Residents In a Room

Episode Number: 58

Episode Title: Ask the Global Health Expert

Recorded: October 2023

(SOUNDBITE OF MUSIC)

VOICE OVER:

This is residents in a room, an official podcast of the American Society of Anesthesiologists where we go behind the scenes to explore the world from the point of view of anesthesiology residents.

We are really all in this together around the world. It's a small world, after all.

Everyone around me was really in the same boat.

There's a charge in young physicians today to not ignore that stuff that's happening in the world.

What can we bring to different communities who have different resources than we do in the United States, but also, what can they teach us to change our practice.

DR. JAKE GAMBOA:

Welcome back. I'm Dr. Jake Gamboa, your host for today's episode of Residents in a Room, the podcast for residents by residents. I'm back with a few residents to discuss global health with an expert in the subject, Dr. Elizabeth Drum. This is a topic I'm passionate about, so I'm excited to dig in. Before we do, let's meet our resident guests.

DR. KELSEY REPINE:

My name is Kelsey Repine. I am CA3 at University of Colorado.

DR. JORDAN FRANKIE:

My name is Jordan Frankie. I am CA3 at UCLA.

DR. JEFF CANNON:

Hi, my name is Jeff Cannon. I'm a critical care fellow at the Massachusetts General Hospital in Boston, Massachusetts.

DR. CHRISTY HENDERSON:

And I'm Christy Henderson. I'm CA3 at Vanderbilt.

DR. GAMBOA:

And Dr. Drum, can you tell listeners a bit about yourself and your global health experience?

DR. ELIZABETH DRUM:

Sure. Thanks for having me here today. I am a pediatric anesthesiologist. I work at the Children's Hospital of Philadelphia, and I'm faculty at the University of Pennsylvania. I trained in Philadelphia at Temple University, and the area that temple is in is a pretty impoverished area. And we had a lot of patients who had poverty, health disparities, low access to care, and many other social determinants of health that really impacted their ability to get good care. I think that was one of the first things that helped me understand the differences in access to health care based on where you live, who you are, what your health insurance is, things like that that you don't necessarily think about before medical school, at least not in my day. Fast forward after training, I returned to Philadelphia to work at temple, where temple was building a new children's hospital, the first hospital that had been built in Philadelphia in a couple of decades. I won't get into the details of why and how, but let's just say that that's something I poured my professional energy into for more than ten years, and at the end of the ten year mark, ultimately the hospital closed, which was a very difficult thing professionally, watching a hospital that you sort of helped build and shepherd close.

And at the end of that, I found myself in a situation where I could, should, had to make some choices about what I was going to do with my career and where I was going to work next, and I could stay there and take care of some pediatric patients, but mostly adult patients. And my passion was really pediatric patients.

As I like to say, I was minding my own business one day, and one of my surgeon friends called me up and said, I'm going to Ethiopia, but I'm not going if you don't go with me. Spoken like a well-informed, enlightened surgeon who didn't want to get himself into something that didn't make sense. So to make a long story short, we went to Ethiopia. We came back from there deciding to commit between the two of us to go to Ethiopia twice a year for five years to see if we could do something to impact anesthesia and ENT education in the country. Ethiopia now has a population of about 120 million. Back then, it wasn't quite that many, but still, this was 2009. At that time had probably at most two dozen anesthesiologists, maybe not that many. There was a one residency program in the one university hospital for the entire country that had a couple residents. So anesthesiology as a specialty was pretty young. It was pretty underdeveloped. It had had starts and stops over the years as well-meaning individuals, institutions, countries had come and tried to bolster the infrastructure. There had been some political instabilities. There was a couple years in which there was a pretty oppressive political regime. Needless to say, the country was in pretty rudimentary shape in terms of how anesthesia was provided. There were a fair number of non-physician anesthesia providers, but again, less than 1000 for again, this whole population. That's really what got me started in global health.

DR. GAMBOA:

Thank you for being here. We're excited to learn from your experience. Just to start out, big picture, what is global health and what is the role of anesthesia in global health?

DR. DRUM:

I think global health is a recognition that at a certain level, we all have the same basic needs. You can talk about things like water, shelter, food, safety, comfort. I think from a medical point of view, it's really important to recognize that we all have basic medical needs. We all have health related factors related to life and all the other things we said before, where you live and work and access to health care. It's, I think, important to understand that many people, myself included, believe that access to health care is a human right and a basic human right. And like many rights, they're not always freely available to everyone. And I think the tenant to me is that that should be our premise. We need to find how to deliver health care to everyone. The challenge is how to do it and systems that are somewhat complicated.

DR. REPINE:

Dr. Drum, what kinds of opportunities exist for resident or early career physicians to get involved?

DR. DRUM:

People tend to want to go somewhere and do something. I think that's a little bit of a leftover mentality from years in the past, where our perception of global health was that you had to go do a mission trip, you had to fly into a country to save the day. I think there's some pretty good evidence that those efforts are not always the right way to impact a population, a culture, a society. That being said, I get asked that question a lot what can I do? How can I get involved? So I think the first thing is to educate yourself, which I think is part of the point of a program like this. Learn about health care in your own community. Learn about the disparities that exist in your institution or your city. There's some really fascinating work going on out there looking at mapping of zip codes and access to health. And that's something you can just start learning about in your own communities. There's a lot of resources out there that can help you learn about what health is like, and health care in other parts of the world. There's websites, there's the World Federation of Societies of Anesthesiologists that you can look at their website and learn about what anesthesia capacity is like in many countries around the world. You can learn about resolutions passed by the World Health Assembly. There's some landmark publications from 2015 that really talk about surgery as a right and a global health problem. So start by educating yourself.

If you're in an institution that has faculty in your own department or in others that are from other countries, ask them, what do you know about health care in your own country? If there are people in your institution who have ever lived or worked somewhere else? Ask them what is that like? If you know people who've traveled to other countries, whether it be for volunteer mission type activity or some other educational program. Ask them about that. Try to learn from their experiences.

There are some opportunities for residents to spend a month as a rotation during their training to go to an established program. There are some. Through the ASA. The Committee on Global Health sponsors a fellowship for people to spend a month in a low resource setting. That's our resident international anesthesia scholarship program. Applications are due at the end of January every year for the upcoming year. The society for Education in Anesthesia has a similar program that the application date is approximately the same in their work in collaboration with health volunteers overseas. Similar type thing for a one month activity. Sometimes fellows are also allowed to apply or participate in some of those activities.

And then the other thing I would say is, if you have a particular interest in an area or a field, try to see if you can figure out who might be doing work in that area. If you have a particular interest in, let's say, Kenya, there are definitely people within the ASA community who have done and or are continuing to work in Kenya. You can try to connect with them. Our Committee on Global Health is really working on a bunch of projects, including sending people to educate local trainees in Guyana and Rwanda. We're always looking for ways to expand our footprint. We don't necessarily have a lot of money to just go start programs and projects, so sometimes what we need to do is connect the people who are looking for work with the people who need help.

DR. FRANKIE:

Dr. Drum, you've already spoken about this a little bit, but do you feel like a resident or attending physician needs to leave their neighborhood, leave their country to provide a meaningful contribution in terms of global health?

DR. DRUM:

I don't think that you need to leave the country. I do think there was a time that that's what people thought. I think one thing that Covid has taught us is that we can really connect with people without leaving the comfort of our own home. There are some educational programs that already exist in a few institutions that have ongoing teaching seminars, for example, that residents probably could participate in. There are organizations that I know that are looking for ways to connect mentors and mentees around the the world. There are teaching programs getting started all the time. I've heard about one the other day trying to do some POCUS education between departments in the US and around the world, and a lot of those don't require anyone to go anywhere. Usually you have to have a stable internet connection, which fortunately for us in this country is not usually an issue. But I think there's many things to do that you don't have to leave the US.

DR. CANNON:

If we're interested in global health work as residents or as trainees. What do we need to know about a possible long-term engagement? So for someone like me who's coming to the end of fellowship and is very serious and considering having a sizable portion of my career be dedicated toward global health, how do you go about finding positions both in the states and in other countries, where you can have that meaningful contribution, not just in your local community, but in the global sense? How do you find maybe career opportunities and staying involved as an attending physician?

DR. DRUM:

I think part of global health that we easily forget is that the most meaningful benefit of activities is when you can look at long term relationships and collaborative efforts. I think one of the faults of things that are more drop in for a week and leave is that you don't necessarily develop those long term relationships. There are certainly some volunteer organizations that return to the same community year after year, have a long term presence. Some of those are also involved in education and training of the local providers. They aren't all, but I think that's one way in which that works. So I would say if global health is something that you're interested in for your career, you probably have to look at it as a long term goal. You are not going to jump in one day and then find yourself doing all these things the next, myself included. When I started on this road, I had no idea what I was doing. I just thought I'd going to go help teach somebody a little bit. And here I am 15 years later. But many of those early interactions and relationships I had in 2009, I'm still in those relationships now with some of the same people and some of the same institutions, and using some of those principles over time. So I think you have to think about what percentage of your life and career you're willing to devote to this. Is this something that you can see yourself moving to another location, and if so, where that is and how long you're willing to be there? Is this something that you can build into a practice in which you are able to get protected time from your practice to work on these initiatives? I will add that those practices are rare and hard to find, especially in our current need for providers and anesthesiologists and economic concerns after Covid. Not that many places are willing to devote time and energy, but there are a few out there. You might have to take some of your own personal time or vacation time to travel, if that's what you're going to do. I did that for several years. You might have to be creative in terms of how you plan out your activities, whether that's take some time off. I know of a few people who are working some part time or locums type jobs so that they can take the time that they aren't working here to do some other work. That doesn't work for everyone in their family and there other factors in life. What you can do, though, is continue to do things like if you have relationships with people, continue to work with them, what do they need? If you are able to go to meetings like the ASA annual meeting or even some specialty society meetings, you might have a chance to meet people from other countries and then continue to develop relationships with them and figure out what they need. So if you're going to go to a place, what do they need figured out ahead of time? Try to help build whatever support infrastructure they need.

DR. HENDERSON:

So going along those same lines, I'm also graduating at the end of this year. And so thank you for answering that question on how to stay involved as an attending. Along those similar lines, what type of global health initiatives should we be thinking about as we consider jobs moving forward?

DR. DRUM:

I will say that although those of us in this conversation clearly have an interest in global health and in health equity around the world, I'm constantly surprised at how few people know what that really is and what that means. So I think part of your. Role, your job, your responsibility. An opportunity for you is to take the knowledge that you already have and help educate other people, whether that's your co-residents, whether that's people who are looking at anesthesia as a career, whether that's the department in which you're going to find yourself working. I am really amazed at how few people understand that much of the world doesn't have enough anesthesiologists, that much of the world doesn't have the basic safety equipment and monitors that we would never take care of a patient without. ulse oximeter is the most common example that people are aware of. But things like entitled CO2, EKG, even blood pressure cuff monitors, especially in pediatrics. Those things are not necessarily readily available around the world. And so few people really know that, and myself included, we get fixated on what we do or don't have today. How come I'm working late tomorrow? How come this surgeon didn't think about X? Those things are magnified millions of times around the world, but we're in our own little bubble sometimes and we forget. So if nothing else, you can help other people understand why this is important to you and perhaps why it should be important to them.

DR. GAMBOA:

You did start to mention this already, but what should residents learn about global health and health equity? And why should we care? Especially for those, maybe, who aren't interested in traveling abroad and participating in global health? In that sense, why is it still important to have this as part of our training?

DR. DRUM:

I think another thing that Covid has taught us is that we are really all in this together around the world. It's a small world, after all, and things that are important to us are important to others. Again, getting back to sort of the basics of life and health, I think it became obvious in our worlds that surgery was really important to the care of patients. And when you couldn't provide surgical services during Covid because you weren't allowed to, or the hospital was only focusing on caring for patients with Covid, or there were mechanisms in place to try to protect patients you recognize like what the impact of that was. So it was pretty easy to say certain surgical procedures were elective. And yes, if you need surgery for cancer, it could wait a day or two. But could it really wait three months? Would that impact your long term survival, or life expectancy or even quality of life? The answer is certainly yes. And so I think that helps people understand what happens when you live in a community or health system that doesn't have those basic needs. So I think understanding that we're all in this together helps people advocate for better health around the world. If you look at certain political conflicts that go on around the world, you can recognize that one of the most immediate things that happens is that people who are in those affected communities don't have access to needed medical care. You can think about disasters like earthquakes, floods, tsunamis, same thing. If your hospitals are closed, no one can get medical care. So I think fundamentally that helps us understand why health is such an important thing and why we should care about it.

DR. REPINE:

It sounds like there's been a shift in the understanding of the importance of global health. In your opinion, what's happened in the world or in health care that has elevated global health as a current issue that we need to focus on?

DR. DRUM:

I think it's a couple of things. I think world circumstances like Covid, like recognition of what happens in war zones, in conflicts and natural disasters. Climate change is certainly going to probably increase the number of natural disasters that are around. So I think those type of world events help people realize it. I think generations of people who are now aware of issues around the world are making their thoughts and voices heard. So the fact that we're having this conversation today, I can't imagine it happening 20 years ago, because that's just not what people who were young in our specialty or even in medicine were asking. I think the other part is that there's been a lot of advocacy work and energy put into global health, global surgery, global anesthesia in the last, say, 10 or 15 years by several organizations, which at this point in life, if you weren't around, then you don't know that that never existed. But things like The Lancet Commission 2015 landmark publication that really highlighted why surgery was important, some important changes to the UN and the World Health Organization, the current World Health Assembly declarations that say access to safe surgery and anesthesia is a public health right. Those are relatively new revelations I would say. Before early 2000, 2010, like most of the money in public health, went towards infectious diseases, treating things like malaria, TB, HIV, all of which are important. But one of the things the landmark Lancet commission did was help the world. People like you and me, but also important bodies like World Health Organization and World Bank, recognized that the burden of disease around the world was shifted towards non-communicable diseases. Things like road traffic accidents and cancer, but also things that could be treated by surgery if you actually had access to surgery.

DR. FRANKIE:

Many of the global health programs, trips that I've seen in the past have focused on medical education, donations, things of that variety, and less on direct delivery of clinical care. What are the medical, legal and ethical concerns or considerations in providing global health services delivery to to various programs around the world?

DR. DRUM:

I think one important thing is to really understand the context of the location, or the people, or the institution or country or organization that you're working with. There are places in the world where you could just wander in and wander into hospital, and as a person who looked like they probably came from the United States, you would just be able to walk in and kind of do what you want. We would never allow that in our own hospitals. Some people in our own departments, though, sometimes can't walk in our own hospitals because they're not judged to belong. So there's a whole sort of cultural competence and awareness of other countries and their perspectives that we need to be aware of. I think there's things like language, there's things like what is important to a community. I've heard stories of people going somewhere, trying to work hard to save a person's life or intervene without recognizing that in that culture, a person with a long term disability is actually going to be disadvantaged for their own life, but also their whole family's life. So we have a very individualized do everything you can for this person mentality in the United States. And I'm not saying that's wrong, but that's not universally shared. There are many examples of patients agreeing to have surgery or procedures, or even perhaps looking for things from a Western doctor thinking that that's going to cure some disease that probably is not really realistic. And I think it's important for us to recognize that. Things like informed consent, which we may be more or less take seriously in our day to day work, takes on a whole different meaning when you have different cultures and different languages, and you don't necessarily understand what it's like to live in the other person's shoes. And that takes a lot of work, especially if you're not well versed in the community and what's important to them and what's available to them. Things that we would take for granted are not necessarily true elsewhere, and things that we think are important may or may not be important somewhere else.

DR. CANNON:

I'm sensing there's a theme within this conversation about how relationships are very important. I think that all aspects of business and health care have elements of relationship building. My question for you is, anyone can try to build a relationship with another health care setting. But as anesthesiologists, what do you think that we can bring to the table that specifically qualifies us to help build some of those relationships with other communities and other global health settings?

DR. DRUM:

I want you to think about your daily work as an anesthesiologist. Many of the things that we do on a daily basis help our local hospital, OR, health system perform and deliver patient care. Things like preoperative evaluation of patients, the patient you see right before you provide the anesthesia care. But more than that, the systems that allow patients to be scheduled for operations have appropriate preparation, like know when to be NPO and what medications to take. And do they need certain blood tests or X-rays or do they need to have blood availability? Those are things that as a specialty, we've really worked hard to develop. Things like safety in anesthesia and surgery, infection prevention and control, quality and safety initiatives, group dynamics. Those are all things that we as anesthesiologists have helped to build and promote within our own institutions. Most people, myself included, didn't create those individually. And yet, as a society and as an organization and as anesthesiologists, we are really a very important part of a highly functioning health system. You can all think of examples where you felt like your individual system didn't work very well, or the team with which you were working--nurses, surgeons, or whoever else--wasn't that functional. But in general, when you have a well organized, well functioning team, you don't notice it. But without that, you can't deliver that care. So I think those are some of the things that we can help other anesthesiologists around the world and other societies understand that as anesthesiologists, we have a lot to bring to the table. Emphasis on safety and quality, standards of care, ways to advocate both within your institution, your department, your Minister of Health, even for adequate access to monitors, equipment, safe places and spaces within the hospital, access to to clean water and electricity. Many places around the world don't have any of those, but they don't know how to use their voice to advocate for what they need. I think many times we forget that we actually, with our surgeons and nursing colleagues, have developed pretty well functioning health systems. And part of the reason the rest of the world doesn't always have them is because everyone's just trying to survive. So helping other anesthesiologists around the world learn that it's okay for them to speak up about why it's important to have available monitors, and why getting access to reliable, consistent medications is appropriate to developing adequately functioning health systems or a recovery room that actually exists with staffing and monitors, and how that really improves patient safety. Not everyone has that perspective. So I think that's one thing that we can do. Clearly, anesthesiologists are involved in a lot of other things as chairs of departments, as deans of medical schools, I even know of a few who are CEOs and COOs of health systems. And clearly helping anesthesiologists around the world realize that there's a lot more that they can do besides, quote, just hanging out in the OR giving anesthesia. But that's the fundamental part of what we do as anesthesiologists.

Now, I'd like a chance to ask some questions of you. I'd like to start with Dr. Gamboa. You are the most recent resident fellow, humanitarian outreach award recipient. I'd love for you to tell us a little bit about that and how you got the award, and what your perspective on this work is.

DR. GAMBOA:

The ASA Resident Fellow Humanitarian Service Award is award sponsored by the American Society of Anesthesiologists. It's given to one individual every year, and it's awarded during the annual ASA conference. It recognizes involvement, outreach programs, but also leadership and mentorship. Getting others involved is a big component of that award and creating efforts that are sustainable. For me, it's a it's a huge honor to be even more connected to ASA and to be recognized.

For me, it started actually from personal experience. I was living in the Dominican Republic during college years and became very sick with dengue fever. I was living in a remote area and became sick. I actually ended up getting hospitalized for 5 or 6 days, but it was the lead up prior to that where I really experienced what health care was like in a very low resource, underdeveloped area, had very limited access to care. I just remember feeling severe pain, fatigue and fevers and having a lot of concern and uncertainty and fear because I didn't know what was wrong with me at the time. I went to a clinic that had very limited resources, but wasn't able to get the care I needed until I was pretty critically ill. I remember acutely during that time my own suffering, but then also became aware that everyone around me was really in the same boat. I wasn't the only one, and many of these other individuals in this community that I was with were not going to be able to get connected to the care that they needed. I had friends whose family members had died from dengue fever. So that was really the moment for me. That was what inspired me to pursue medicine as a career, and to eventually be in a position where I could help to address these, these health inequities, to help be able to provide care and access to these individuals who needed it the most. I've been fortunate to continue to work in global health even prior to deciding to pursue anesthesia. When I chose anesthesia as a specialty, I wasn't sure how that was going to integrate into my desires. I wasn't fully aware of all the opportunities and the need for global anesthesia and improved quality and access to surgical care. At the University of Colorado, I was fortunate. To go on an elective, actually in Guatemala, and establish new partnerships and do site assessments, and then also go to Paraguay a few months later to help with the team. There's a lot of opportunities, and now I'm actually doing a fellowship in global health, a new one at the University of Colorado. So I hope to continue to pursue and to advance these efforts and to be a part of global health and have it integrated into my career.

DR. DRUM:

I'm fascinated about your interest in global health and how that developed, and what makes you interested in global health, and what do you think the ASA should be doing that we're not? And how can we get people to understand, and how can we get people to to care about these issues?

DR. FRANKIE:

My initial interest in global health was born out of an interest in infectious disease. So after college, I spent three years doing HIV research at Massachusetts General Hospital with Rochelle Walensky, who's actually the previous CDC director. We were looking at early infant HIV diagnosis in sub-Saharan Africa, and that got me really interested in learning about epidemiology in resource limited settings, testing, diagnosis, treatment. And so in medical school, I decided to do a concurrent MPH. I went to Sinai in New York City, did an MD, MPH with a focus on global health for the MPH. And then the summer between my first and second year of medical school I spent in Navrongo, Ghana, which is in the Upper East Region, very rural, right on the Burkina Faso border. And I was doing this cardiovascular disease research, looking at trying to assess exactly what you were talking about, this dual burden of non-communicable and infectious disease. As these countries become more and more developed, the infectious disease burden remains the same, if not getting worse at times. But non-communicable diseases like heart disease, diabetes, hypercholesterolemia, hypertension, all of those diseases that we're very familiar with in very developed countries are starting to have an increased incidence in those countries as well, or starting to be more salient in people's minds.

And I remember this moment when I was interviewing one of the community health workers, and we were talking about diabetes, and I asked about Glucometers because the clinic itself barely had any power. Access to batteries was difficult. I was asking how they tested people's blood sugars. And she told me the story, which I still remember, I think it's so crazy that in that area, they would have patients urinate on the ground and see if ants came to see if there was glucose in the urine. And just think about the creative ways that you have to go about testing, diagnosing, treating diseases in these resource limited settings. It opened my eyes and my mind to all the challenges that these places face -- supply chain issues, even getting patients to the clinics. It was really eye opening.

I think no discussion today of global health is complete without acknowledging the Israeli-Palestinian conflict that's happening right now. And just this morning before I came in, read an article about how a million people are cut off from clean water, food, electricity, trying to evacuate a thousand patients from a hospital where they have no way to do that. They have no ambulances, they have no safe roads. There are millions of people in that part of the world who don't have access to their medications right now. And so I think there's a charge in young physicians today to not ignore that stuff that's happening in the world, to try and be a change agent. We're one person and our specialty in particular we treat one patient at a time. And I think that's a beautiful thing that very few physicians nowadays have. But I think anesthesiologists also can be change agents in helping address population or community level issues as well. And that's what attracts me to global health.

DR. REPINE:

In my undergraduate studies, I was a psychology and peace studies major, so got exposed to a lot of international aid and kind of what that looks like from a political standpoint. After college, I was able to work for the center for Global Health at the Colorado School of Public Health and was able to travel to Guatemala to work on some maternal as well as pediatric projects there. That was a phenomenal opportunity. I feel very grateful to have that experience. I think that that showed me as much as we've had amazing medical training here in the United States, we also have a lot to learn from our colleagues who practice medicine in these low resource settings. I learned a lot from all the physicians and health care workers in Guatemala. I admire their courageous intellectual curiosity and figuring out these problems like you mentioned, and how they are able to navigate a health care system that can often be difficult. So I think in pursuing global health as a physician in the future, not only is what can we bring to different communities who have different resources than we do in the United States, but also what can they teach us to change our practice in the United States?

DR. CANNON:

My experience with global health was born out of a chance encounter where my father, who's an anesthesiologist, was haphazardly invited to be a last minute fill in for an anesthesiologist on a medical mission trip to Kenya. And at the time, I was in undergrad, and he had mentioned it to me and said, they have other non-clinical spots on these trips to go and help and help connect with the community and help increase health literacy and things like that. So I very gladly and bright eyed and bushy tailed, jumped in and joined in on this trip. And it was incredibly eye opening in many ways, as I think as many times when people visit a developing country for the first time, for whatever reason, there are a lot of eye opening moments of this is not what I expected. I remember landing at the airport in Nairobi and having this idea of what was going to be on the other side of the airport doors, and we came out and there were skyscrapers in the distance, a construction crane and cars everywhere. And it was again in my young, never been anywhere other than my small town West Virginia mind. It was very eye opening. I said, this is probably the biggest city I've ever been in, and I flew halfway, a quarter way around the world to be here. And then meeting the people and hearing their stories and engaging with them was wonderful. So it kind of started my interest in global health was traveling and seeing my dad work, but also being on the non-clinical side and volunteering and helping.

And through some other great events during medical school and had started in undergrad, but in med school I was connected with an Ivorian physician in Cote d'Ivoire, Dr. Bernard Cardillo, who's born and raised in his own country. He went to medical school there and then traveled elsewhere for a master's of public health and in Alexandria, and did his PhD in Canada and just had this incredible mindset towards his own country's role in global health. And we were connected through a medical missions group. And I reached out to him and asked if I could learn more about public health and global health through him, and he very nicely invited me to come spend time with him and his family in Cote d'Ivoire. And I didn't know what I was expecting because there was no itinerary. I just flew there, had never met Dr. Cardillo, had never seen a picture of Dr. Cardillo, was connected with him through this medical missions group. And I showed up at the airport in Abidjan, Cote d'Ivoire, and someone was holding a piece of paper that said, W.V. and I went towards that piece of paper and I said, this must be the person who's picking me up. And so it was Dr. Cardillo and met him and spent two weeks with just him and his family, and just spent one on one time being mentored in all the things that I didn't know that I was going to learn about that week and the weeks that I was there. I was thinking I was going to get these grand thoughts on how to deliver global health and what it looks like to be, you know, he's a physician in his own country and collaborating with aid groups around the world. Our very first discussion was about how aid comes in from other countries to his country, and what he knows is coming in on paper, but what he would actually see on the ground and then talking about something like the way the environment was changing and how that was affecting how they delivered care out in a city versus out in a less populated region. So again, opened my eyes to so many different aspects of global health.

And then through my time in med school residency and now in fellowship, I've increasingly sought to be involved with different aspects of global health. But what I've found most enlightening is, as you've mentioned, Dr. Drum, the need and desire for simple opening of eyes in your own community. I remember when I went to medical school in West Virginia and one of the schools that I interviewed at there, but didn't ultimately go to when I mentioned to the dean there that my ultimate, you know, kind of long term goal was to do global health. He very, very seriously looked at me and said, do you not realize that many places within West Virginia are at the level of a developing country in terms of their access to health care? And it really did open my eyes. It made me pause. I'd never thought of that.

And so as I've sought to integrate global health into my practice, as I'm finishing up my time in training, I've had the dual thought of the community in which I exist needs access to health care and needs people who care about not just the four walls of the hospital functional, which is important, but can we get people here and get them access to safe, equitable care? And having I think that dual approach has informed some of my, you know, initial career search options and some of our initial conversations on the Committee for Global Health and some of the initiatives that we have going on there. And I'm just grateful to be a part of the society that seems as though we're moving in a direction where we're more globally minded, thinking more about the environment, more thinking more about our global communities and how we all do play a part. And I'm excited to be a part of that.

DR. HENDERSON:

And I'll just briefly mention, my interest in global health started when I was little. I spent the first half of my childhood in Mexico, and so contrasting life in Mexico to life in the rest of North America really opened my eyes and and kind of helped me realize the, the differences in health care just on this one part of the world that we live on. But I wanted to answer your other question, Dr. Drum, which was how the ASA can get involved in global health or maybe reach more residents like us to to know about it. And I'm going to echo some of the things that you said, because I think they're really important. So things like getting involved in the Global Health Committee can be a great way to build relationships, especially if you're at a program that doesn't have a global health fellowship or doesn't already have projects and mentors in that field. Getting educated yourself, whether that's getting a master's in public health or just learning about the community that you're in, in differences there are in accessing health care. And then the last thing I'll say is just coming to ASA and meeting people in person that actually have gone places or have started projects in their own communities that maybe is in your neighborhood, I think are great ways for residents to get involved.

DR. DRUM:

Thank you so much for inviting me to this podcast. I've really enjoyed talking with you, and I've actually really enjoyed getting to know you all a little bit, and I'm very happy to see such young, energetic, upcoming leaders in our specialty. And I know we're in good hands. Thank you.

DR. GAMBOA:

Dr. Trump. Thank you so much for being here, for sharing your expertise and your experience. This was a really great conversation that I enjoyed. I hope the listeners who tuned in learned something new. If you listened and enjoyed, remember to follow, subscribe or share and tune in again next month for more Residents in a Room, the podcast for residents by residents.

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