DrPaulFarmer

Picking up where we left off in this conversation not too long ago, there’s room for optimism and some for a bit of honest discouragement, too. Without a strong health system, the ability to respond effectively to epidemics is sharply limited because, regardless of who signs up to help, and from where, the formal health system is ideally the largest potential source for the staff, stuff, space, and systems needed in health emergencies. If after the wars in West Africa, which ended over a dozen years ago, there had been substantial investment in health systems strengthening, then Ebola wouldn’t have been able to mow through these countries, east to west and all the way from forest to coast, and the assistance of international bodies and NGOs and specialists would've been far more effective. One thing we need to do to prepare is to learn from what went wrong, of course, but also what went right. I have no doubt that people will look back at the massive investment you’ve made in polio eradication and note that in Nigeria, and other areas where that team and it’s partners were numerous and well supplied, this capacity could be rapidly diverted to the public health and surveillance work required to diagnose and track Ebola, as well as contacts. So the first task is how to steer attention to health systems and a care network like the ones in Rwanda and Central Haiti. The second biggest challenge in this work will be to avoid separating prevention/surveillance/control from care. This has been the downfall of many disease-control efforts across that region and that continent for over a century.

Hi /u/luminousVeil, Not very often. There’s probably no better insurance against depression caused by seeing injustice than fighting injustice. Looking at many of my friends from college who are successful in business, I know that they often face greater crises in meaning in their lives. We’ve brought many of them into our work with good clinical results.

Welcome to our world. You couldn’t have a better goal than the one you already laid out, and you don’t have to decide what path you’ll take (e.g., family, peds) in your first couple of years. Getting involved in global health equity will help you know what’s the best clinical training for you. The way you put it ‘to be conscious of the culture, language, etc’ is also spot on. I’m always disappointed when in medical schools and hospitals we advance the notion of cultural competence as if it were within the grasp of even anthropologists, forget about busy clinicians. What we should be striving for is cultural humility, which is a great building block for a career in global health equity. There are plenty of people at UA who are deeply engaged in this work and have been for years, and you should try and be part of that community no matter where you end up.

Hi /u/Shmedler -- Don’t you go anywhere! We need quantitatively-minded folk in this work. And not just because it’s been part of a narrowly conceived donor strategy to come up with quantitative measures of relevance in global health. It’s also because any knowledge of how well we’re doing in responding to ill health requires a commitment to measurement. There’s plenty evidence that measurement alone improves the quality of the work. As an aside, my first recruits as the chairman of a department at Harvard Medical School were in biostats and epidemiology since we were weak in quantitative methods.

Paul: I work with my friends, and most of us have been friends for a long time. So the chances of us all feeling hopeless at the same time are much reduced. After the 2010 earthquake in Haiti, there were plenty of days when something akin to hopelessness washed over me. Obviously there was a lot of grief, since we lost many colleagues and friends, but we were always more than the sum of our parts in those weeks and months right after January 12. That’s the lowest I’ve been, and friends always shore each other up. But the real reason I distrust hopelessness is because when we’re talking about things like childhood stunting, in Indonesia or elsewhere, we’re talking about hopelessness on behalf of others, which they can ill afford.

Ophelia: That’s lovely PJ.