Dear E

When you were tiny, just twelve weeks old, I went back to work. I cried as I gave you a kiss and handed you off to Dad so I could go to my first shift, cried in the car on the drive in to the hospital, cried in the call room as I set up my pump parts, ready to go at a moments' notice, so I could pump even if the ER was packed. I remember the first time I was pumping when a code was called, and I spilled milk and flanges scattered across the floor as I scrambled to grab my badge and stethoscope and rush back down to the ER. At 12 weeks, I was not ready to be away from you. You needed your Momma.

It did get easier, but even as you got older and less dependent on me and my body for love, nutrition and comfort, I couldn't help but have this nagging feeling, this sadness, every time I left. It shifted- from guilt about being away from you when I knew how much we both loved breastfeeding cuddles, to feeling haunted by your cries when I left you in your nanny's arms, even when I found you laughing and smiling with her hours later.

It was a feeling so intense I even turned down a dream job in global health at a reputable hospital, the perfect next step in my career, to be home more with you and baby brother. I was tired of being the Working Mom, constantly missing you, wanting to show up 100% for my job and 100% for you, and feeling like I was failing at both.

Now we're home together as a family of four. I have you and M all to myself (except for Yiayia, who I am happy to share with.) I take you to the playground, to 'cookie dates' at Starbucks, to library class. With M in my arms I tuck you in for naps, help you start an art project or science experiment, make your favorite snacks. The (not so) perfect stay at home Mom.

But now that I've been both Moms, I see things differently. M is 9 weeks. I'm going back to work Friday. Dad will watch you guys while I spend 3 hours at my own Dad's outpatient clinic. You know I am a doctor and that I 'take care of sick babies.' You know I use a stethoscope and bring you back stickers from our nurses at clinic and the busy urgent care one town over. After getting home I trip over myself to change out of my scrubs and hold you. I'm convinced your mommy's home hugs are your best hugs ever. And this broken patriarchal society we live in, I love showing you that I, your mother, can provide for you and for my family.

I'm not sad I turned down the busy hospital job. 15 hour night shifts and a 0.8 FTE are sacrifices I am no longer willing to make for my career, at least not for now. I swapped the high intensity (and high paying) jobs in hospitals for lighter, more flexible work. I swapped the steady paycheck for the ability to say 'no' to work whenever I want to - something that for me feels priceless at this stage in my life. Its a little scary, but I'm thankful I even have this choice. It's a privilege I know many cannot afford.

I used to think that if I succeeded as a doctor I failed somewhere as a Mom, and that if I threw myself into motherhood I was failing myself in my chosen vocation. But it's just not true.

I realize now that it's not that I hated being a working mom. I just needed to do both, on my own terms.

I'm not a stay at home Mom. And I'm not a working mom. I'm just mom.

Love you.

Mommy

Travel with a baby (hi, we have a baby!)

 Um, hi, hello! I always tell myself I will never take a month off from writing...and then life hits. And to be honest, I don't think I've ever had a bigger distraction than the one we've got right now...

In November I became a mom, maybe a couple days after that last post (and a few days early, to my shock and disbelief!) It has been a wild ride but suffice it to say we are so incredibly happy to have little E in our lives.

I'm not up for sharing the birth story just yet (may never be, to be honest) but I did want to pop on here and share how our travels went and what we learned. We traveled a lot before E came into our lives, and since her birth we've lived in 3 different places(!) Some days I felt really awesome managing to continue working in global health and travel with a baby in tow. And some (many) days I felt like I was drowning and life was irrevocably changed and I was failing at both my career and being a good mother. I think both are true to an extent (that's a story for another day.) So without further ado, here's some general advice and things we found that made traveling with a baby easier. 

Have a loose routine. Like it or not, your life will change when a baby arrives. When E first came (aka before reality hit,) I was very motivated to keep life as unchanged as possible. I tried to get her to sleep anywhere, with normal daily life buzzing in the background, in hopes that she'd learn to sleep on the go. HA. ha. Did you know that babies are actual humans? (note the sarcasm here.) And sure, some humans can literally sleep anywhere...Others need pitch black, total silence, Abby the bear and a lavender diffuser in the room to sleep well. Once we were exhausted into submission, we found a happy medium that worked for us by tracking and identifying our kiddo's wake windows/sleepy times and establishing a flexible schedule and sleep routine that worked for us. We loved the Huckleberry app for this (side note: none of these shares are sponsored.)

Obviously we didn't want something too complicated so it would be easy to implement in a bunch of different places (in the last month alone we have put her down for naps/bedtime in 2 houses and 3 different hotel rooms plus the occasional car or lap on the airplane.) So I'd argue for something really simple/loose- for us it's change diaper, sleep sack, books, bed with the sound machine on/lights out for naps (we just add a bath for bedtime, which can be skipped in a pinch) and naps around 9 am, 1 pm and 5 pm +/- 30 minutes. It really did work wonders for us. E is a different kid when she's able to sleep well, and this simple routine goes a long way in helping her get the rest she needs.

...And be willing to break it. Ok so I know I just went on and on about how amazing routines are...but hear me out. If you've got limited time somewhere (whether a few days or a few weeks,) you're not going to want to spend 5 hours of your vacation sitting in a hotel room in the dark, texting your significant other because you can't actually speak since the little one is sleeping two feet away. Peter and I agonized over this for a long time. Ultimately what worked for us was prioritizing naps in the first parts of the day, and either skipping or pushing off the later nap to do things as a family, since the third nap is hit or miss for her anyways. Sometimes we ended up with a grumpier baby. Sometimes it ended with E excitedly flailing her arms at the sighting of her first ever bison, a truly sweet and hilarious thing to see. 

We really tried not to do this every day, but on weekends or special occasions we wanted E to see or do something with us as a family, we made it work. It ended up giving us some sweet family moments that we would have missed out on if we were nap-trapped in our hotel room. 

Have an on the go routine option. I guess this is an extension of having a routine. South Dakota is pretty rural and spread out, so we spent many 3 hour chunks of time driving with E having a meltdown because she was so tired and couldn't sleep more than 10 minutes. That was until we stumbled on the magic of mimicry- in an act of desperation I flung my nursing cover over the car seat, we blasted the AC to make some white noise and just kept driving in total silence. While I wouldn't recommend using this method routinely, it did work for us and could prove useful if you're in a bind. 

Modify your expectations. When we first arrived in South Dakota one of the first websites I found had a list of '15 things to do in a day in the Black Hills.' Being a realist with a 5 month old, I cut the list down to 8 or 9 things that were realistic with an infant and sounded like fun. In the span of 4-ish days in the area we did 4-5 of them. Some of that was weather and not baby-related, but the reality is time just disappears with an infant. The days of driving for 8 or 9 hours straight are gone- instead, every 2-3ish hours we were stopping to check a diaper and feed. When we visited the site of the Wounded Knee Massacre I ended up stuck in the car nursing and didn't get to climb the hilltop to pay my respects. 

The first weekend I was super disappointed that my 7-item to do list went so terribly. By the last weekend there, we'd figured out that for stuff we were trying to do (mostly scenic drives, sight-seeing and short hikes) a list of 3 felt less daunting- 2 things we would definitely get done and one that was a maybe, depending on how well the day had gone. You can probably adjust this based on driving time, how long it takes to do something, your child's age, etc. But the more laidback schedule definitely made for a more enjoyable time for all of us.

Stay close to the action. I wish we had learned this sooner! Our first weekend out exploring we booked a hotel that we knew was kid friendly but was also an hour away from the hikes and parks. With a small infant often the timeframe that they're awake and happy is pretty short- in our case at most 3 hours on a good day. Staying somewhere we could walk or quickly drive to the spots we wanted to check out made a huge difference! Less time driving = more time to do things you enjoy as a family. It's that simple :) If you do one thing differently on your travels, I'd say this should be it, even if it means paying a little more for that convenience.

Come up with your packing list. Having moved to two states in E's first 6 months, I now have a good sense of what we do and don't use for her in the span of a couple days, a couple weeks, etc. This will definitely look different for everyone, but in general we realized we should have packed more clothes and fewer toys. E went through multiple outfits a day some days thanks to spit up, drool, and blow outs, and babies are often down to play with just about anything (just make sure it's safe/not a choking hazard.) They also LOVE repetition- she ended up playing with the same 1-2 toys every car ride, and we read her 4 of the same books over the span of of that month we were gone. I would also add that it is helpful to calculate how many diapers your kid goes through in 24 hours, then figure out how many you should bring for your travel day from there and maybe multiply by 1.2- just for peace of mind :) then you can buy as many diapers as you need once you arrive. We always purchased more than we needed and ended up donating what was left over to a local organization. 

As far as large items, a few things to know before you go: if you're renting a car you can also rent a car seat, and most hotels have pack and plays/cribs you can use- just ask! If you've got a mobile little one I'd also think about if there's a safe space to put the baby down, if you can make a space up by moving stuff around, or if it's worth it to try and buy an exer-saucer or playpen secondhand. I'd also add if your kiddo is taking some solids a high chair would be useful if you're going to be somewhere long term. We had some pretty comical dinners where we'd sit E on our laps in a diaper with a towel to keep things clean. A high chair would definitely have made life easier!

Stroll (or carry? or...) So this is less of a recommendation than a call for advice...do you bring your stroller or carry your little one through the airport? We've done both- it was super useful to have in Boston when we flew to Florida with all our stuff- but once we arrived at our hosuing in South Dakota we didn't touch the stroller as Peter carries E in our Lille carrier (linked, no commission.) I imagine once the family grows the stroller is kind of a must. But with one baby and a backpack diaper bag we found it much easier to navigate travel with our Sakura Bloom or the Lille. We also found the more stuff we could check or gate check to the final destination, the easier life was. And the less sore and exhausted we were by the time we made it to our lodging.

If you're a parent let me know what you find to be the best way to travel with your little one! Would love to hear more tips/advice. :)

Photo by the insanely talented Lyndsay Hannah. Definitely check her out if you are in the Boston area and in need of a family photographer.

Global Health will never be the same (and maybe it's not a bad thing.)

During my time overseas I got tapped to assist with a training session of sorts for the resident physicians at the hospital. A handful of people had flown in from the U.S. to facilitate the sessions, and they ended up staying at the same complex as me and inviting me out to dinner a couple times.

On one night out in particular, one of the visitors casually mentioned over club beers that he was exasperated with his group of trainees. They just weren’t interested in the research topic he wanted them to get involved in. He complained that he wasn’t sure how his study was going to get off the ground in time if they didn’t get on board (and by ‘on time’ he meant before he returned home a few days later.)

I quietly sipped my beer and said nothing. These comments surprised me. I had been around a couple of months and gotten to know several of the resident physicians. Most of those involved in the training session were senior trainees who had their own ideas about what problems concerned them in their patient populations, and what they wanted to study. I also knew a little about this person’s study topic of interest, and from my brief time on the ground knew there were probably a dozen different research projects that, if pursued and funded, could have a much bigger impact on our ability to help our patients.

Fast forward several months and both me and this person are back in the United States, for the foreseeable future or until our government can get itself together and stop being the punch line of pandemic response jokes. I haven’t written about it much (between school and work and life changes I haven’t had much time to sit and write my feelings about the pandemic and global health out) but I have definitely thought about this a lot. How being forced out of so many poorer nations where we are used to being hands on and taking the lead has forced us all to take a step back, to slow down, and really reflect inwardly on what our motives are and how to best move forward if we truly want to be of service.

I am not a perfect global health worker. I have had my share of mistakes and white savior moments. I’d like to think I’ve learned from them, and from my time working with the pediatric team in Liberia, although there will always be room to improve. And I can’t help but think that being forced to stay home, having limited access to all but 14 other nationals in the world, is a good thing for Western global health workers.

For a long time, we’ve been flying in for short visits, trying to use that fleeting time to establish connections, and accomplish whatever teaching or research is on our agenda. But what about our colleagues on the ground? The doctors, nurses, and public health workers that work in these clinics and hospitals every single day, and know the health system like the back of their hand? They see when infants come in time and time again with birth asphyxia, or when their adult patients show up sick and dying from an AIDS-defining illness because of the cultural stigma that keeps them from seeking care for their HIV. They see these problems every day, up close and personal. Are these not the best people to decide where resources go for research, for interventions and system changes? Who are we (myself included) to arrive somewhere for a few short weeks of the year and decide that we know best what the problems are in this hospital, or system, or community? And who are we to decide we know best how to fix it?

I’m not trying to say I’m glad that Americans can’t go anywhere (though it’s definitely the right decision for the rest of the world to shut us out right now.) My time working with the doctors and staff in Liberia was invaluable; I learned so much from my colleagues, and hopefully was able to be of use to the residents and residency program as well. So much can be gained by both parties from long-term, on-the-ground collaborations involving face-to-face clinical time overseas.

But if the pandemic does anything, I hope it forces Western global health workers to take a back seat- let their partners and collaborators in their respective home countries take the wheel and direct the work towards the problems they see as most important. Let’s continue to share resources, but without the many caveats and contingencies we’ve become so hellbent on tacking onto delivery of global health care. Instead of barging in with that brilliant idea already written out into a proposal, work with a partner overseas – help them to draft a proposal of their own idea, to navigate the colonialist world of academia to get their own research ideas off the ground. Maybe this is the kind of work we should have been doing all along.

This is getting long so I’ll cap it here. For some more interesting perspectives on how global health may change in the post-pandemic era from people who are much smarter than I am, check out this link…hope everyone stays safe and well this week!

Weeding through the conspiracies.

Well, hi! If you told me in February I would be back from Liberia, in Boston, working at home while SARS-COV2 wreaks havoc around the globe, I would have given you major side eyes, but here we are. I’ve been working from home about 6 weeks now, mostly doing some data entry with a little bit of analytics thrown in, and a lot of wondering what the future will be like, not just for myself but anyone working in global health and international development.

While I hate that the pandemic pulled me from my field site early, where I was just getting comfortable and learning so much from my patients and colleagues, the switch up of big countries like the U.S. fumbling through the realities of this pandemic while places like Liberia hit the ground running, years of experience with the Ebola epidemic in tow, has been an interesting and refreshing change in the narrative. Not that anyone has the perfect response down (I’m convinced we won’t know what that looks like without some degree of hindsight and reflection,) but it was about time for Westerners to eat some humble pie and realize we have as much to learn from our partners in underserved parts of the world as we do to offer.

There is a lot that is bad about this pandemic (hi, stating the obvious here!) From the little things like not knowing when we’ll be able to hug our loved ones, to the big things like the much worse impact on black communities and the poor, to the plain and simple fact that this virus has killed more a quarter of a million people (see WHO’s latest situation report for more alarming numbers.)

But to me one of the scariest aspects of the Covid-19 pandemic is the misinformation circulating online. Maybe not even the misinformation itself, but the sheer speed at which the conspiracy theories, pseudo-truths and totally false allegations have made their way to social media. Even as patients died gasping for air in overcrowded hospitals in Queens, Facebook experts were calling into question the gravity of the situation, incorrectly crunching mortality rates then spreading the information like wildfire to their social media followers. Information comes out so quickly that it must be extremely difficult as a lay person to know what is and isn’t reliable information. I really do feel for the public on this one, especially those without a background in medicine and research.

Things reached a head late this week with the plandemic video. I was planning to ignore it until it started circulating in a private email chain with family members in the medical field, some of who decided to partially defend the video in the name of censorship and the right to free speech. Americans have always embraced our rights to do and say what we want, when we want, often to a fault (see: vaccinal refusal, or the shooting of a black man going for a jog by armed civilians.) We fight for the right to say and do what we feel is best without government interference (if you’re the right kind of citizen, that is. A conversation for another day.) To live and let live. But what happens when your voice and your circulation of false information endangers the health and wellbeing of others? When your choice not to wear a mask, not to vaccinate, endangers your 65 year old neighbor with diabetes, your newborn niece or nephew, or just the unlucky person you happen to pass by in the grocery store?

I thought about watching the video just to break it down piece by piece. I chose not to because a. it’s 26 minutes and life is short/too precious to waste time on listening to information that sounded incredibly suspect just from the title b. there’s a long and detailed about page that tells me what I need to know and c. several physicians and specialists have already written some great responses. I’ve included them below. Please read them. Some are admittedly more inflammatory than others. If you think or thought at any point that Plandemic was a plausible reality, I ‘ll try my best not to judge you. These are frightening times, and there is a weird comfort in latching on to ‘answers’ like the ones provided in this video, strange and incredulous as they may be.

https://www.npr.org/2020/05/08/852451652/seen-plandemic-we-take-a-close-look-at-the-viral-conspiracy-video-s-claims Great breakdown of the major allegations of the video, put out by NPR. All responses carefully cited.

https://www.facebook.com/jenniferkastenmd/posts/a-response-to-videos-including-plandemic-by-judy-mikovits-phd-on-the-origins-of-/133429318310015/ One of the best, most well-written responses in my opinion. She sticks to facts and avoids inflammatory language that may generate an emotional reaction that stops you from reading. Well cited with reliable sources.

https://respectfulinsolence.com/2020/05/06/judy-mikovits-pandemic/ The first response I saw to the video. Slightly inflammatory. I admit I along with many pediatricians/physicians who have been responding to vaccine hesitancy for several years now do find it strenuous and sometimes tiring to find ourselves in the same arguments over and over again as we work so hard to protect our patients and our families. But this is an excellent piece with citations for every counter-argument. It sticks to the facts.

https://instrumentofmercy.com/2020/05/07/why-your-christian-friends-and-family-members-are-so-easily-fooled-by-conspiracy-theories/?fbclid=IwAR1hkFgPo_zjOAEjmkB_GVGSm_WhWnAJ3ZOx-EXcCmoZWK3f-1HuE9hhGdk Probably the most inflammatory. I am a Christian, and I have also seen a pattern of Christians (not all, but a handful) I am friends with on Facebook, posting conspiracy theory content more frequently than connections from other parts of my life. Skip the intro and dive in at the section titled ‘Why we all love a good conspiracy theory.’ Some really great psychology and logic behind why we as humans are intrigued by these theories and how we can think critically through them.

https://theconversation.com/is-this-study-legit-5-questions-to-ask-when-reading-news-stories-of-medical-research-117836 Lastly, a great read on how to differentiate between good and bad scientific studies. While not directly related to the Plandemic video, a lack of knowledge about science writing and how to critique research articles leaves anyone vulnerable to misinterpreting data, science and facts. I will fully admit that scientific papers can be hard to read and interpret.

I hope these responses to the Plandemic video are helpful to you. No offense meant in any way. While I am happy to answer questions and have healthy discussions, I am not interested in debating this video so please don’t comment or message me with comebacks as to why I’m wrong or the video is correct. I’m not changing my view on this one and if you aren’t open to thinking differently about these issues this isn’t the place for you.

Stay safe everyone,

Look for the Helpers.

Well I’ve been home a week today, and besides sleeping very well at night, I’m feeling sort of useless. As of right now I’m not needed back until next week, and until our new data collection system is up and running, there won’t be much I can do remotely to help my colleagues overseas. While I’m insanely thankful to be home, with my husband, who still has his job and brings me oat milk lattes every morning (the real MVP,) as someone with an medical degree I’m feeling pretty restless right now, wanting to help out but not sure where to go from here.

So I decided to come up with a short list of ways to help from home during this pandemic. I’m sure this list isn’t exhaustive, and it certainly isn’t much of a contribution compared to those on the frontlines of this crisis (not just nurses and doctors, but those keeping the grocery stores stocked, delivering much-needed supplies, running tests, organizing response logistics…the list goes on…) I’m pretty sure its better than binge-watching the rest of Mad Men on Netflix.

Stay home. This cannot be emphasized enough. And I think most people get it. We’re starting to sound like broken records at this point. But to the Evangeline Lilys of the world, who think this is some thinly veiled mechanism to slowly redact our freedoms…just stop. If you care more about your freedom than the life of your immuno-compromised friend, your elderly parent, the physicians, nurses and other health workers who risk their lives for us every day…. Then I don’t think there’s anything anyone can say to make you listen. But if those people matter even one iota to you, please stay home.

 Donate your masks and protective equipment. Hospitals in New York, Boston, and pretty much anywhere with a lot of Covid-19 cases are running critically low on masks and other personal protective equipment. Currently at my job we are being rationed one mask per shift, and other hospitals only have enough for one mask per week per health worker. Please help us help you, and donate any unused masks or protective equipment you may have to the nearest hospital.

Donate to support others in need. Global crises always have a way of disproportionately harming society’s most vulnerable groups. School closures and job disruptions have left even more people than usual going hungry both in the United States and Globally. Food banks can help safely deliver needed supplies to those who are most in need (check out feedingamerica.org to see how you can help,) and WHO provides much-needed supplies and support to Covid-19 responses in low-income countries. Check out the Covid-19 Solidarity Response Fund for more details.

Shop small. It’s probably no surprise to anyone that small businesses are suffering. If your budget allows, ordering a gift card, or having food delivered from your favorite local restaurant, can help keep places going while their business has otherwise screeched to a halt. Don’t forget to tip well; those in the service industry have just lost the majority of their income (maybe a sign that the tipping culture in the U.S. is an epic fail, and we need to pay everyone a fair wage? What a novel idea…) If you know any artists, makers or musicians, consider ordering from their online shop if they have one, or venmoing a few bucks in exchange for a virtual serenade (I did this with @Castroviolin who plays beautifully in both famous halls and the NYC subway and it was lovely.)

Show your kind side. It sounds dumb but I really do believe our attitudes and behavior can impact others in small and meaningful ways. Thank the grocery store workers who are showing up to make sure you can buy food and toilet paper for the week. Facetime with a friend you haven’t seen in a while, and check up on family members who may live alone and feel especially isolated and vulnerable right now. If you’re able, Venmo a few dollars to friends or family in the healthcare workforce to get themselves a coffee or a snack during this stressful time. And make sure you’re being kind to yourself- eat well, drink plenty of water, exercise indoors if you can, and allow yourself the space to process this crazy new world we live in however helps you best. Just be sure to reach out to loved ones or a trusted mental health provider if you feel like its getting to be too much.

Thoughts? Any other ideas about how to help during these strange times? Let me know!

Stay safe and healthy,

Well, I'm Back

I wasn’t expecting to be writing my next post from outside of Liberia, but here we are. The plans changed slowly and suddenly at the same time. That may sound strange but it’s true. First, just under 2 weeks ago, a supervisor’s visit was cut short by Covid-19. Before she left we talked about the possibility of me leaving early and what it would entail, but nothing was set in stone. Then the craziest week of my life went down (can’t go into details but I have never been more stressed out in my entire life…) All the while I felt torn in two by the decision to stay and continue my work in Liberia or go home. Even with plans on the ground getting canceled left and right, and lots of fear of the unknown, there was still so much work to be done. I had finally fallen into a good workflow, become friends with my colleagues in Liberia, and felt like I was making progress in the right direction with our research goals. Ultimately the decision wasn’t in my hands and I was recalled by my program.

And then I left. It took 2 of 3 bookings getting canceled (all made within 24 hours of each other because airlines were changing routes and canceling things left and right,) a night spent hurriedly doing as much data entry as I could before leaving, and 2 last minute visits to a tailor (priorities, right?) before I was en route to the airport, starting the long journey home.

I didn’t sleep the night before my flight. Once the decision was made my mind began to torture me with all the possibilities for things to go wrong- delays, crowds and cancelations, running out of cash (I was already short due to an emergency the week before I departed,) running a fever before boarding the plane. I donned a surgical mask for the flight, anticipating dense crowds at the airports, but Roberstfield was calm and eerily empty. I think I was part of the last wave of foreigners to leave. I had one last cassava leaf at the airport café before boarding a half-empty flight to Accra, where I waited in a quiet airport lounge before boarding the flight that would deposit me at Dulles. Most people donned masks but were feeling uncommonly jovial and friendly- perhaps relieved knowing soon they’d be home and not stranded far from family during a global pandemic.

A few people coughed on the 11 hour flight back to the U.S. I tried not to worry about it too much, but couldn’t help but notice how gaping the openings were in my ill-fitting surgical mask. I was expecting mass chaos, crowding and long waits once we arrived in Dulles, but even with my border agent pausing every 10 seconds to check with his neighbor that he was asking me the right screening questions, there was absolutely no line or delays. I missed my flight anyways but was promptly booked onto another half empty flight back to Boston. From there it was surreal how fast everything happened. Less than 2 hours later as we deplaned I almost immediately exited the terminal, nearly blowing past my husband because I had left the secure area. I thought I would cry, or laugh, or be overwhelmed with emotion, but I was to numb with surprise and shock. He took my bag, handed me my coat and we headed back home on an uncharacteristically empty Storrow drive.

I am both relieve and disappointed at the same time. Despite having some health issues in Liberia, I really was having an incredible experience. The specialists, consultants and residents and I had all gotten to known each other, I had figured out where I fit into their system, their world. Up until the week before I left, some really great projects were going to be ramped up. One of the pediatricians had taken me with her to visit waterside market, and she I had plans to make pepper sauce before I went back.

Apart from all this, I definitely feel some guilt as well. Guilt that I am home, on my couch, unpacking, with my husband only a few feet away, in a country with an ICU, with ventilators, with intensivists, and with way more capacity to handle a surge in cases of Covid-19. Guilt that my friends and colleagues are still in Liberia, facing uncertainty and a disease that has been shown to cause serious illness in healthcare workers. I still feel the decision to leave was the right one- both due to my health and because I would hate for my job to spend hundreds of thousands of dollars evacuating me in the event of a medical emergency when that money could be better spent elsewhere.

I’ve spent the last couple of days since getting home sleeping, unpacking and trying to wrap my head around Covid-19’s impact on Boston. Soon I’ll meet with my team to devise a game plan for work these next few months. Hopefully it will make me feel less helpless. In the meantime I’ll keep reading the situation reports from WHO and prepping myself mentally for whatever lies ahead the next few months. Hope everyone is staying safe and healthy these days. 

One day in a Liberian Pediatric ER

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. PS- You can also follow along on instagram if to see more of the day to day things, if you are curious.

Global Health Careers: Part II

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

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.)

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

Photo by Caleb Woods via unsplash.com

When measles cases in Brooklyn and Rockland county shot  past the hundreds last spring,¹ 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,⁵ 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.  

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/