Medicine across the world and close to home
The Carver College of Medicine’s Global Health Distinction Track gives medical students a chance to explore differing modes of health care delivery and give back in meaningful ways.
Fourth-year medical student Patrick Schwartzhoff of Davenport, Iowa, began to notice a pattern during his undergraduate studies as a microbiology major.
“A lot of things we were studying were disproportionately affecting international communities in lower to middle-income countries,” he says.
Schwartzhoff’s parents both worked internationally during their careers, so he was accustomed to thinking of himself as a global citizen. He wanted to use his career to meet the health needs that he was learning about throughout the world.
“Seeing the differences in health care delivery between nations was interesting to me,” he says.
He added a global health minor, and after graduation, he continued this path by joining the Carver College of Medicine’s Global Health Distinction Track.
Re-imagining global health
What comes to your mind when you hear “global health?”
Maybe you pictured a doctor temporarily stationed in a low-resource country halfway across the globe to administer vaccinations or deliver babies at a small community clinic. Or maybe you thought of something bigger, like the work of Doctors Without Borders or another international medical organization.
This was the frame of reference Meg Mali (17MD), of Sioux City, Iowa, had in mind when she began the Global Health Distinction Track. She soon took her first class with Robin Paetzold, MBA, the college’s director of global health programs, and learned that the scope is broader than she thought.
“She emphasized the importance of research and sustainability in global health,” Mali says. “It’s not just going somewhere, providing care, and leaving. It’s helping a hospital or a community develop what they need to provide safe care, follow up with patients, and monitor for complications.”
Global health does indeed encompass the work of international physicians providing direct care to patients. But it can also cover many other medical activities—some of which take place much closer to home.
Mali’s rotation to Tuba City, Arizona, a community within the Navajo Nation, taught her that you don’t have to travel far to find people who have limited access to health care.
“Patients with limited access to care exist all over the U.S., both in rural and urban areas,” Mali says. “It was eye-opening to care for patients who live in the U.S. but don’t have access to running water or electricity in their homes.”
Schwartzhoff also underwent a global health rotation in the U.S. He spent six weeks with the Centers for Disease Control, working alongside the Illinois Department of Public Health to address a pediatric strep outbreak and develop guidelines for local health departments for addressing COVID-19 in homeless shelters.
“Global health affects us domestically as well," he says. “What happens here can affect outcomes across the world. We have a great example of that with COVID.”
Schwartzhoff has also volunteered on the trainee advisory committee for the Consortium of Universities for Global Health, an organization of universities across the world to enhance collaboration for the future of global health.
“The purpose is to provide a trainee perspective,” he says. “We’ve been trying to get more representation from all the players who may be involved, not just medical students.”
Discovering a passion abroad
On-the-ground experience in another country is an important component of a global health education, too. Mali gained this experience during her rotation to Karnataka, India, where she worked with the non-governmental organization (NGO) Swami Vivekananda Youth Movement to develop standards for blood transfusion and preventing infection after surgery.
The NGO also offers community education programs on important health topics such as diabetes, cancer screenings, and end-of-life care.
“They’ve been a longstanding and sustainable group within Karnataka,” she says. “They actually go door-to-door in the community, to patient’s homes, to provide palliative care services. I learned how a big NGO functions and provides care to a lot of different aspects of the community.”
She also discovered her interest in surgery. Her first exposure to the operating room was shadowing Indian physicians during general surgery and obstetrical cases. General surgery was a natural fit for a career in global health, she realized, because having the ability to perform basic surgeries safely lays a solid foundation in areas with limited access to care.
“Subspecialty care can piggyback off of that,” Mali says. “But if you can’t do standard general surgery procedures, like exploratory laparotomy for instance, you're not going to be able to do the more complex things.”
The value of research
Mali decided she wanted to conduct research that would help give under-resourced communities the tools they need to improve care in a sustainable way. She was awarded a Fulbright Fellowship to study patients’ access to breast and cervical cancer care in Ghana and the Republic of the Gambia—unfortunately, her research year was interrupted by the COVID-19 pandemic, so she wasn’t able to travel.
From her home office in Utah, she ran a survey of hospitals in Ghana and The Gambia to catalogue the services they had available for the diagnosis, treatment, and surgical management of these cancers. Then she and the other research fellows presented their findings to the countries’ health officials.
“We provided some suggestions, but ultimately our goal was to provide the health ministries with the information so they could make decisions that they deemed to be highest priority to expand care in their own countries,” Mali says.
Schwartzhoff put his microbiology background to work studying the health effects of tick-borne bacterial infections during a summer research opportunity with the Universidad Federal de Río Grande del Norte in Natal, Brazil.
“I really enjoyed my time in Brazil,” he says. “I saw some pretty interesting things and learned about working with different amounts of resources."
Opening doors
This spring, Schwartzhoff will travel to Sweden’s Karolinska Institute for a clinical rotation in internal medicine.
“It will be really interesting to see, from the on-the-ground, clinical point of view, how health care delivery and the financing of it is different in Sweden,” Schwartzhoff says.
As for what’s next after medical school, he is pursuing residency training in internal medicine and considering future training in infectious disease. He is grateful for the support of the many researchers and physicians he worked with during his time in the track.
“The Global Health Program is a great place to find mentors who genuinely care about you,” Schwartzhoff says.
Mali is now in her seventh and final year of surgical residency training at the University of Utah.
“The Global Health Distinction Track had a huge impact on where I ended up going with the research part of my career,” she says. “For my surgery training, I looked specifically at programs that had a big global health and global surgery standing. That was a continuation from my work in the Distinction Track.”