The Clinical Problem Solvers

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During this WDx VMR series episode, Kiara presents a case of chest pain to Priyanka, Ana Clara, Elena, and Anna. 

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Ana Clara

Ana Clara Miranda is a 4th-year medical student from Brazil. She grew up in Belo Horizonte and moved to Rio de Janeiro in 2017 to attend medical school. Her medical interests are Pediatrics and Infectious Diseases. Today, she intends to go to the United States for an international clinical experience as a visiting student and, in 2023, apply for a Residency Program. Outside medical environment, she loves going to the beach with friends, enjoying nature and baking cakes.

Elena Vasti

Elena Vasti is a second year resident at Stanford in the department of Internal Medicine. She attended UC Davis to study Human Development and Exercise Biology and went on to UCLA Fielding School of Public Health to complete an MPH in Epidemiology and Community Health Sciences. She decided to switch careers to pursue clinical medicine and matriculated at UCSF School of Medicine in 2015. She enjoys running every day, analyzing movie trailers and both listening to and joining the CPSolvers any chance she gets! She plans to pursue a career in academic cardiology.

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Raha and Shub join #PrezSharmin to tackle a clinical unknown presented by Carlos

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Dr. Agrawal

Shub Agrawal is a PGY-2 at Emory’s J. Willis Hurst Internal Medicine Residency. She grew up in Athens, GA and attended New York University for undergraduate degrees in neuroscience and anthropology. She attended the AU UGA Medical Partnership for medical school where she first became passionate about medical education. She is currently doing medical education research about how to best use podcasts in UME and GME curriculum. She hopes to spend her career teaching and designing curriculum in academic medicine. Outside of medicine, she enjoys spending time with her family, friends and imagining all the trips she will take once it is safe to travel again! 

Dr. Sadjadi

Raha Sadjadi is a PGY2 internal medicine resident at Emory University School of Medicine. She grew up in the San Francisco Bay Area and attended UC Berkeley for undergrad. After spending her whole life in the Bay Area, she moved to Atlanta to complete medical school at Emory University. At Emory she pursued her passion for caring for underserved populations while rotating at Grady Hospital and she found wonderful mentors invested in her growth as a physician and human.  For these very reasons, she remained at Emory to complete her internal medicine residency. She is interested in transplant hepatology and in reducing healthcare disparities. 

Dr. Rubiano

Carlos Rubiano is an Inpatient Medicine chief at UNC Hospitals where he also completed his internal medicine residency training. Prior to moving to North Carolina with his wife with whom he couples matched with, he completed his medical school training at Florida State University and undergraduate training in Biology at Florida Gulf Coast University. In medicine, he has a particular interest in medical education and hopes to be a clinician-educator as a soon-to-be hospitalist and one day as an ID clinician. Outside of medicine he loves playing pickleball and invites everyone to try this booming sport. 

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Eamonn and Ashley join Jack in tackling a clinical unknown presented by Travis

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Eamonn Maher

Eamonn hails from Charleston, West Virginia. He attended Marshall University for medical school and is currently in his final year of Dermatology residency at SLU. He will complete a Complex Medical Dermatology fellowship at NYU next year and hopes to practice with a focus on cutaneous lymphomas, connective tissue diseases, and immunobullous disorders. Outside of work he enjoys jiu jitsu, playing soccer, and spending quality time with his wife. 

Ashley Boerrigter

Ashley Boerrigter is a third-year OBGYN resident at St. Louis University, where she will be Administrative Chief Resident for the 2021-2022 academic year. She attended medical school at the University of Kentucky and her academic interests include medically complex pregnancies and curriculum development. Hobbies include tennis, sailing, and alternating between beach sunning and mountain skiing. 

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Summary

In this episode of Clinical Problem Solvers: Anti-Racism in Medicine, we are joined by Michelle Morse, MD, MPH, Deputy Commissioner for the Center for Health Equity and Community Wellness (CHECW) and the inaugural Chief Medical Officer at the NYC Department of Health and Mental Hygiene (NYCDOHMH), and Paul Farmer, MD, PhD, Kolokotrones University Professor of Global Health and Social Medicine at Harvard University. Together, we discuss what global health equity looks like in the age of COVID-19.

Learning Objectives

After listening to this episode listeners will be able to…

1. Recognize that  global health equity and global vaccine equity are everyone’s responsibility 
2. Understand what decolonizing global health really means 
3. Appreciate the importance of solidarity and human interconnectedness 

Credits

• Written and produced by: Dereck Paul, MS, Chioma Onuoha, Utibe R. Essien, MD, MPH, Rohan Khazanchi, LaShyra Nolen, Naomi Fields, Michelle Ogunwole, MD, Jazzmin Williams, and Jennifer Tsai MD, M.Ed
• Hosts: Utibe Essien, MD, MPH, Dereck Paul, MS, Chioma Onuoha
• Infographic: Creative Edge Design
• Show Notes: Chioma Onuoha
• Guests: Michelle Morse, MD, MPH (@michellemorse) and Paul Farmer, MD, PhD

Timestamps

00:00    Introductions

04:00 What Brought You to Global Health Work?

11:50    Why is Global Health Equity Everyone’s Problem?

23:40   How has COVID-19 Changed Global Health Work and Perspectives? 

40:30  The Role of Identity in Global Anti-Racism Work

49:00   Decolonize Global Health Movement

1:02:49 Hope for the Future 

Takeaways

1. The Global COVID-19  Response Must Be Anti-Racist 

An anti-racist COVID-19 response means that quality care, quality vaccines, and quality public health information must be provieded to all. From social distancing to contact tracing to vaccin distribution, every step should be considered through an anti-raicst framework. This includes financing vaccine acquisition for all countries and avoiding the global north vaccine hoarding that is happening today. It is important that we avoid vaccine tunnel vision and recognize the broader social context and need for social support systems worldwide. 

2. The Four S’s  

As Dr. Paul Farmer often says, an effective infectious disease global health response requires: 

• Staff – caregivers with the knowledge and passion to address health concerns
• Stuff – the physical materials required for effective treatment or intervention 
• Space – places where people can safety receive appropriate care 
• Systems – policies and institutional systems that facilitate needed health responses

3. Why should everyone care about global vaccine equity?

“Unless everyone is safe, no one is” – Dr. Paul Farmer

The world is incredibly interconnected and, as COVID-19 has shown, we have to recognize the idea of collective survival. Health and well being is a global endeavor and an interdependent fight. Furthermore, we must reclaim the heart and soul of medicine: caretaking, healing, and the creative aspects of the profession that oftentimes get pushed to the side. American physicians and health professionals have immense power and a duty to use that power for the greater good to interrupt, and interrogate the colonial and imperial practices perpetrated by our own government. We must hold our government accountable. At the heart of this is a need for global solidarity. 

Pearls 

The Importance of this Moment 

Both of our guests highlighted the HIV/AIDS movement as a catalyst for their continuing passion for global health equity. The COVID-19 pandemic provides a similar opportunity today for us to scale up our critical consciousness and re-examine the functioning of our society. People are naming racism, settler colonialism, and imperialism more than ever. In this current moment we can build on that momentum, shift perspectives and work towards long lasting equitable and anti-racist change.

Dangers of American Exceptionalism 

It is imperative that we look beyond the walls of our nation and the privileges that living in the United States afford us in order to recognize the danger of American exceptionalism and how it impacts people across the world. For example, currently the United States, and other wealthy countries, are hoarding COVID-19 vaccines making it difficult for other countries to vaccinate their populations. Considering the interconnectedness of our world, by preventing equitable vaccine distribution we will only lengthen the current pandemic. As a country, we must expand our global critical consciousness and strive towards global equity by financing vaccine acquisition, investing in our education systems, interrogating American privilege and more. 

Decolonizing Global Health – Allow the Global South to Lead 

Part of decolonizing global health means being willing to take a backseat when it comes to defining, researching, and executing global south health priorities. This is especially true for large outside universities and institutions that habitually fail to engage domestic stakeholders in research and health decision making processes. We must trust the communities we serve to teach us and to guide initiatives. 

References Mentioned

21:30         

Rwanda Vaccine Roll Out https://www.usnews.com/news/world/articles/2021-03-05/rwanda-becomes-first-african-nation-to-use-pfizer-covid-19-vaccine

55:00

Equal Health Students “#KnowBeforeYouGo” Video on Volunteering in Haiti 

http://www.equalhealth.org/news/2016/8/7/equalhealth-students-launch-video-knowbeforeyougo-addresses-misconceptions-about-volunteering-in-haiti 

Additional References 

1. Farmer, P., Kim, J. Y., Kleinman, A., & Basilico, M. (2013). Reimagining global health: An introduction. Berkeley: University of California Press.
2. Farmer, P. (2020). Fevers, feuds, and diamonds: Ebola and the ravages of history. New York: Farrar, Straus and Giroux.
3. Goodwin, C. (2020, December 23). Paul Farmer on How We Tell the Story of a Pandemic. Retrieved from https://www.thenation.com/article/culture/paul-farmer-fever-feuds-interview/
4. Richardson, E. T., Malik, M. M., Darity, W. A., Mullen, A. K., Morse, M. E., Malik, M., . . . Jones, J. H. (2021). Reparations for Black American descendants of persons enslaved in the U.S. and their potential impact on SARS-CoV-2 transmission. Social Science & Medicine, 113741. doi:10.1016/j.socscimed.2021.113741

Transcript

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Disclosures

The hosts and guests report no relevant financial disclosures.

Citation

Morse M, Farmer PE, Onuoha C, Khazanchi R, Nolen L, Fields N, Ogunwole M, Tsai J, Essien UR, Paul D. “Episode 7: Anti-Racism, Global Health Equity, and the COVID-19 Response.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. April 1, 2021.

https://clinicalproblemsolving.com/wp-content/uploads/2021/03/VMR_March-25th.mp3 Rabih and Reza tackle a clinical unknown, presented at VMR by Dr. Usha George. Episode Quiz

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Dr. Usha George

Dr. Usha George (MBBS (MAHE India), MSc (Respiratory Medicine) Imperial College University of London, FRCP London) is at present attached to Sunway Medical Centre, Malaysia. It is a 650 bedded private tertiary hospital, also involved in training medical students. I practice as a Respiratory and General Medicine Physician .My special interest is in clinical and diagnostic reasoning.

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We continue our campaign to #EndNeurophobia by tackling this neurology clinical unknown, with the guidance of Aaron Berkowitz.

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Maria Jimena Aleman

Maria Jimena Aleman was born and raised in Guatemala where she currently is a medical student in Universidad Francisco Marroquin. After suffering from long standing neurophobia, she has embraced her love for neurology and will pursue a career in this field.  She also looks forward to dedicating her life to breaking barriers for Latin women in medical fields and improving medical care in her country. Maria is one of the creators of a medical education podcast in Spanish called Intratecal. Her life probably has a soundtrack of a mix between Shakira and Louis Armstrong. Outside of medicine she enjoys modern art, 21st century literature and having hour long conversations over a nice hot cup of coffee or tequila.

Mohamed Elashwal

Mohamed is a senior medical student at Alfaisal University in Riyadh Saudi Arabia. He was born in Egypt before he moved with his family to Saudi. Mohamed is interested in adult neurology; his neurophilia started in one morning report during his neuroscience rotation when he could feel his heart racing and his brain twisting thinking about the cases. He plans to apply to neurology residency next year. In his free time, Mohamed enjoys baking, and cooking; he also likes playing the piano (level: very amateur).

Kannu Bansal

Kannu is a junior resident at All India Institute of Medical Sciences, New Delhi, India working in the Kidney Transplant Wing. Despite my current affiliation with transplantation, I love to explore everything related to medicine. My passions include quizzing, teaching, and learning, and that’s how I came to know about CPSolvers. I plan to pursue Internal Medicine Residency in United States. Outside of medicine, I like to watch soccer, Formula 1, and sketch pencil portraits.

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The CPSolvers team breaks down a *bite-sized​* case of dysphagia.

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Sarah Onorato presents a case to Dr. Ann Marie Kumfer & Dr. Debra Bynum

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Dr Ann Marie Kumfer is a new residency graduate and academic hospitalist at UNC. After completing medical school at Texas Tech University, she moved up to North Carolina for residency. She liked UNC so much, she decided to stay as an academic hospitalist after completing residency in June. She also serves as a section editor for the Human Diagnosis project. She is passionate about diagnostic reasoning, teaching, and guacamole.

Dr. Debra Bynum is the Director for the Internal Medicine Residency Program at the University of North Carolina. Originally from eastern North Carolina, she graduated from Davidson in 1990 with a degree in Biology and a focus on ecology and marine biology. From there, she came to Chapel Hill for medical school and stayed at UNC for residency training. After completing a year as Chief Resident, she joined the faculty at WakeMed hospital where she worked in the clinic caring for Raleigh’s underserved, attended on the inpatient service with UNC residents and students, and helped to found one of the first hospitalist programs in the area.

After three years at WakeMed, she returned to UNC for further training as a fellow in the Geriatric Medicine program and was appointed to a faculty position in 2001. During the subsequent fourteen years, she held multiple leadership positions within the School of Medicine, the Department of Medicine, and the Geriatric Medicine Fellowship and Internal Medicine Residency programs. She directed the Acting Internship for senior students as well as co-directed the clinical skills course for second year students, served on the School of Medicine education committee, and helped to design, implement, and co-direct both a transition course for new third year students as well as a teaching elective for fourth year students. She served as the Program Director for the Geriatric Medicine Fellowship from 2008-2014 and was selected to lead the Internal Medicine residency program in May of 2014.

Want to learn more about the Women in Diagnosis (WDx) series?

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Jack presents a case of abdominal pain and hypotension to Steph and Dan

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Lindsey, Kiara (#bossladies), and Scott discuss a clinical unknown presented by Devika

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Scott Walker

Scott Walker grew up in Knoxville, Tennessee (Go Vols) where he completed his Bachelors in Kinesiology and Nutrition. He currently attends The University of Central Florida College of Medicine as a third year medical student. He is interested in entering the field of Emergency Medicine and is passionate about medical education and medical mission trips. He spends his spare time watching The Office with his wife or weight lifting.

Dr. Devika Gandhi

Devika Gandhi is a third-year internal medicine resident at Indiana University. She is originally from Dayton, Ohio and received her undergraduate degree from the University of Akron. She earned her medical degree from Northeast Ohio Medical University in Rootstown, Ohio (Go Walking Whales!). After residency she will be an incoming gastroenterology/hepatology fellow at Loma Linda University in California. During her free time, she enjoys reading, cooking, and going out to trivia with friends.