One day in a Liberian Pediatric ER

Thursday, February 20, 2020

I can't believe a month has gone by since I arrived in Monrovia! A month feels like a long time and no time at all with the pace at which things happen here. On the one hand, things move slowly...getting anything done (even something as simple as a blood pressure, and even in an emergency situation) can feel like it takes ages. On the other hand, time flies by as the days that are packed with dozens of sick patients needing various evaluations and interventions.

I thought a month was enough time to share a bit about what my day looks like here. Because there is a residency program, a lot of aspects of the day are familiar, with a Liberian twist :) No days are exactly alike but they tend to have a general pattern, something that goes like this:

6:10 am: alarm goes off. Depending on how late I stayed up worrying about this or that sick patient, I either hop out of bed to do a quick home workout or scroll through my phone a bit. I drink a ton of water as there's no clean water to refill my nalgene bottle with at work and take my anti-malarial pill. I usually listen to a podcast or audiobook while getting dressed ready to go. Liberian doctors tend to dress pretty formally (and have great style) so unless you're on call no one wears scrubs- they will typically dress in business attire with a lot of beautifully patterned custom-made dresses and suits sewn from lappa fabric (more on that another day.) I usually wear business attire and a white coat with a small notebook, pen and the WHO blue book (basically a global health pediatric bible) in the pockets.



7:00 am: the sun has started rising just enough that its safe to walk to work (as someone who is obviously Western you can't really blend in here, and petty crimes aren't uncommon.) I usually bring my breakfast to work- a banana, coffee and peanut butter smoothie that I may have become slightly addicted to. The hospital is 15 minutes away and if the weather is nice I get to catch a beautiful sunrise through the Sahara dust that blankets the atmosphere during the dry season.

Beautiful mural at the hospital's main entrance. It depicts the history of medicine in Liberia, including the traditional healers all the way up to the present day. 

7:15 am: I arrive in the pediatric emergency room to pre-round. The room is shaped like a T- the base of the T has a a row of chairs on one side where patients who have been triaged wait to be seen, and a large desk and chairs on the the other side where the docs can sit and review charts, interview patients and document. Unless there is an active resuscitation going on (which isn't that uncommon,) I sit down here and review the charts.



The top horizontal bar of the T contains 8 patient beds (there's also two doors to the left- one leading to the outpatient department, one to another room for patients who will have shorter admissions.) These are the sickest and/or newest patients. After reviewing the vitals, notes, diagnosis and medications served, my goal is to examine all of these kiddos before 8 am. Because of the aforementioned codes/high acuity (new sick patients arrive all the time, or I may get caught up addressing a patient who is getting worse right in front of me), this doesn't happen as much as I'd like. You just kind of have to take things as they come here.

8:00 am: morning meeting occurs on the wards in the main hospital, meaning I am usually dashing upstairs at 7:55 am to grab my white coat and make it in time (some things never change; I will forever be afraid of lateness, even when it isn't uncommon here.) Similar to the U.S. system, the overnight team presents all admissions from the last 24 hours, as well as any deaths. The consultants (attendings) and specialists (board eligible pediatricians in the process of becoming attendings) will comment and highlight teaching points on various cases. The West African medical teaching and lecture style is pretty formal compared to American training, but I try to weigh in occasionally if I feel I have a useful or unique perspective to add. Residents and attendings can also share announcements, concerns and issues at the end of morning meeting so they can be discussed in an open forum where everyone can have their say.

9:30 am (ish): this is where the day becomes more fluid. After morning meeting I head back to the peds ER for rounds. Depending on the specialists, rounds can either involve significant teaching, be rapid fire/brief, or not happen at all if the ER is very chaotic with a large volume of patients to see. We usually have several medical students, an intern and 1-2 residents around to present each patient, discuss the current medications and plan, and decide what the next steps in care are.

Something that's been a fascinating adjustment for me is patient ownership. In the U.S., as a resident I'd arrive on the wards each morning with a neat list of 5-10 patients I was primarily responsible for that day. Here, every patient is under the care of all of us as a team; the resident presenting the patient is arbitrarily chosen and the third year, specialist and consultant all agree on the plan together (though the most senior person has the final say.) Its been a fascinating deviation from what I am used to that is a better fit for the Liberian culture and practice style.

We see a lot of very sick patients; birth asphyxia (when the baby is deprived of oxygen and comes out critically ill with neurologic damage,) sepsis and other infections, and severe malnutrition are incredibly common and come with very high mortality rate.

One factor we consider in decision-making that I didn't expect was the cost to families; apart from a limited selection of medicines, everything we choose to do costs money. From a CBC to an x-ray, to selection of the correct antibiotic, parents have to scrounge up what little money they have to buy sometimes life-saving treatments for their kids. For a parent who makes only a dollar a day, even spending five dollars on a lab test or medication can be close to impossible.

Noon- 2 pm (ish): after rounds I tend to stick around for a bit to see how I can help without impeding work flow. This could mean I am writing in the chart, following up on a blood pressure or discussing a complex case a bit further with the residents and specialists. Eventually I make my way upstairs to work on research, helping the residents gain uptodate access, and looking up papers and articles on various interesting cases we've had to share with the team.

2 pm- 5 pm (ish): Depending on the day, there's loads of things going on during this time. Like any residency program, various lectures are given, either by the residents or by a local or visiting consultant or specialist. There are also various official exams at any given time of year; currently the first years are preparing for their exams (something between a Step 1 and Step 2-type of test) and we meeting regularly to review topics and go over questions. I also spend time with our research nurse entering data, tracking down missing information and troubleshooting whatever issues may be arising in the ongoing research work on a given week.

While the clinical work is a great learning experience for me, I find my work in the afternoon to be more rewarding; because of resource limitations there's not a whole lot I can do to improve outcomes on the level of individual patients. It can be incredibly emotionally draining to see your third newborn in 24 hours die from the same preventable illness (true story. More on that later.) But with collaborative research, and with actionable, big-picture policy changes, slowly over over time you can start to enact meaningful changes, and hopefully over time see improved outcomes.

5 pm-6 pm (ish): I check in with the peds ER 1 last time before heading home. If things are quiet, this could just be hanging out with the specialist, or reviewing patients of concern (watchers) with the overnight resident team to come up with contingency plans. Its not unusual for an actively crashing patient to be rushed in though, requiring resuscitation of some kind. These cases are the hardest because if I don't leave before dark it isn't safe to walk home, and because of recent gas shortages its not always easy to find a cab to drive you. So much of this job causes scenarios like this, of moral discomfort. I can't say that leaving feels like the right thing to do, but I can't help anyone if something bad happens to me. There's way more to unpack there than I feel up to sharing at the moment, but it is definitely an uncomfortable conundrum I encounter pretty regularly, so it would feel odd not to at least acknowledge it.

My favorite fruit stand...its bananas how good the bananas here are (pun intended)


6 pm: If I don't stop at the supermarket or fruit stand by the hospital to grab more bananas, I arrive home, usually covered in sweat. I tend to immediately throw on my swimsuit and jump in the pool to cool off if I have time. Taking a couple minutes to swim some easy laps and unpack what I've seen/heard/felt throughout the day helps me to transition from the "everything is on fire and everyone is sick" mode into a more relaxed and reflective state. I tend to cook something easy and quick, maybe watch 20 minutes of a show while having dinner, then read on a few topics I jotted down throughout the day or get some research work done, depending on what's on my to-do list.

9 -9:30 pm: wind-down time before bed. One thing I really appreciate here is a consistent schedule; not working evening and overnight shifts like I do in the U.S. is one of the nicer luxuries of my time over here. The overnight team can call me any time but usually don't unless there's something they feel I can specifically help them with. I usually read a novel, listen to a podcast, watch something or whatsapp call family before going to bed around 10 pm.

And that's a typical day as a clinical pediatric fellow in an urban Liberian referral hospital! In the future I may share more of the specific types of cases we see, or how the health system works, and hopefully introduce some of the incredible doctors I have been working with, but for now I just wanted to share what happens on a day-to-day basis. Hope its interesting to someone :) Feel free to share any particular questions or thoughts in the comments.








Global Health Careers: Part II

Sunday, February 2, 2020



Ok, so here’s part 2 for global health career paths… I am a physician so this is pretty physician-geared, but I want to re-emphasize that there are tons of areas of work in global health, many of which don’t require any sort of clinical degree. I just wanted to share some of the resources I’ve accrued in case anyone else is interested in this kind of work. These ideas are by no means an exhaustive list. I sorted these out chronologically/by career stage so it should feel like a sort of pathway into global health from start to finish, but if I’ve learned anything in the last couple of years its that there are probably dozens of ways you could go about doing this and there’s no ‘right’ way to pursue a career in global health. Hopefully its helpful to someone interested in getting involved in this field :)

Undergraduate/pre-med. With some exceptions, I would not rush into field work at this stage. Unless you have something concrete to offer such as EMS skills or language proficiency, I really would spend this time learning, reading, and absorbing everything you can from the field of global health. Work experience overseas is great, but be selective about the programs you choose to become involved with. You never want to be in a position where your presence is causing more harm than good. For me working through a Fulbright grant offered a great opportunity to work overseas doing research without becoming involved in direct medical care. It was easily one of the coolest things I’ve ever done. For more information on how to apply for a Fulbright Grant, see their website here

In the meantime there are plenty of great resources you can explore to continue learning about the field- you can follow mailing lists such as NPR’s Goats and Soda, Johns Hopkins’ Global Health NOW and the Center for Global Development. There are also many great books- too many to list, but Mountains Beyond Mountains and The Spirit Catches You and You Fall Down are two that I was recommended again and again.

Right after undergrad is also not a bad time to pursue an MPH, especially if you’re still not sure if clinical medicine is for you, or you’re not sure your application for medical school is strong enough yet. If this isn’t you, I’d strongly consider waiting until during or after medical school. The reason for this is twofold: one, if you hold off on getting your MPH until residency or fellowship, there’s a good chance someone will pay for it for you- yay! Secondly, a master’s degree in public health is the kind of graduate training where it kind of does matter where you go. While you don’t have to go to a top 10 program, you should definitely aim to go somewhere with a robust global health curriculum and reputation, as networking is one of the key reasons to get an MPH. Here’s a list of some of the top master’s programs when it comes to global health. 

Medical School. Ok so first off, just learn how to survive and thrive in the insanely rigorous environment that is medical school. If you plan to practice clinical medicine, the best thing you can do to prepare yourself for a job in global health is to learn great clinical medicine. Once you feel you’ve found your footing in medical school, you can start to seek out opportunities and experiences in global health. This may take the form of a rotation overseas or online, an interest group, a spring break trip or lecture series. Whatever you do, I still think you should prioritize quality over quantity- make sure if you are going to work overseas your have adequate supervision, and your presence is not causing more harm than good. This may mean an ‘away’ rotation with a medical school that has a well-established, positive relationship with a hospital overseas rather than an experience with your own school.

Medical School is also a great time to consider an MPH; some people take time to do it before clinical medicine rotations begin, or before they apply for residencies. You’re already going into a ton of debt so it will be a balance of finding the best program for global health you can get accepted into and the program that won’t cost you an arm and a leg (this is key! It’s a lot harder to work in this field if you accrue a ton of loans.) On that note, while virtually everyone takes on loans for medical school, if you truly want to pursue a career in global health, you want to know all your options, and consider things like scholarships and the public service loan forgiveness programs.

Residency. Again, step 1 is focusing on becoming a strong clinician. But before you submit your rank order list, if you are considering a career in global health, I would strongly, strongly recommend ranking programs with global health tracks. These tracks vary widely, from a few courses with a short project assignment to an entire extra year sent at a site overseas. In pediatrics the programs doing the most in global health are generally Boston Children’s, CHOP, UCSF and Baylor School of Medicine, but there are plenty of small and mid-sized programs with great opportunities as well. A quick google search will give you pages and pages of info, and the ABP guide (linked here) is also a great resource and guide for trainees interested in global health tracks and pathways.

If you aren’t at a program with a strong global health track or presence, don’t worry. There are definitely still options to stay involved in global health. Baylor’s International Pediatric AIDS Initiative offers 4-6 week rotations to outside residents. I also did nearly all my mandatory presentations on global health topics, from journal clubs on hand-held echo use in diagnosis rheumatic heart disease to resident as teacher talks on HIV/TB. Staying involved in global health societies, such as the Consortium of Universities in Global Health, and the AAP’s SOICH (if you are in pediatrics) other ways to continue to network as you complete your training.

Everything else. Once you’re an attending, the world really is your oyster. If you are truly passionate about a subspecialty field, now is a great time to become involved in global health as a fellow, as there’s huge need for specialty care in low and middle-income countries worldwide. ID, critical care, neonatology and emergency medicine tend to be subspecialties with a decent amount of overlap with global health, but it does vary A LOT from program to program.

I was somewhat undecided about subspecialties, and wanted more on the ground clinical experience, so I went for a global health fellowship. Only a handful of pediatric programs offer an entire fellowship for global health (At the time that I was researching options last year it was UCSF’s HEAL program, Utah, CHOP and Boston Children’s Hospital.) Some are more research driven and require NIH K-grant funding, while others (like mine) are funded through the fellows working as gen peds clinicians in community hospitals for half the year to fund the other half of your time being spent working abroad. A big driver for me was that I am getting part of my MPH funded (yep! Another reason waiting to get your MPH isn’t always a bad idea) but I also feel very, very lucky to be able to work with and learn from the network of people here who are doing amazing things in global health.

I will also say many people just get out there and practice global health. This may be through a U.S.-based program (BIPAI hires general pediatricians for their HIV clinics, and Seed Global Health hires physicians to teach Helping Babies Breathe Curricula in resource-poor settings) or through an international NGO (MSF is very competitive and offers only longer stints unless you work in certain specialties, but there are many smaller organizations looking for physicians to assist with various projects.)

One extra option I’ll throw out there- the CDC has a field epidemiologist training program that basically trains both physicians and non-physicians to address epidemics in the field and is another great way to get on the ground experience and training. The UK and EU also have a similar track.

Hope this has been a helpful guide to anyone who is interested :) Feel free to message me or comment if there's anything you're particularly curious about. 


  

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

Source: https://www.dreamstime.com/royalty-free-stock-photography-sierra-leone-liberia-image4954487 
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, https://commons.wikimedia.org/w/index.php?curid=3575700

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 unsplash.com



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 unsplash.com 

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. 

References
1.     Goldschmidt, D. (2019, May 13). More than 800 cases of measles in US, with NY outbreak continuing to lead. CNN. Retrieved from https://www.cnn.com/2019/05/13/health/measles-update-cdc-800-cases/index.html
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 https://qz.com/africa/1711485/measles-is-killing-more-people-in-dr-congo-than-ebola/
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 https://www.cdc.gov/flu/about/burden/2017-2018.htm
4.  Vaccine Safety: The Facts. (2018, October 10). Retrieved October 23, 2019, from https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Vaccine-Safety-The-Facts.aspx.
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 https://www.aap.org/en-us/aap-voices/Pages/It-Takes-a-Herd.aspx.
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 https://www.who.int/immunization/sage/meetings/2017/october/2._target_immunity_levels_FUNK.pdf
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 http://www.pbs.org/independentlens/blog/unwanted-sterilization-and-eugenics-programs-in-the-united-states/





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 joyfelicityjane.com 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. :)