they have limited oversight of the care they provided or to evaluate the outcomes of their procedures. These ethical violations have the potential to cause immense harm to the host communities and institutions (2).

Furthermore, reciprocity is almost non-existent, the student exchanges are almost always one-directional because of an unequal access to resources and/ or opportunities for students from the Global South to visit the Global North. At last, all the flying needed to get all these students to these developing countries also affects climate change negatively (3).

This introduction outlines the three main problems within Global Health Education that need solving: The colonial dynamic of our partnerships, The environmental impact of travelling, and the systemic lack of reciprocity that makes the current system a "one-way street’’.

3.1 ErasmusArts2030: Why restructure now?

Why are we having this conversation now? The revision of the ErasmusArts2030 curriculum is happening right after a period where the COVID-19 pandemic took away the illusion of equality in Global Health. It showed us that while diseases might be global, the power to make decisions and the access to resources - like vaccines - remains strongly in the Global North (4).

Furthermore, nowadays we see universities everywhere making statements about diversity and inclusion, but we must be careful. Khan et al. warn us about ‘’virtue signaling’’ which is making statements without actually changing the underlying structures. If Erasmus MC were to just simply ‘rebrand’ the current Minor Global Health Exchange program, without actually restructuring it, we will be engaging in what Khan calls ‘rhetoric without reform’ (5). We can not just say we are decolonizing, we have to carefully restructure how money, people and power move.

3.2 The Colonial Legacy and Power Asymmetries

We cannot discuss Global Health further without talking about its history. Global Health did not just appear one day, it arose from colonial medicine (6). Colonial medicine was originally a system designed to protect the colonizer by bringing Global North healthcare systems to a Global South colonized country. The health of the colonizing population was almost always prioritized over that of the local population and it was frequently used to classify people into racial categories or run new vaccine experiments (7).

And while we might think those days are over, the structures that were created during those times are still here. Abimbola et al. describe these as ’power asymmetries.’ Unwritten rules that decide who gets to be the teacher and who has to be the learner. Till this day the route is still almost always from the Global North to the Global South (4). This creates a systemic issue described as ‘epistemic injustice.’ Epistemic injustice is subdivided into ‘testimonial injustice’, where the knowledge from the Global South is given less importance, just because of who they are. Secondly, there is ‘’interpretive injustice,’’ this happens when individuals struggle to make sense of and share their experience of the world (8). If we keep sending students to these Global South countries without educating them thoroughly or without changing this system, we keep perpetuating this power asymmetry.

3.3 Planetary Health vs Global Health

We are facing a conflict between our goals, an almost paradoxical dilemma. We cannot claim to support Global Health if we are not thinking about the environment and actively undermining Planetary Health. Currently we are flying thousands of exchange students (mostly from the Global North) around the globe for Global Health to learn about health equity. This negatively influences the climate crisis, and Global South countries are disproportionately affected by this crisis (9).

A single economy class flight for a normal exchange can emit up to 1130kg of Co2, and if you include non Co2 effects this number nearly doubles. To put this number into perspective: The sustainable annual emission budget is around 1610kg per person (3). This means that a single student exchange flight can take up their entire carbon dioxide emission budget for the year. This creates a paradox where we are attempting to improve Global Health globally, but in the process we are damaging the environment Human Health depends on.

3.4 Reciprocity and the ‘One-way street’

Finally, we have to discuss equality. At the moment our exchanges are a ‘one-way street.’ The Global North goes to the Global South, but it's rare for students from the Global South to visit the Global North. Structural barriers make true reciprocity almost impossible with our current system. These barriers consist of, among others: scholarships that are only available to High income country (HIC) students (Like Erasmus MC grant), stricter visa requirements that make traveling from the Global South to the Global North harder, and a fear of ‘brain drain’ if more students from the Global South were to visit the Global North. Brain drain especially could have negative effects on the country of origin of the student (10).

Furthermore, students who participate in these types of exchange programs are often already privileged. Admission criteria tend to favor students who have previous international experience, which is something that is only available to wealthy students (1). This entire system in its current form, makes it nearly impossible for things to change, and thus Global Health Exchanges will (without change) stay only available to privileged students from the Global North.

3.5 Why do we still do Global Health Exchanges?

With all this criticism you have just read, you might be wondering: why do we still do exchanges at all? It is important to tell you that these exchanges are really beneficial for the student. Multiple systematic reviews by Jeffrey et al. (2011), Thompson et al. (2003), and Mutchnick et al. (2003) conclude that students who went abroad will develop a better cultural competence, and improved clinical examination skills because they are taught to rely less on technology like lab tests. Statistically they are also more likely to pursue a career in primary care and work with underserved populations (11-13).

However, we believe that currently these individual benefits do not outweigh the systemic costs on Global South countries, and our planet. We can also not keep supporting the inequality the current system is creating. We can not continue to prioritize our (Global North) learning at the expense of the Global South.

3.6 Structure of this advisory report

In this advisory report you are about to read, We will first report more thoroughly on sustainability and fairness issues of the current model, We will explain why the current situation is no longer sustainable and fundamental changes are needed. After that we will present a proposal for a reimagined exchange program for ErasmusArts 2030. This model will prioritize virtual exchanges and true reciprocity. This will allow us to keep the valuable learning experience for our students, while cracking down on colonial and environmental wrongs in the current exchange program.

Advisory Report

As chair of the committee of internationalisation, my advice to the board is centered around one fundamental change: Moving from the current model of ‘’charity and tourism’’ to a model of ‘’solidarity and partnership.’’ This advisory report will detail our recommendations for a sustainable, equitable and reciprocal future of the Minor Global Health Exchange program. The report will address the three main problems outlined in the introduction: The colonial dynamic, the climate paradox, and the lack of reciprocity. To meet these ambitious goals for ErasmusArts 2030 we must make deep structural reforms.

4.1 Sustainability and Equitability: The Foundation of Reforming Global Health Exchange programs.

Before proposing the new structure of the Minor Global Health exchange program, we must first know why the current model is unsustainable, not only environmentally speaking, but also ethically. We cannot simply slightly tweak the current model, we must rebuild it on a strong foundation of equity and justice for the Global North and especially for the Global South. This requires a critical re-evaluation of resource allocation and institutional priorities.

4.1.1 Dismantling the "White Savior" Complex Through Structural Change

The first step in reimagining our current approach is acknowledging that our current approach is described as a ‘white savior’ mentality. Where students intervene in the host country to ‘fix’ problems without them knowing or discovering the root causes of these problems while they are there (14). We also can not blame the individual student for having this mindset, but rather the structure of our current exchange program. It is prioritizing the learning needs of the student rather than the needs of the host country. As I stated in the introduction regarding my time in Polokwane, students often leave as ‘winners’, while the host country gains very little. This current system almost mirrors colonial medicine, except now we are taking clinical experience instead of minerals.

In order to solve this ‘white savior’ mentality, Erasmus MC must commit to long-term, bidirectional partnerships instead of short-term, non reciprocal visits.

Recommendation: institutionalising partnerships: The minor Global Health Exchange program should end exchanges where a student visits for a few weeks with little preparation to the specific situation they will find themselves in. Instead, partnerships should be based on a formal multi-year Memoranda of Understanding (MoUs). This is a more formal version of a ‘gentleman's agreement’, where we will define that the host institution can decide on the learning objectives and the unique benefits that our students will receive. An ethical partnership requires the host institution to have an equal say in who visits, when they visit, and what they will do (10). This means asking our partners: ‘What do you need from us?’ instead of telling them ‘this is what we want to learn.’ These MoUs should clearly state the mutual benefits and responsibilities, ensuring that the content serves the goals of both institutions, not just Erasmus MC.

Recommendation: Joint Governance: We propose creating a ‘Global Health Advisory board’ for ErasmusArts2030 that includes representatives of all our partner institutions in the Global South. This board would hold veto power over new exchange initiatives. This way we ensure that no program is implemented without specific approval and input from institutions affected by the new initiative. This directly addresses and aims to resolve the ‘asymmetry in power and control’ (6). This board should hold quarterly meetings to review program outcomes, address problems, and set strategic directions.

4.1.2 The climate crisis: A Carbon Budget and Offset for Education

We cannot ignore the data emissions in the new Global Health Exchange program. A single typical exchange flight will consume the individual's sustainable carbon budget for an entire year (3). Therefore, unlimited mobility is no longer a sustainable education strategy. If we claim to care about Global Health we must care about Planetary Health undermining it. The communities we visit are often the ones most vulnerable to the climate change we are accelerating (9). Continuing with business as usual would be a form of environmental injustice.

Recommendation: Implementing a ‘Carbon budget’ model: We propose implementing a carbon budget for the Global Health Exchange program. This means we will have to limit the total amount of physical exchanges we can do per year. Travelling will no longer be a privilege for every student attending the exchange program, but a privilege only granted if physical exchange is necessary to achieve a specific learning outcome. This way we will only send out students to learn (for example) specific tropical clinical medicine skills, instead of general observation. This budget must be in line with the international climate goals as established by the Paris agreement (15). If for whatever reason the Minor Global Health Exchange program were to exceed their carbon budget, they must invest in high-quality offset programs or reduce travel in the following year.

Recommendation: Offsetting our emissions: Furthermore, for every single exchange we do allow. We advise the board to invest in a carbon-offsetting project within the host country. Preferably chosen by local communities or municipalities. This way we will ensure that the climate change acceleration we are causing is directly offset and benefits the countries that are affected the worst (9). These local investments could consist of, but are not limited to: solar panels for a partner institution, reforestation programs in the region where our students are guests, or funding for improving climate resilience. Offsetting our emissions this way will turn a ‘guilt tax’ into a system that promotes direct support and solidarity with our partner institutions from the Global South.

4.1.3 Breaking Down the ‘One-Way Street’

Funding and visa restrictions are the primary barriers to reciprocity (10). At the moment, Dutch students can usually easily go to Global South countries like Tanzania, Indonesia, etc. But students from these countries face these huge barriers to come visit Rotterdam. This is no longer acceptable for an institution that claims equality. It creates a dynamic where knowledge only flows one way. This is reinforcing ‘epistemic injustice’ (8) which has already been discussed in the introduction.

Recommendation: A ‘Reciprocal Exchange Fund’: We advise to establish a reciprocal exchange fund. For every Erasmus student we send abroad, we should allocate funding for a student or staff member from the host institution to come to Rotterdam. This funding must be comprehensive and cover almost all costs, because of the extremely high financial barrier. The funding should cover: Travel, housing, visa application fees, insurance and a budget to cover the minimal costs of living in the Netherlands. This way we will directly address the financial problems (1) that prevent talented, but less wealthy students from the global south from visiting. This fund should be protected from budget cuts and treated as one of the most important operational costs of the Minor Global Health Exchange program.

Recommendation: Visa Advocacy: Structural barriers like visas are cited as a reason why reciprocity is difficult (10). Erasmus MC, as a leading institution, must advocate at the Ministry of foreign affairs together with other Dutch universities running exchange programs in order to make student visas more accessible for students from Global South institutions we have good long-term relations with. This way we will streamline the entry process for students from the Global South. Furthermore, we should provide legal and administrative support for our incoming colleagues. This will remove the burden from them, and smoothen out the application process even more since it will be handled by professionals.

4.2 The New International Student Exchange Program for ErasmusArts 2030

Based on the above principles of sustainability and equity, we propose a radical restructuring of the exchange program. We will move away from the idea that every student will need to travel physically in order to complete the program and become a ‘global citizen’. We propose a new model for the minor that consists of two phases. One that prioritizes specialisation over generalisation. The phased model will make Global Health Education accessible to every student, but it will reserve physical travelling for a small group of students who are best prepared to engage ethically and effectively in the host country.

4.2.1 Phase 1: Virtual Exchange and Internationalisation at Home

The most sustainable and inclusive way to teach Global Health, is to bring the world to Erasmus MC instead of Erasmus MC to the world. This phase will ensure that every ErasmusArts 2030 student in the Minor Global Health Exchange program will gain global competence, not just the few that will travel in later phases. This goal will be achieved by the following two implementations:

Collaborative Online International Learning (COIL):

In the new curriculum we will implement mandatory COIL modules for students. It is important to mention that COIL is different from regular virtual exchange or online courses. COIL is an ‘’inclusive, environmentally friendly teaching and learning method... in which educators from different educational institutions in different countries connect to co-design and co-facilitate collaborative online learning assignments’’ (16). Unlike regular online learning, COIL requires positive social independence. This means students must collaborate with each other to succeed in their assignment, they cannot complete assignments individually (16). This will force meaningful interaction between international students, instead of them working parallel on the same assignment.

It is important that the COIL course will be designed according to three foundational pillars:

1. Co-design: The COIL courses must be created together with Erasmus MC and our international Global South partners, to ensure equal academic weight.
2. Embedded in the Curriculum: It must be a core, graded part of the curriculum, not an optional extra.
3. Collaborative focus: The COIL module must contain assignments that require negotiation and teamwork for our students with the Global South and vice versa. This is to build intercultural competence. (16)

An example of a COIL designed assignment: Infectious disease management:

Students from Erasmus MC and the Global South will present a joint case, Erasmus students will talk about high-tech diagnostic capabilities available in Rotterdam. On the other hand, students from the Global South will share their expertise on bedside diagnosis, clinical presentation and working without advanced labs. This assignment will create mutual respect for these different types of knowledge.

Creating a Global Classroom:

We will invite doctors from our Global South partners to teach lectures in the new program, virtually or in person (funded by the reciprocal exchange fund). This way we directly address the epistemic injustice (8), by centering expertise from the Global South in our mandatory classes. Our students will no longer learn about tropical diseases from Global North doctors or Dutch textbooks, but rather from doctors who diagnose and treat these diseases every day. This will expose students to diverse perspectives, not available from Global North doctors.

For the lectures we will be teaching our students, we should choose lecturers from the most problematic country regarding the specific disease or problem. These doctors will be treating the diseases the most often and will likely have the most expertise. South African partners can teach the lectures about HIV and TBC, while we should look at countries like Nigeria for lectures about malaria.

4.2.2 Phase 2: Selective Physical Exchange

Physical exchanges will still exist in the new Minor Global Health exchange program. But they will be fewer, longer and 100% reciprocal. We will redefine the exchange as a ‘fun trip’ to an ‘earned placement.’ This change is crucial to minimize the burden for the host institutions and maximize the learning impact for our students. We will achieve this by implementing selection criteria for traveling, increasing the duration of stay, mandatory pre-departure training, and by offering an alternative to students who do not qualify for physical exchange.

Selection criteria:

Admission for physical exchange will no longer be based on who can afford to travel. This directly addresses the current issue, where only privileged students get access to travel and participate in these types of exchanges (1). A selection process will be developed, where students can apply through a standardized application process. In this application, students will be rated based on their participation and grades in phase one, a motivation letter, an interview, and a review of the students academic record and extracurricular activities.

These selection criteria will be transparent and publicly available.

Furthermore, we should provide grants to students from low-income backgrounds to ensure equitable access for students.

Duration of stay:

We will get rid of the current short 6-7 week stay because these often cause more disruption than benefit to the host institution (1). The new exchange program should last at least 3 months (ideally 4 to 6). This will allow students to integrate in the local community and contribute meaningfully, it also carries the advantage of minimizing the carbon cost per day ratio. This longer placement in one place will allow students to not only adjust culturally, but also allow them to understand the complexities of the health system.

Mandatory pre-departure training:

After selection, if students are qualified to travel. They will first have to follow courses on the history of colonial medicine, ethical dilemmas, and cultural differences. This way we will address the ‘pre-departure training gaps’ identified by Kalbarczyk et al. (17). The new program will also include country specific language lessons and lessons on recognizing your own bias. This way we will ensure that students visiting the Global South will enter not as ‘white saviors’ but rather as learners who understand their position. This training will also be assessed and graded, if students do not end up meeting a certain standard they will be prohibited from traveling. This final assessment can be performed with a reflection essay or an exam.

4.2.3 What do we do with Students who Don't Qualify for a Physical Exchange?

Not every student will be able to travel in the new program, due to the carbon emission budget and the selection process. However, we must make sure that these students still have a way of completing their Minor without traveling. This will be made possible by organizing internships with certain institutions within the Netherlands. We will start using the ‘Global is local (18)’ concept for these students. As you might know, Rotterdam is a super-diverse city with significant migrant and refugee populations who face specific health challenges, often ones mirroring the diseases we see in the Global South. In 2025 there are a total of about 298.000 people living in Rotterdam with a country of origin outside of Europe. To put that into perspective, there are about 289.000 native Dutch people living in Rotterdam (19). This means that there are more than enough opportunities to bring students in contact with patients from all over the world here in Rotterdam.

We will establish connections with Asylum Seeker Centers (AZCs), local community health centers in diverse neighborhoods like Rotterdam-Zuid and with NGOs who work with undocumented immigrants (like ASKV). Students can complete their ‘exchange’ here in Rotterdam. They will still face the same issues students who do get to go on a ‘real’ exchange will face, like cultural and language barriers. And even the social determinants of healthcare. This program will be set up for students in a way that it will give a learning experience just as valuable as going abroad.

This program will have the same academic value as the program the students who do go abroad take. Students will still have to complete mandatory ‘Global Health’ training, (which is the same as Pre-Departure Training) to understand the context of migration and equity for the patients they will be seeing in Rotterdam.

This way we ensure that students who do not get to travel due to financial, personal or selection reasons, are not marginalized and still get to engage with Global Health challenges right here in Rotterdam.

4.2.4 Welcoming Global South Students in Rotterdam

The true measure of the success of the new Minor Global Health exchange program will be in how well we host the students that visit us. This means helping international students with housing, clinical integration and social integration.

Housing and support:

We need to make sure that we have affordable housing reserved. Lack of housing is often a dealbreaker for students to start an international exchange program. Erasmus University is already running a housing exchange program for temporary international students in collaboration with platforms like SSH and Roomplaza. But this is not enough, according to the same web page: ‘’Important to know is that student housing in the Netherlands is not arranged for you by the university. This is your own responsibility. We strongly advise you to plan ahead and start looking at least 3 months before arrival. Most of our students find their student home on the private market’’ (20).

The Board of the Erasmus MC Faculty of Medicine must start lobbying at the Executive Board of Erasmus University in order to have Erasmus University reserve a certain number of rooms for international medical exchange students.

Furthermore, we must establish a buddy system: Every exchange student we host, will be coupled to a Global health student who did not go abroad. They will support the incoming students with navigating Rotterdam and Dutch culture. This system also combats isolation because the international student will be able to build a network of friends and colleagues with their buddy, instead of having to try alone in a foreign country.

Clinical integration:

Every incoming student will be paired with an intern (co-assistent in Dutch) who preferably has completed the Minor Global Health in previous years. The role of the intern will be to act as a cultural and language bridge between the patient/ doctor and the international student. He will translate during rounds, explain Dutch hospital structure and hierarchy, and ensure that the international student feels welcome in the hospital. The advantage for the Dutch intern will be that he practices leadership and gets to learn about a different culture.

This means that the international student will follow the same program as a Dutch intern. They can take histories with the intern translating, and propose differential diagnoses during meetings.

Each incoming student will also be assigned a senior doctor or staff member as a mentor. The mentor will be responsible for the students' learning goals, and facilitate their integration into department meetings like journal clubs or research meetings.

Social integration:

We must organize regular social events for our international students to ensure they feel part of the Erasmus faculty of medicine community instead of visitors. These events will allow for cultural exchange between students beyond the clinical setting.

These events will be held at a wide variety of places in Rotterdam. It is important that these events are also available to our Global Health students who did not get to go abroad. This way they will still be exchanging information and learning from students from the Global South. Events should widely vary from typical Dutch sports like field hockey to dinners and having nights out. This way there is always something fun for everyone.

MAIN CONCLUSIONS & RECOMMENDATIONS

The revision of the ErasmusArts 2030 curriculum presents Erasmus MC with a choice. We can continue with our current model that, despite good intentions, perpetuates colonial dynamics, accelerates the climate crisis, and privileges few at the cost of many. Or, we can choose a harder, but just path of decolonization, sustainability, and true partnership.

This advisory report outlined that the current ‘’business as usual’’ is no longer maintainable. Our analysis of the colonial legacy (6,7), the climate paradox (3), and the lack of reciprocity (10) demands a fundamental restructuring of the international student exchange programs.

Summary of recommendations:

1. Institutionalize reciprocity: Move from short visits to long-term partnerships maintained through Memoranda of Understanding that prioritise the host institutions agenda. Establish a Global Health Advisory Board with veto power for our Global South partners to ensure collaborative decision making.
2. Implement a carbon budget: Limit physical exchange to cases where it offers unique and essential learning outcomes. For every flight taken, invest in a local community chosen carbon offsetting project in the host country to mitigate the environmental impact.
3. Break the ‘One-Way Street’: Create a reciprocal exchange fund visa, housing, and travel costs for incoming students and staff from the Global South. Actively advocate for visa reform at the ministry of foreign affairs with other universities.
4. Adopt a Two-phase model:

• Phase 1 education for all: Implement Collaborative International Online Learning (COIL) modules and a ‘global classroom’ taught by doctors from the Global South. This will ensure every student gains global competence without the carbon footprint.
• Phase 2 Physical Exchange: Reserve physical exchange for a selected group of well-prepared students. Replace short term stays with longer three plus month stays that allow for meaningful contribution and cultural integration.

1. Create Local Alternatives: Create a ‘Global is Local’ program for students who can not travel. Partner with local NGOs and asylum centers in Rotterdam to teach Global Health competencies within our own diverse city.

Final word:

We acknowledge that these recommendations require significant investments, financial, logistical and emotional. Giving up our privilege to easy travel and sharing our power with our partners is not easy. However, it is the only way ErasmusArts 2030 doctors will not only be ‘global’ in terms of passport stamps, but global in their mindset, ethics, and solidarity.

By adopting this proposal, Erasmus MC will not only improve their quality of education and international student exchange programs, it will also take a never seen before leading role in the global movement to decolonize Global Health. It is an opportunity to show the world that we value the lives and knowledge of our Global South partners just as much as our own. Lets seize this opportunity.

References

1. Gichane MW, Wallace DD. Dismantling and reimagining global health education. Global Health Action 2022 -10-26;15(1).
2. Efird CR, Lightfoot AF. Missing Mayberry: How whiteness shapes perceptions of health among white Americans in a rural Southern community. Social Science & Medicine 2020 -03-29;253.
3. Adorjan K, Falkai P. Air travel for global health - flying in the face of sustainable development - Lancet 2019.
4. Abimbola S, Asthana S, Montenegro C, Guinto RR, Jumbam DT, Louskieter L, et al. Addressing power asymmetries in global health: Imperatives in the wake of the COVID-19 pandemic. PLoS Med 2021 -04-22;18(4).
5. Khan M, Abimbola S, Aloudat T, Capobianco E, Hawkes S, Rahman-Shepherd A. Decolonising global health in 2021: a roadmap to move from rhetoric to reform. BMJ Glob Health 2021 -03;6(3).
6. Qin R, Alayande B, Okolo I, Khanyola J, Jumbam DT, Koea J, et al. Colonisation and its aftermath: reimagining global surgery. BMJ Glob Health 2024 -01;9(1).
7. Mauro Capocci DC. Empire, Nation-building, and the Age of Tropical Medicine, 1885–1960. Springer Nature: Palgrave Macmillan, Cham; 2024.
8. Bhakuni H, Abimbola S. Epistemic injustice in academic global health. The Lancet Global Health 2023 -05-24;9(10):e1465.
9. Worldbank. Social Dimensions of Climate Change. 2025; Available at: https://www.worldbank.org/en/topic/social-dimensions-of-climate-change#:~:text=Extreme%20weather%20events%20are%20deeply,the%20wellbeing%20of%20their%20families. Accessed Fri 28 Nov, 2025.
10. Arora G, Russ C, Batra M, Butteris SM, Watts J, Pitt MB. Bidirectional Exchange in Global Health: Moving Toward True Global Health Partnership. The American Society of Tropical Medicine and Hygiene 2017 -07-12;97(1):6.
11. Effects of International Health - a systematic review - Fam Med 2011.
12. Blue A, Mutchnick IS, Moyer CA, Stern DT. Expanding the Boundaries of Medical Education: Evidence for Cross-Cultural Exchanges.
13. Thompson MJ, Huntington MK, Dan Hunt D, Pinsky LE, Brodie JJ, Thompson. Educational Effects of International Health Electives on U.S. and Canadian Medical Students and Residents: A Literature Review.
14. Büyüm AM, Kenney C, Koris A, Mkumba L, Raveendran Y. Decolonising global health: if not now, when? BMJ Glob Health 2020 -08;5(8).
15. United Nations. 7. d Paris Agreement. 2015; Available at: https://treaties.un.org/pages/ViewDetails.aspx?src=TREATY&mtdsg_no=XXVII-7-d&chapter=27&clang=_en. Accessed 22 nov, 2025.
16. Hackett S, Dawson M, Janssen J, Van Tartwijk J. Defining Collaborative Online International Learning (COIL) and Distinguishing it from Virtual Exchange. TechTrends 2024 -09-21;68(6):1078.
17. Kalbarczyk A, Nagourney E, Martin NA, Chen V, Hansoti B. Are you ready? A systematic review of pre-departure resources for global health electives. BMC Med Educ 2019 -05-22;19(1).
18. Rowthorn V. Global/Local: What Does It Mean for Global Health Educators and How Do We Do It? Annals of Global Health 2016 -03-29;81(5).
19. CBS. Bevolking; herkomstland, geboorteland, leeftijd, regio, 1 januari. Available at: https://opendata.cbs.nl/#/CBS/nl/dataset/85458NED/table?ts=1764772944435. Accessed 1 Dec, 2025.
20. Erasmus University. Housing exchange Spring Semester 2025-2026. 2025; Available at: https://www.eur.nl/en/education/practical-matters/orientation-arrival/housing-international-students/housing-exchange-spring-semester#:~:text=Important%20to%20know%20is%20that,%2C%2D%20and%20%E2%82%AC%201050%2C%2D). Accessed 1 Dec, 2025.

Use Of Artificial Intelligence

This Advisory report made use of Artificial intelligence (AI).

AI was used for the following purposes:

To help identify supporting evidence in scientific articles.

To help improve spelling and structure of the report.

The value of the use of AI was in efficiency and readability.

By using AI, I was able to find supporting arguments in the research faster, because I didn't have to read them initially. Once AI found potential supporting arguments in one or more articles, they were read by me to assess the argument for eligibility in this report.

An example prompt that was used: Are there previously provided articles that mention climate change and its effects on global health education? If so, provide me with the doi and page number.

The use of ai for readability was useful in order to restructure some unclear sentences or correct spelling mistakes in the final version of this report. This provides a better reading experience for the board.

The prompt used: (attachment: my report) Check this essay for any spelling mistakes or unclear sentences. Reproduce the original text, with your corrections in bold font.

Based on this prompt a few changes were made to the final version to correct spelling mistakes and correct the flow of a few sentences.

SEARCH STRATEGY:

No specific search strategy was used in the creation of this report: The first 10 articles provided in the background literature folder were found to be sufficient enough for creating a base for this report. Additionally supporting sources were found through web browsing on sites who are known to be trustworthy sources for the creation of this report (e.g. Eur.nl, cbs.nl, Worldbank.org, pubmed.ncbi.nlm.nih.gov, etc.). In those cases we were looking for specific information, known to be available on these websites.