"Global Health" is "Health"
“I have no idea what's awaiting me, or what will happen when this all ends. For the moment I know this: there are sick people and they need curing.” Albert Camus, The Plague
“The people showed a great concern at this, and began to be alarmed all over the town, and the more, because in the last week in December 1664 another man died in the same house, and of the same distemper.” Daniel Defoe, A Journal of the Plague Year
In 2009-10, I was part of a team caring for about a dozen critically ill children with pandemic H1N1 influenza (pH1N1). They had presented to the PICU as part of a pandemic that killed more than 12,000 people in the United States alone. The infection control measures were stringent. Public anxiety was very high. We learned from each sick child and fortunately none of our patients died. Looking back on the experience, as much as H1N1 disease stressed the entire health care system and as anxious as the public became, it still felt like a “typical” pandemic.
Ebola feels different. Three countries in West Africa have been devastated – medically, economically, and socially. In the U.S., one infected traveler has died. A handful of other infected persons have all recovered thus far. Scores of exposed individuals have been quarantined. Every hospital and practice has struggled to prepare for the possibility that a traveler from West Africa might appear with fever and vague constitutional symptoms. As cases in Dallas and New York City were unfolding, the level of public alarm reached levels that Daniel Defoe might have recognized.
Even before the Ebola outbreak, the ABP’s Global Health Task Force was examining the impact of global health on US pediatricians and patients. In June, members of that task force reported the major implications of their analysis. In the context of the Ebola outbreak, we are reminded that “global health” is simply “health”.
Global health tracks and rotations have proliferated among pediatric training programs. In fact, they represent some of the greatest attractions for many residents looking to select a residency program. Yet there are concerns. The approaches to global health in training are highly variable with some programs offering a rigorous curriculum and supervision, while others offer not much more than for residents to arrange for an (unsupervised) month in an interesting foreign country. Because most pediatric program directors are not experts in global health, there appears to be value in convening such experts to help generate guidelines on curricula, assessment standards, and risk management.
I suspect all of us know a lot more about Ebola now than we did six months ago. Updated recommendations for pediatricians can be found online at the Centers for Disease Control and Prevention and JAMA Pediatrics.
But even before Ebola captured the headlines, a growing list of “global” diseases had emerged as threats to children in the United States including dengue, SARS, West Nile virus, Chagas disease, and others. Pediatricians in the southwest and all over the country had started caring for migrant children from Central America presenting with various health problems. If nothing else, our experience with Ebola has made clear the very high cost of failure to understand and recognize a disease emerging from other parts of the world. Our subboards and question writing committees will need to grapple with where global health fits in the content specifications of the certifying exams. Beyond the knowledge expectations for certification, increased familiarity with global health threats will help achieve the goal of healthy outcomes for children.
Amidst the public alarm, the enormous pressure on hospitals to be prepared, and the policy and ethical challenges generated by the Ebola epidemic, one legacy of this outbreak will surely endure, namely the quiet heroism of the healthcare workers in West Africa (where hundreds of healthcare workers have died) and also in Dallas, Atlanta, New York, and several European cities. Their extraordinary professionalism bears witness that whatever else may be happening, “there are sick people and they need curing.”
This is what I think. If you would like tell me what you think, please comment below.
David G. Nichols, MD, MBA
President and CEO