Q: Can you share some of your most memorable global medical experiences? Was there a specific type of medicine you focused on during these trips?
A: While each of my global health experiences has brought a deep insight into health disparities and significant cultural growth, my first global health experience was my most memorable. As a postgraduate year two family medicine resident at The Ohio State University, I traveled to a remote hospital in Zimbabwe, about a three-hour drive from the capital city of Harare.
The experience took me far out of the comfort zone that I faced as a medical school student and resident. The cultural aspect, mixed with a high burden of disease and pathology, made every turn a challenging experience. I saw more interesting pathology in one day there than I experienced in a year of residency. In a one-month elective there, we delivered babies, performed surgeries — and all with limited resources. It stands out as a life-changing and career-altering month for me and has shaped my worldview.
In terms of the type of medicine, I learned early on that high-quality global health projects should offer a degree of sustainability. That involves working with local health ministries to ensure a good outcome. Education also helps make a positive impact after the trip is over.
Q: How did your education at the American University of the Caribbean School of Medicine prepare you for your global medical endeavors?
A: Being at AUC prepared me in a big way: adaptability! One of the biggest challenges with global health is being able to quickly adapt to an ever-changing environment. I firmly believe that access to health care is a right and not a privilege.
AUC has done a nice job of folding in global health options for students, but I think they should be promoted even more than they are. Participating in a global health elective can be a differentiator when applying for residency programs and demonstrates a student’s compassion and desire to give back and take part in the global health community.
Q: What motivated you to engage in volunteerism? Are there any experiences or moments that stand out to you?
A: The news can make me feel a little helpless. I see tragedy, suffering, and challenges on a human level. I am often left with the question, “What can I do?” We can all donate money. We can donate supplies. But when I donate my time doing something I am passionate about, I feel like I can make a more positive impact. Sometimes that outreach has a domino effect and shows others that there are, in fact, opportunities to make a difference instead of feeling insignificant, overwhelmed, and a bit helpless. Moreover, the effect these trips has on me is so profound. It makes me a better person, a better physician, and a better human.
On a trip to Kenya a couple of years ago, I spent a lot of time talking with a soon-to-be-father about the process of birth, taking care of a newborn, and being a dad for the first time. He and his wife were about to have a planned C-section for twin baby boys. I scrubbed in to assist at the birth and all went well. I saw the new family each day on rounds. The day they were leaving the hospital, they told me they had named the baby boy that I handed off to them Nanda, after me. It was one of the rare times that I was a bit lost for words. I was so touched.
Q: Could you tell us about the volunteer activities you are currently involved in? How do these activities influence your work as chief medical officer at TGH Urgent Care?
A: I’m not currently involved with a lot of local activities outside of some local charity fundraisers and offering to assist with shadowing, teaching, and precepting current students, residents, and those in advanced practice registered nurse (APRN) and physician assistant (PA) programs locally. I want to get more involved with local free clinics and get back on the schedule of one global health trip per year.
In general, I think global health has made me more conscious and aware of social determinants of health and health care disparities that we see locally, which has a trickle-down effect in how we see patients and help them to better access high-quality care in our local communities.
Q: How have your past global medical experiences shaped your approach to your current role as CMO? Are there specific lessons or skills you gained that you apply in your daily responsibilities?
A: Learning to be sensitive about health care disparities, social determinants of health, and cultural competency are all applicable lessons for almost every patient, locally or globally. Especially in areas that are new to you, it’s important to learn about what matters to patients and their families and what can impact their lives.
Q: What advice would you give to current medical students who are interested in pursuing global health opportunities? How can they prepare themselves?
A: Jump in! It’s okay to push yourself out of your comfort zone. There is so much personal and professional growth that takes place when you leave your bubble of what to know and expect. I do find that it’s imperative to read, read, read, and research where you plan to go. Learn about the history of the country and the people. Try your best to become culturally competent. Learn about the burden of disease. Learn about the specific challenges that are faced by those that live there. Read about current socioeconomic situations and health care treatment options. We tend to learn about how to evaluate and treat patients using our health care system, but there are many, many other great validated methods, medications, and treatment modalities in other areas of the world. Learn about the options for testing and available pharmacologic treatments. Most importantly, be open to listen and to change and adapt any preconceived notions that you have. I would also recommend anyone who travels for a global health experience to journal each evening. It helps you process what you see, learn, and experience and allows you time to reflect on your experience. Read your journal after a week, month, and year. Continue to journal after you return. It’s often difficult to return to “normal life” when you get back — others are the same, but you are changed. It’s unreasonable to expect everyone else to understand what you experienced, and it takes time once you return to process. Try to find a mentor or someone you can talk with when you return to decompress and exchange ideas with.
Q: Looking back, how do you think your global medical experiences have contributed to your personal and professional growth?
A: On a personal and professional level, participating in global health missions has made the human experience more robust and palpable to me. Seeing firsthand the challenges that many outside the United States have is a truly remarkable experience.
The power of positivity. The ability to overcome challenges. The ability to be happy (without material things that consumerism and industry push at us), the love of family and children, the universal power of music, dancing, religion, and expression are all amazing and cross all cultures. To see how religion, food, exercise, etc., can impact individuals, families, and communities.
Q: What are some memorable obstacles or challenges you faced in a particular location? How did you overcome them?
A: I think one of the more difficult things to figure out is how you can contribute. How can you do something that is not “brigade medicine” to make sure there is a level of sustainability to the process and the care that is provided. You might understand what you would do to work up a complex case in the United States, but understanding how you might do so with limited resources, labs, imaging, medications, follow-up is different in every single situation. It takes some time to learn and get comfortable with your options. Each situation has different limitations and being able to adapt to them on the fly can be very difficult.
Q: Could you share some remarkable stories about patients or communities that have left a lasting impression on you?
A: There are so many! Zimbabwe in June 2006 was amazing and rough. It was one of the hardest and most rewarding. The abject poverty and lack of resources were hard to see. Probably more so, given that it was my first trip. The burden of HIV/AIDS and tuberculosis was overwhelming at first. Delivering babies there, no epidurals, no pain medications, limited in all ways but still with great results and healthy babies and mothers. A few other stories that really left their mark include seeing a mom struggle to breastfeed. Formula was not an option due to cost and availability. Another was caring for a baby born in Lesotho born with duodenal atresia. The surgeon there performed surgery, and we took shifts manually breathing for the baby, who did not survive. That was hard.
A really positive experience was helping set up Partnership for Ongoing Developmental, Educational & Medical Outreach Solutions (PODEMOS), a nonprofit charity that provides ongoing care for marginalized communities in Honduras. PODEMOS, which means “we can” in Spanish, is still going strong 15 years later.
Q: How do you develop cultural awareness to help you work most effectively with different communities around the world?
A: Read, read, read. Try to connect with people who have worked there and learn about what is expected, what you might see, what you might experience. Most established charities and organizations offer required pre-trip reading. I tend to try to read a lot — medically, socially, politically — to better understand what is happening in the area. I read when I get back, too. Once you’ve interacted with people in the community, you have more context and a better understanding of more complex situations.
Q: You’ve traveled widely and served in many communities. Is there a country or region you haven’t been to yet that you’re eager to visit? What draws you to that place?
A: I’ve been eager to visit Southeast Asia (Thailand, Vietnam, Laos, Cambodia) for some time. I feel like I know the least about the history, culture, and medical practices there and I want to learn and experience more. I like the two phrases: “Education is the reward for living” and “Travel is the great educator.” If those are both true, and A+B=C, then I postulate that “Travel is the reward for living.”
Thank you, Dr. Nanda, for sharing your inspiring journey and insights. Your dedication to global health and your extensive experience highlight the impact that a compassionate, well-rounded medical education can have on communities worldwide.
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1Dr. Nanda is CMO of TGH Urgent Care powered by Fast Track. https://www.fasttrackurgentcare.com/meet-the-physicians/paul-nanda-md/
