Dr. Fola May is an Assistant Professor of Medicine at UCLA, a staff physician in the Veterans Affairs Healthcare Network (VA), Assistant Director for the UCLA STAR program, Co-Director of the UCLA Global Health Education Program, and Director of Internal Medicine Programs for Seed Global Health.
The field of public health is equally important to the practice of medicine itself. I learned this important lesson in the early 2000s, when I was an undergraduate student at Yale, during a six-month service project in Nicoya, a tiny town in the Guanacaste Peninsula of Costa Rica.
As the daughter of a doctor, I’ve been immersed in medicine for virtually all of my life, and growing up, I frequently joined my father on medical mission trips to West Africa. My father was raised in rural Nigeria and immigrated to the United States to study medicine in the 1960s. After training as a doctor, he felt a strong calling to return to his roots and fulfill his calling to give back to the West African community that had given him so much. I shared his passion to give back, and although I was just a teenager at the time, helping in the pharmacy, triaging patients, and watching surgical procedures, I, too, fell in love with medicine. Looking back, I’ve always felt like I was born to work in global health – but of course at the time, I didn’t really know what that meant. I was just doing something I knew was good, side-by-side with my dad.
As this desire to connect passion, purpose, and practice grew through my formative years, I embarked on my first medical service project, alone, completely independently from my family. As a volunteer at a women and children’s hospital in Nicoya, one of the first things I noticed was the critical shortage of physician providers. At the hospital — the only one on the Nicoya Peninsula — there were several nurses and midwives, but only three doctors to oversee over 2,500 births annually. Midwives led medical decisions and nurses ran the wards, with the doctors called in only for serious or emergent scenarios. The hospital was sorely understaffed; if too many women showed up in one night, poor outcomes were likely. I saw, with my own eyes, incidents of newborn mortality. Coming from America, where we’re lucky enough to have 2.55 physicians for every 1,000 people, the differences were striking.
In Nicoya, expecting mothers who had received community education about their pregnancy knew to come to the hospital early in labor to receive help from a skilled birth attendant. These mothers experienced better outcomes than those who presented late in labor or tried to labor at home. I realized that medical professionals — doctors, nurses and midwives alone, cannot solve the world’s pressing health issues. Medicine, at its best, does not operate in a vacuum, but in close collaboration with public health initiatives, officials and workers.
I decided I would dedicate my life to combining these two fields to contribute to society, particularly in low resource countries and domestic communities where this collaboration is especially important. This was the early 2000s — there were relatively few people who focused on both as a career. It was a light-bulb moment, but also a challenge: at the time, global health hadn’t yet become it’s own field, and many people told me that combining clinical medicine, global health medicine, and public health was not possible.
Undeterred, I headed to Cambridge for my Masters in Epidemiology. This program was a powerful experience that provided me with global perspectives of public health, clinical medicine, and epidemiology. The program also helped me ground the field experiences I already had working in Nigeria and Costa Rica in formal education. We learned why health issues like obesity and HIV affects populations differently and how we can make sure access to high quality care is not just achievable, but equitable. I noticed common themes in the health disparities seen in high resource countries like the U.S. and U.K but also realized many strong parallels between public health challenges in resource-rich and resource-limited regions of the world.
For example, gastroenterological diseases, which I specialized in after residency, are common in both domestic and global contexts. Gastroenterological infections like helicobacter pylori and hepatitis are global epidemics that manifest in various ways across global regions and, thus, impact populations quite differently. Through my years of work in South Africa, Uganda, Malawi, and Tanzania, these themes have constantly been reinforced.
This lesson is even more apparent these days, now that global health is a thriving field within medicine and public health. Based in Los Angeles, I only have to travel a few miles from my tertiary care medical center to witness deficiencies in access to care and disease management that aren’t too dissimilar from those I have seen patients encounter in Uganda. In these underserved areas, people don’t have adequate access to health information and providers, and care isn’t always provided at a high-quality standard. Issues of and solutions to improve health delivery and access to care in our own communities are often transferable to global settings, and the opposite is also true. For example, mHealth — text messaging for HIV care and management — was first rolled out in South Africa before the idea was imported for use for various diseases in the United States.
In resource-limited contexts, both locally and globally, we have to be creative. In medical schools and at public health programs across the country, we’ve largely gone from promoting a direct service model to a “train the trainer” model where we build medical education and support underserved communities and international health ministries. We now know that the way to go is through sustained intervention rather than ad hoc service missions. Before, we were simply slapping bandages on the problem. That’s easy, or easier, to do. Bringing together all stakeholders to address the root cause of the health issue and remaining on the ground to ensure the transfer of skillsets to professionals that can achieve change is more difficult.
Luckily, the current generation is ready to rise to the challenge. In the age of the Internet, today’s medical and nursing students have access to all the information they need at their fingertips. And it’s why I am glad to be at a place like Seed Global Health, where we can connect the dots between in-country need and the immense capacity for teaching, training, and giving that our volunteers hold. As a mentor to emerging healthcare leaders, I have witnessed this generation’s curiosity of the world, and I can attest to their strong desire to do good and achieve social justice. With these bright minds and big hearts at the helm, I can’t wait to see what the future of global health brings us.