Philip Cotton, a dual citizen of the United Kingdom and Rwanda, has been a key figure in global health education, holding leadership roles at the University of Rwanda, including Vice Chancellor, and contributing to the Mastercard Foundation’s Scholars Program. A former professor at the University of Glasgow with a background in family medicine, he chairs the Board of Rwanda Biomedical Centre and holds several honorary professorships. Beyond academia, Philip is a Methodist preacher and a founder of a fair-trade organization, with significant contributions recognized by the Order of the British Empire: and other prestigious awards. His work exemplifies a commitment to advancing health education on a global scale.
What inspired you to embark on your journey in global health education, and why did you choose Rwanda as a focal point? How do the differences in global health education between Rwanda and the United Kingdom shape your approach and insights?
I went to medical school in Glasgow, Scotland and was always taken by the curriculum that covered Social and Community Medicine [and] encapsulated family medicine. As a student, I got increasingly involved in fair trade and trade justice, which culminated in the setting up of a trading company and an NGO.
Early on, I started to make journeys to Africa. In Glasgow, you [had] two elective periods of study. I spent my first elective period at the India Institute for Medical Sciences in Delhi [in India] and my second one in Pemba Island in Tanzania and also in part of mainland Tanzania called Bagamoyo, where I was able to witness firsthand medicine practiced in a rural community and with some of the most vulnerable members of society. We also had several inspirational organizations in those days. There was an organization called Med Act, which was for students who felt [called to] Social and Community Medicine, which in those days probably wasn't called Global Medicine. Then later on, I encountered organizations like PRIMA [Partnership for Research and Innovation in the Mediterranean Area] famed [for] look[ing] at the delivery of primary care and family medicine in poor[ly] [resourced] settings. For me, there was always an emphasis on global health.
[My work in] Rwanda came about in 2006 when I was asked to come as a clinical academic to do some accreditation and review of higher education. We started initially with the (then) National University of Rwanda and progressed a year later to the School of Public Health and [particularly] the School of Medicine. That [work] began my association with Rwanda. I then made several other visits for other reasons to the country, and in 2013, I joined a team of people to merge all of the public universities and higher learning institutions in Rwanda to form one national public university known as the University of Rwanda. I worked [for] the Ministry of Education for six months, and when the university was launched, I became principal of [the College of Medicine and Health Sciences], one of the six colleges in the University of Rwanda. Two years later, I became Vice Chancellor of the University of Rwanda.
For me, it’s difficult to accurately pinpoint the differences in global health education between Rwanda and the U.K. because I left the U.K. at a time when global health wasn't taught in an explicit sense [or as a distinct discipline]. Since I left the U.K., there's been a real growth in One Health [health looking at the interconnection between peoples, animals, plants, and their shared environment], in planetary health, but also, of course, in global health. My impression at that time was that global health was taught as elective modules or as intercalated degrees in undergraduate medicine, for example, whereas here in Rwanda, we were able to integrate One Health as both a discipline and an approach as we merge the former institutions and coalesced some faculties and rationalized other programs.
What measurable outcomes or success stories can you share that demonstrate UGHE's effectiveness in empowering Africans to achieve leadership roles?
Gosh, yes. Let's look at UGHE [University of Global Health Equity] for a moment. We have an undergraduate medical degree. We have a master's degree in global health delivery—that is our signature degree. We [also] have executive education programs. [At UGHE] we've educated, taught, [and elevated] young people from more than 24 African countries. People have come to learn in the master's program or in executive education and then gone back to their home countries or places of work. When I look at the Masters in Global Health Delivery [MGHD], we [have] 239 alumni, of whom 73 percent were employed within three months of returning [home], [and] 65 percent of those have reported a salary increase. [MGHD alumni have] also produced more than 40 publications and are now working for organizations such as WHO, UNICEF, USAID, PIH, and the Ministry of Health.
There [have] been several awards given to alumni since leaving the University, including the Rising Star Award from the World Federation [of] Societ[ies] of Anesthesiolog[ists]; the Rwanda Woman of Courage Award; the Queen's Young Leader Award; [and the] Excellence in Advancement and Diversity and Social Justice Award from the American University of Beirut, for example. Of our own alumni here in Rwanda, the Minister of State in Health, the Advisor to the Minister of State, the Head of the [Development] Department of Workforce, and the Head of the Department of Work Health workforce in the Ministry of Health [are all] graduate[s]. Towards the end of last year, six of our MGHD alumni were appointed to key roles in the Ministry of Health. [These are] just some examples of the ways in which people have taken on leadership roles. This study and the knowledge, skills, and passion that people bring, develop, and [then] take away to their places of work mark them as leaders in their field.
What are the main challenges you foresee in the future of global health education, and how is UGHE positioning itself to address these challenges and lead in the field? For example, in relation to AI, is UGHE incorporating advancements in artificial intelligence into its curriculum and research, and what potential do you see for AI in revolutionizing global health education and improving healthcare outcomes?
Let me [start with] how UGHE is positioning itself to address these challenges. First, it has spent several years now developing [a] curriculum, curricular experiences, cases, [and] problems, so that students can find solutions to those problems. We use many of the [educational] innovations that are in universities around the world, but we focus quite heavily on experiential learning.
Our students go down to the community. They sometimes walk for two to three hours to be with the patients and then start the journey with the patients [and] community health workers [to] the clinics and maybe up to the hospital. [The students] understand the lives [patients] lead, the [community] support they have, the way in which they present to health facilities, [their] health beliefs, [the] forms of treatment that are available, and how they are supported in taking those treatment[s]. [Our students] understand the lives that people lead every day, the chaos sometimes in those people's houses, the availability of food, the availability of carers—and a lot of time is spent understanding, listening, watching, observing, and sometimes asking and sometimes doing.
All of our students have a liberal arts introduction to their training and specific options for study, [which includes the study of] geopolitical issues as well as ethical issues. You'll find these features in other universities, but we also teach and learn [and assess] in context. The university is built in a rural part of Northern Rwanda, close to the Ugandan border, near a district hospital that's supported by Partners in Health. We engage in community service [and initiatives]. We [are] developing curriculum materials—[as well as] approaches for learning and teaching and assessing—and some of our community health workers and their patients are involved in our student assessments, [including] clinical [and other types of] exams.
We have made the offer to other institutions that we will share any of the resources that we have, whether it's curricular content, learning resources our students use, or our assessment items. We've had several institutions and organizations come to spend time in the university, trying to understand what we do so that they can make modifications to their own curricular approaches.
Some of the challenges in the future are a little bit contentious. I've described experiential learning, learning in context, [and] learning in the field, and I think one of the challenges will be if global health is taught as an online program. I think there's a lot that can be achieved through online study, but there has to be some recognition of learning in context. Many of the issues that we currently narrate as health issues are increasingly complex, increasingly political, increasingly [linked] to climate change, increasingly linked to world order. The challenge will be to stay one step ahead of some of those influences.
UGHE is beginning to explore the potential as well as the pitfalls of AI. Of course, AI has a story to tell, [and] people have a story to tell of using AI in assessment[s]. [We are] ensuring that we [maintain] the integrity of our assessment[s]. We are also [launching] a Center for Transformative Technology in Education, really expanding the work that started in our Simulation Center. We're going to be working with colleagues in North America and in other parts of the world on the use of AI in learning and teaching. We [are] also looking at the applications of AI in research and in [the] implementation of research findings.
It's an exciting place and an exciting time. I think there are huge advantages in terms of healthcare outcomes. [AI was] involved in Rwanda during COVID[-19], and robots were involved in some assessment[s] of patients and also people moving in and out of the country. AI also allows us to curate a life[time]'s work, lectures, and talks of some of the leading visionaries in the field, and we're very excited to explore [these possibilities].
Have there been conflicts or challenges in integrating Western methodologies with Rwandan traditions at UGHE, and how have these been addressed? Can you highlight any specific strategies or programs that exemplify this?
We have tried, in many ways, to recognize and protect African heritage in our teaching, even in the design of our buildings and the aesthetic of our campus, and also in terms of cultural events. There [have] been a lot of things to hold on to and [ways] to celebrate African heritage. We [have] also managed to hold dear some of the traditions of storytelling, of gathering together as a community, and we use that explicitly in teaching and learning, and I've seen it most recently used in [graduation ceremonies].
I don't think there have been conflicts or challenges in integrating different teaching methodologies. We have appl[ied] a great deal of thought and time to the different ways in which people learn because their experience[s]—in high school [and] growing up in their communities [and] learn[ing] from grandparents and parents—influence the ways in which they expect to learn when they come to university. We [have] done quite a lot of work around integrating different ways for people to learn as well as they can, whether they're visual or auditory learners. Often, people come to university having had no diagnosis of their style of learning, and so we spend quite a lot of time with students in the early phase as they learn in large groups, in small groups, by reading and reporting, by having to problem solve. The methodologies that we use in UGHE are methodologies that you might be able to pin on a particular place or associate with a particular movement within teaching, but [they have been adapted and personalized] by us.
The main conflicts are really in terms of the expectations of learners who perhaps have come from education systems where they learn predominantly by rote, and they find that rote learning doesn't get them very far in university and assessment. Regurgitation of material is no longer the way in which we assess students' performance. I think those are individual conflicts, rather than conflicts with methodological approaches.
Dake spoke with Cotton on July 29, 2024. This interview has been lightly edited for length and clarity.
The views expressed in this piece are the interviewee's own and are not reflective of the views of the HIR.
