Global health hospitalists are passionate about their work. The Hospitalist asked them to expand on the reasons they choose this work.
“Working in Haiti has been the most compelling work in my life,” says Michelle Morse, MD, MPH, an instructor in medicine at Harvard Medical School and deputy chief medical officer for Partners in Health (PIH) in Boston. She has worked with the Navajo Nation in conjunction with PIH’s Community Outreach and Patient Empowerment (COPE) program. The sharing of information is “bi-directional,” Dr. Morse says.
Her Haitian colleagues, she says, have developed “transformative” systems improvements, and she’s found that her own diagnostic and physical exam skills have strengthened because of her work abroad.
“You really have to think bigger than your group of patients and bigger than your community, and think about the whole system to make things better around the world,” she says. “I think that is a fundamental part of becoming a physician.”
UCSF clinical fellow Varun Verma, MD, says he was tired of working in “fragmented volunteer assignments” with relief organizations. Three-month clinical rotations, in which he essentially functions as a teaching attending, have solved the “filling in” feeling he’d grown weary of.
“Here at St. Thérèse Hospital [in Hinche, Haiti], they do not need us to take care of patients on a moment-to-moment basis. There are Haitian clinicians for that,” he says. “Part of our job is to do medical teaching of residents and try to involve everyone in quality improvement projects. It’s sometimes challenging discussing best practices of managing conditions, given the resources at hand, but I find that the Haitian doctors are always interested in learning how we do things in the U.S.”
Evan Lyon, MD, assistant professor of medicine in the section of hospital medicine, supervises clinical fellows in the department of medicine at the University of Chicago. He believes hospitalists who take on global health assignments gain a deeper appreciation for assessing patients’ social histories.
“There’s no better way to deepen your learning of physical exam and history-taking skills than to be out here on the edge and have to rely on those skills,” he says. “Back in the states, you might order an echocardiogram before you listen to the patient’s heart. I think all of us have a different relationship to labs, testing, and X-rays when we return. But the deepest influence for me has been around understanding patients’ social histories and their social context, which is a neglected piece of American medicine.”
Sharing resources and knowledge is what drives Marwa Shoeb MD, MS, assistant professor in the division of hospital medicine at UCSF. “I see this as an extension of our daily work,” she says. “We are just taking it to a different context.”
Gretchen Henkel is a freelance writer in southern California.