Global Health Careers: Part I

Tuesday, January 7, 2020

Crete, 2015

I was interested in global health and international work pretty much from the outside of my interest in medicine as a career. In the dozen or so years since then, the field has evolved tremendously, shifting towards more long-term and sustainable solutions and working in partnership with the local medical communities, rather than the short-term mission-style model.

Back when I started on this path I had no idea what a career like this entails; in many regards its still a learning curve and I’m figuring a lot of it out as I go. My first global health experiences in college were not great, though I didn’t realize it at the time. I joined a group of students to triage patients and distribute medications and vitamins during a couple of week-long missions in Central and South America. At best we were helping with workflow at a quarterly pop-up clinic, but at worst we were screening for diseases we didn’t have the medicines or resources to treat, without appropriate medical supervision. While we probably didn’t do any harm (something that can definitely happen in situations like this- see this new story for an extreme example), we certainly weren’t doing anyone any good.

The experiences left a bad enough taste in my mouth that I decided to stop working internationally and for the time being focus on learning good clinical medicine. I put the idea of international relief on the back burner until I had to skills to truly contribute something. But when the time came for that, I was a little lost as to how to go about pursuing a job in the field of global health. With a ton of guidance from mentors and acquaintances (and even more deep dives on the internet and google searches,) I found a few different career paths, job opportunities and fellowships that helped me formulate a much clearer plan for how to use my medical degree and pediatrics skills to serve others.

So for starters, here are a couple of things I learned during the last few years that I think are really important. I will get more into the nuts and bolts of global health careers in the next post.

With the medical director for one of BIPAI's many satellite clinics, Lesotho, 2017

1.     Approach work with humility. This is really rule number 1, 2 and 3 for doing good work in global health. While there are definitely things that can be brought to the table as a U.S.-trained physician, I guarantee my colleagues in Liberia are much more skilled than I am at dealing with malaria, malnutrition, other diseases we don’t see very often in our training. The history of global health is not so neat and pretty as you may think; its riddled with outdated, colonialist and often exploitative motives and strategies that are better off left behind as we move forward. I will be learning as much from the physicians and nurses in Liberia as they’ll learn from me. The absolute last thing many low and middle income countries need is another foreigner barging in, enforcing ‘better’ Western ideals and leaving a mess behind, or worse, gaining credit and fame for work and research done in these countries with no recognition for the health workers on the ground who were integral to getting this work done. As soon as you realize this work is not about you, you’ll already be in a better place to make a difference.

2.     Find a good mentor. Emphasis on good. I wish this had happened to me sooner. As a woman in medicine, pursuing a field that is somewhat atypical, I spent quite a few years feeling lost and rudderless, trying to figure out where I fit in to the big, messy picture that is global health work. I spent way too much time trying to fit myself into expectations of what a doctor’s career should be, and then feeling bad about myself for not really fitting that mold or being happy with who I was becoming as a physician. That all changed once I found a mentor who actually listened to me, tried to understand what I wanted to do, and then did everything in their power to get me to where I am today. I’ll never, ever forget that feeling of realizing this person was there to help me grow, advise me and achieve my own goals, rather than push me into a place or position I didn’t quite fit in. This is so, so crucial, really in any field, but especially for women in medicine and anyone interested in global health. (Sidebar: it may feel like you need to find someone who has a lot of global health experience, but I’d argue you should  pick a mentor based on their enthusiasm and investment in you; someone who is as passionate about your career as you are will be a much better mentor than a more experienced but indifferent person who happens to work in the field.)

3.     Be prepared for burn out. We all know medicine pushes humans to the absolute limits; the long hours, frustration of trying to navigate a broken system, and constant interface with human stress and suffering take a toll on everyone (and if someone says it doesn’t, they’re lying.) These challenges multiply when you enter a system with fewer resources and higher mortality than we are accustomed to as American health care specialists. You can’t help anyone if you develop compassion fatigue and burn out. Know what keeps you going and have an ‘emergency’ plan for those days that are really, really hard. For me its spending time outdoors and skype dates with friends and loved ones; for a colleague its Nutella, face masks and venting sessions with friends in the field. Set time limits to your work days, realize that you as a single person cannot fix every single problem you encounter, and give yourself the grace to accept it.

That’s it for now, I’ll try to write up some of the many, many career options I’ve found in global health in the next couple of days :)

Off to Liberia (next week.)

Friday, January 3, 2020

Since I have a couple days of downtime thanks to some surprise visa issues I figured now was a good time to share a little of what I've learned about Liberia in the months leading up to this trip. Apart from the usual resources such as the CIA world factbook, good old Wikipedia, and google news alerts, I learned a TON from Helene Cooper's Memoir The House at Sugar Beach (linked here). It was riveting and beautifully written, definitely a must-read if you are interested in this part of the world. I am currently reading her book Madame President: The Extraordinary Journey of Ellen Johnson Sirleaf, which you can find here.  I've also been following this blogger to get some insight into the culture and what daily life is like in Monrovia and elsewhere in the country.

I also feel its important to say you could write an entire textbook on this nation's history and I am in no way an expert on this subject; I am just sharing the major highlights and parts of Liberia's history, culture and traditions which I've found really interesting.

While the country was founded by American freed slaves, prior to their arrival over a dozen distinct tribes with their own kings, traditions and customs lived across the region for centuries. The American Colonization Society funded the emigration of a group of former slaves to the West coast of Africa between 1820 and 1843. Although it seemed like a beneficent idea to many, most African slaves at that time had lived in the United States for generations and were not prepared to re-settle on the humid, tropical West coast of Africa. Many became sick and died; just under half survived to 1843, while the ACS continued to fund the journey until the foundation because bankrupt and essentially abandoned the existing settlements to stay afloat. The Americo-Liberians, who came to be known as the Congo, declared their independence in 1847.

From that point until 1980 the Congo minority ruled over the indigenous groups of Liberia in a government model very similar to the United States; being Congo generally meant you were wealthier than the 'country people' and had far more agency than indigenous people of Liberia (does this sound familiar?) Ongoing corruption and skyrocketing prices of basic food and supplies in Liberia led to several often-violent political upheavals between 1980 and 2003. All told 250,000 lives were lost, and many more fled the country. By 2003 much of Liberia's infrastructure was destroyed.

From 2003 onward Liberia has experienced much more stability, but still faces challenges from corruption, exploitation from foreign companies such as Firestone (here's a well-done piece by the Washington Post on the topic and another multi-part longform article from Propublica) and the 2014-2016 Ebola epidemic.

By Sahmeditor - Own work, Public Domain,

In spite of these hurdles, Liberia is a beautiful, culturally diverse and naturally rich place with great potential for growth. While mortality rates remain very high due to diseases such as malaria, tuberculosis and diarrheal illness, a training program exists at the main hospital in Monrovia, where I'll be working, to produce more Liberian-born pediatricians to tackle issues in infant and child mortality such as neonatal disease, early childhood pneumonia and malaria, and malnutrition. Some other things you may not know about Liberia:

  • Most Liberians speak English- Liberian English, which is actually a collection of creolized dialects of English. Another 30 or so languages are also spoken in pockets throughout the country by various ethnic groups
  • Liberia's people consist of 16 ethnic groups, in addition to the Americo-Liberians (Congo) and several expat groups. 95% of the population is made up pf these indigenous peoples, including Kpelle, Bassa, Grebo, and many others. 
  • Due to the influence of the Congo people who came to Liberia from the U.S. in the 19th century, much of Liberia has influences of antebellum south, from the building styles to the religious culture. 
  • Liberia has some great literature- next on my reading list is Murder in the Cassava Patch by Bai T. Moore (see the wiki page here)
  • Something else I'm looking forward to trying is the FOOD. Rice is a staple as are cassava, fish, citrus, plantains, okra, coconut and sweet potatoes. Stews are often flavored with habanero and scotch bonnet chillies (insert flame emoji here) and eaten with fufu, a combination of plantain and cassava flour mixed with water. Check out Anthony Bourdain's No Reservations on Liberia for some mouth-watering visuals (linked here)
  • Liberia had a thriving tourist industry prior to the war. With gorgeous beaches to the West and tropical mountainous regions to the East, its natural beauty landed it on Lonely Planet's list of top 10 places to visit in 2020. There's even a growing surfing community at Robertsport. So if anyone's looking to escape the snow this spring, you know where to find me. (Bonus: the USD is widely accepted!) 
That's all for now. I 

How I Feel About Vaccines

Tuesday, November 5, 2019

girl covering her face with both hands
Photo by Caleb Woods via

When measles cases in Brooklyn and Rockland county shot  past the hundreds last spring,I began to realize the gravity of the situation at hand. In the hospital where I was working, we had already admitted several children with severe measles infections and a young boy with a superinfection of his chickenpox rash that required intravenous antibiotics. In our pediatric ICU, a strong, healthy high school track star was intubated and fighting for her life after contracting pneumonia following a severe bout of the flu. These children could have avoided significant pain and suffering had they been vaccinated. 

I wish vaccine-hesitant parents could see what I see. Measles, flu, even varicella- these diseases can cause tremendous suffering, and even death. In 2019 more people in the Democratic Republic of Congo died of measles than of Ebola.2 In the U.S. the 2017-2018 flu season left an estimated 80,000 people dead.3 186 of those were children.

When I reassure vaccine-hesitant parents that there is incredibly strong evidence that vaccines are safe and effective, and that the study suggesting an association between vaccines and autism has long since been debunked,it doesn’t seem to work. It’s a matter of choice, they tell me. Of their individual right as a parent. But the problem is that this is a choice that affects the health and safety of other people, too.

Viewing vaccine choice as an individual right and issue does not take into consideration the dual purpose of vaccines. Yes, vaccines will prevent an individual from becoming ill. But they also have another crucial effect: herd immunity.6 When at least 90%-95% of a population is vaccinated (the number varies slightly by vaccine,) the illness becomes less common and everyone is protected,7 including those who cannot be vaccinated because of their age or health. They can go to school, to parks, or to other public places with little worry of becoming ill, because the herd of vaccinated neighbors, schoolmates and cohabitants protect them. What should these children do now that vaccination rates in some communities hover as low as 50%? Measles is so aggressively contagious that we shut down our entire urgent care clinic for cleaning when a patient was diagnosed. For children who are to sick or too young to get the MMR vaccine, even walking into your doctor’s office during an outbreak becomes unsafe.  

person injecting someone on his arm
Photo by Hyttalo Souza via 

To be fair, the medical community shoulders some responsibility for vaccine refusal and hesitancy in the United States. In the age of endless information, perhaps it’s been too easy for us to be dismissive of parental concerns and hesitation, without delving deeper into where these concerns are coming from. Some communities have genuine reason to view the medical community with doubt and suspicion, given the Tuskegee syphilis experiment,8 or the coerced sterilization of some minority women.9 Perhaps we have been too quick to tell parents to stop googling, when we should have been having open conversations about why families seek out alternative, questionable sources for information in the first place.

Shortly after the outbreak was declared I was back on the wards. The child with chickenpox had lost his IV, and I was asked to help replace it using an ultrasound machine, since his severe rash was making the task difficult. Even before I entered the room, I could hear him crying. He had been miserable for days with significant itching and pain. As I prepared to place the intravenous line in what was probably a third or fourth attempt that day, a strange thought popped into my head. I wondered if this little boy was given the option of getting vaccinated or being subjected to this, what would he have chosen? 

Note: certain details in this story have been changed to maintain patient privacy. All of the cases discussed are real. All words, thoughts and opinions are my own. 

1.     Goldschmidt, D. (2019, May 13). More than 800 cases of measles in US, with NY outbreak continuing to lead. CNN. Retrieved from
2.    Rossman, J., & Badham, M. (2019, September 18). Over 3,000 people have been killed by a deadly virus in DR Congo this year —and it’s not Ebola. Quartz Africa. Retrieved from
3.  Center for Disease Control. (2018). Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2017–2018 influenza season. Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2017–2018 influenza season. Retrieved from
4.  Vaccine Safety: The Facts. (2018, October 10). Retrieved October 23, 2019, from
5.   Eggertson, L. (2010). Lancet retracts 12-year-old article linking autism to MMR vaccines. Canadian Medical Association Journal, 182(4), E199–E200. doi: 10.1503/cmaj.109-3179
6.     Boyd, R. (2016, April 18). It Takes a Herd. Retrieved October 23, 2019, from
7.  Funk, S. (2017). Critical immunity thresholds for measles elimination. Critical immunity thresholds for measles elimination. London School of Hygiene and Tropical Medicine. Retrieved from
8.  Brown, D. N. (2017, May 16). ‘You’ve got bad blood’: The horror of the Tuskegee syphilis experiment. The Washington Post.
9.    Ko, L. (2016, January 29). Unwanted Sterilization and Eugenics Programs in the United States. Retrieved October 23, 2019, from

Songs that sound like crisp fall air

Thursday, October 3, 2019

Music has always been such a massive part of my life. From early childhood I have distinct memories surrounding music- of listening to Bob Dylan crowing hoarsely outside on our patio, to falling asleep on a long haul in our big green van to the sound of No Doubt's ex-girlfriend. I would watch VHS tapes of B.B. King and Stevie Ray Vaughn with my Dad in his smoky music room, and lie on itchy blankets in the grass on a warm, wet Florida July evening listening to my Mother play the Sousa Alarm in a university band (she wasn't a student there, to be clear- she just loved playing so much she convinced the conductor to let her play each summer. Wonder where I get this love of music from...)

One of my most distinct memories is that time of year when the weather changes (yes, it happens in Florida too)- the air becomes crisper, clear, dry and cold. We had a family car when we were growing up- a gold 1980s Volvo that belonged to my grandmother and was shared among the cousins who were old enough to drive for years after she passed away. My brother and I inherited it around 2005. The AC worked intermittently at best, and those cool mornings driving to school with him were some of my favorite memories from high school.

We both became obsessed with the In the Reins EP. I've written about it before- the blend of Americana steel guitar and Mariachi-style brass instruments blends into a strange-sounding album that's only imperfection is being too short. Here's one example but I highly, highly recommend listening to the full EP. It is easily one of my favorite albums of all time. (Sidebar: I ran into Sam Beam in the parking lot before he played a show when I was in college. It was one of the best moments of my life. Later that evening he dedicated the song 'History of Lovers' to his 'friends from the parking lot.' I have the blurry digital photo to prove it too if you keep scrolling.)

This is a terrible picture and I love it so much. Taken at The Moon in Tallahassee in 2008.

All this to say, I love how music brings you back to a specific place and time in your life. It's such a beautiful, strange phenomenon, isn't it? Also on my fall list: Snow Patrol's Final Straw (the opening track) and Taylor Swift's Red (the whole album, although I'm not as into the more upbeat, pop tracks.) What's on your fall playlist?

Checking In

Wednesday, September 11, 2019

Hello! Breaking out of my sleep deprived phase to check into this space. My brain feels like I'm back in intern year mode again- the overall hours are WAY better but switching between 3 pm- midnight and 10pm-8 am shifts is really putting my circadian rhythm through the ringer. LOL. Oh well. Here's a mix of things I've been reading about/thinking about lately.

Upsetting piece from Vice on coerced sterilization of indigenous women in the U.S. and Canada. If you think mistreatment of Native peoples of North America is in the past, this article is a sad reminder that this is simply not true.

On the positive side, stories like this one remind me that it's not all bad news out there. Amy Yeung is doing amazing work both on the sustainability front and keeping children from going hungry in Navajo reservations. You can shop her store- a mix of upcycled pieces, unique vintage and hand-crafted Native American jewelry and arts- online here.

Interested in working towards a more planet-healthy diet and don't know where to start? Tania from recently published a guide on her experiences. Her instagram is full of great recipe stories and some favorite vegan restaurants around London and beyond. Even if you don't feel like you're up for the challenge of going completely vegan, have a look around- swapping out even a couple of meat-based meals per week for beans, pulses or other veggie options can make a huge difference in your health and the health of the planet. P and I recently tried her chickpea curry and loved it.

On a similar note, this study has been making rounds in the news, and it seems like most outlets are focusing on the observations of increased stroke risk in vegans and vegetarians. Reading through it, it looks like the risk of stroke could be as little as 1.02 times greater to as high as 1.4 times greater risk, or roughly 3 more strokes per 1000 people. While they did adjust for fruit and vegetable intake, to me it wasn't totally clear if they were able to control for proportion of calories coming from processed foods (such as nut cheeses or veggie meats.) It will be interesting to see what subsequent studies show...

Unless you've been living under a rock, you are probably at least aware that Taylor Swift released a new album recently. Since 1989 came out I never know what to expect when she says an album is going to be different from her prior work, but this one is pretty great. Rolling Stone put out this article ranking all her songs up through Reputation, if you're interested in a deep dive (I completely agree with their choice for number one track.) And you know you've got musical street cred when Pitchfork reviews not only your new album but 5 of your prior works (they also clearly recognize the lyrical genius that is Red, haha.)

And for anyone still hating on popular music (I'm going to go out on a limb and say that's pretty much nobody, haha), this meme dissection says everything I could possibly want to say on that as someone who grew up with a love for folk rock, classic rock, country and blues and zero interest in boy bands or Britney Spears. Music can move us in so many ways. We're not in high school any more, so you're not a sell out for loving different types of music. Neil Young's Ragged Glory and Harvest albums are just as genius as Jay-Z's Blueprint 3 and Iron and Wine's EP with Calexico. Its more fun that way anyways...

This is getting long and rambly! I'll blame the weird work/sleep hours. Happy hump day! I'm going to try and post a few more travel posts and a couple more personal ones in the next couple weeks. All depends on how my work/school schedule goes. :)

Maintaining Sanity on Night Float.

Wednesday, August 21, 2019

My sister recently started her sub-internship on night float (side bar: my sister is in her last year of medical school?! Cue the quarter life crisis) and it brought me back to those good old days when I was a wee intern….

And didn’t sleep, froze my butt off every night, and jumped out of my skin with every page, even the ones that were just asking for a Tylenol order. 4 years later, I have a weird appreciation for working in hospitals at night- the quiet hallways, being able to chat with patients and their families uninterrupted, and getting so tired you start laughing at the most nonsensical things with your senior resident. I figured I’d write this out for my sister (if she reads this blog, she might be too cool for this kind of thing. LOL) and any other new interns or almost-interns about to dive into their first experience working nights at hospitals.

Get comfy. Night float shifts are often long, lasting anywhere from 10 to 14 hours. Many nights you’ll be on your feet a lot, and won’t be spending a ton of time sitting or resting, so good shoes are key. Many healthcare workers swear by Danskos; a well-fitting pair will last you for ages ( one nurse I work with has had hers for 7 years,) but make sure to try them on before you purchase, as each pair is handmade and therefore will fit slightly differently. I personally have loved wearing my Allbirds and have also used my running shoes in the past; both worked fine for me.

Another thing people don’t realize off the bat is that hospitals are cold, and they get even colder at night. I would walk into work wearing fleece leggings pretty much from August through mid-June. A fleece or zip-up jacket plus cozy socks and you have a semi-tolerable work environment. Some of my colleagues even had a hospital blanket stowed in their lockers.

Have a sleep strategy. I have never been a good sleeper. I am one of those people whose brain likes to play the game of ‘lets dive into your most cringe-worthy memory or deepest regret!’ as soon as my eyes shut, and breaking routine can really exacerbate my insomnia. I generally had two approaches to sleeping on call- I would prioritize trying to get REM sleep in at least once; at my hospital I had to follow up on midnight and 4 am vital signs, which meant I could sleep for 4 hours in between if my brain would settle down or I was tired enough. If sleep wasn’t coming easily, though (like, say, if I was having the recurring nightmare of the code pager going off and my legs turning to jelly. That was a fun one.) I would hammer out some work- either easy readings, life stuff that I’ve been procrastinating on, or mindlessly running through a few board prep questions. About half of the time these activities were boring enough that I’d eventually nod off.  

There were definitely nights I wasn’t going to be able to sleep; you just have to accept that you’re being paid to work no matter what, and that being paid to sleep is a kind of bonus perk that happens once in a while, but isn’t guaranteed. This mentality helped keep me from getting too stressed out if my grand plans didn’t work out.

Another semi-related tip for interns: do your own night rounds. You certainly don’t have to see every patient, but walk through each unit shortly after nursing sign out to check in, see what’s going on, provide updates and change or correct orders as needed. I would even bring a computer around with me to change orders in real time. This does two things: first, it shows the nurses that you are attentive and care about their contribution to the patient’s care plan. Getting friendly, recognizing names and faces and even engaging in small talk really does go a long way. Second, it reduces the number of pages you will get at 2 am to change that Tylenol from round the clock to as needed, or other non-urgent matters. 😊

Time your caffeine boluses. I tended to be sensitive to caffeine. It made me jittery and jumpy, and would occasionally exacerbate an essential tremor that came out of nowhere in residency. I would usually drink a half cup of coffee before work, then, depending on how the night was going, either plan to lie down and sleep and have another coffee or tea before signout, or on PICU nights when I knew I’d be up, time an 11 pm- midnight coffee to keep me going until signout.

Maximize your home rest. I think of this as two parts- creating a cozy environment to sleep in regardless of time of day, and balancing the need for sleep with the need to maintain a normal circadian rhythm. For me this usually meant blackout curtains and ear plugs (you’d be surprised how noisy it can get during daytime hours at home) plus a 3-4 hour nap, then getting up to do errands or enjoy some sunshine, have dinner, and go to bed early so I was rested enough for the next day. I always found days that I slept much longer than 4 hours led to trouble sleeping later in the evening that could worsen my insomnia for days.

Others I’ve worked with have used working out right after call to ensure they get really good sleep, taking melatonin, or just pushing through the day and going to bed early in the evening. The bottom line is you have to figure out what works for you, but in general if you go into REM sleep for too long, your brain is going to be confused and think you need to be awake every night.

New Year's 2016, celebrating with sparkling grape juice in the pediatric ICU
Have fun. No, really. While there are definitely plenty of rough nights to be had in residency, there's also some true camaraderie to be had on night shifts. Some of my deepest conversations with colleagues and coworkers occurred on night float. Some of us had ‘family dinners’ where all 9 people on the floor teams at night would order Thai food and hang out/chat for half an hour. Sometimes we got together and watched Harry Potter marathons on the fuzzy-screened box of a TV in the heme/onc signout room. A curmudgeonly older nurse would break character on Saturday mornings and make French toast at 4 am for anyone passing by. For one intern’s birthday, we raided the supply closet, made her a birthday crown out of the weirdest supplies we could find, and celebrated with ginger ale mocktails served in plastic pink cups at midnight.

Hope this is at all helpful to someone, and best of luck to all the new interns who started this summer and the sub-interns trying on this role for the first time!

Israel: Jerusalem

Monday, August 19, 2019

After a long and

I was operating on less than 2 hours of sleep for our day trip to Jerusalem, so I'll keep this one short, mostly because I don't remember much of it, haha. I think the smartest thing we did was get up at crack of dawn to catch a 'sherut' (shared taxi or van- more here on different ways to get to and from Jerusalem) into Jerusalem in time for a 7:00 am divine liturgy at the Church of the Holy Sepulchre. To participate and receive holy communion, watching tendrils of smoke lace their way through light and darkness in the lofty Greek chapel, was something I'll never forget.

The rest of our time at the Holy Sepulchre was a mix of fascinating, reverent, and feeling like we were being herded around like chattel. There were SO many different groups of pilgrims it made it hard to move around, although it was nice to see so many people coming to worship and pray. If we had one take home lesson from our experience, its that a lot of these religious sites should be visited as early as possible. By 9 am it was hard to feel serene with the level of crowds that had amassed.

Other than the massive crowds, our experience was great. Jerusalem is definitely a less secular city than Tel Aviv, and we really enjoyed wandering through the various quarters and exploring a place that's been occupied by people for so many millenia. My only other piece of advice is to do research online- this trip was a last-minute tag along for me to one of Peter's work trips, which meant we didn't know a ton going into it. For example, we totally missed out on seeing the Dome of the Rock because there's only a couple short periods each day that its open to non-worshippers (you can find the hours here.)

Hopefully someone finds this interesting/useful for their upcoming visit to Israel and Jerusalem. I'll try to post one more time before my classes start up again.