Reflections on Global Health and Palliative Care
By Dr. Kayla Wolofsky.
In this blog post, Dr. Kayla Wolofsky shares how she arrived in Global Health and Palliative Care, providing some tips for those who are interested to work in settings where resources are limited.
Tip 1: Ask yourself why you want to work in global health? What is your passion?
For me, it all started with the Dracunculus medinensis, also known as the Guinea worm.
As a child I was fascinated by the Guinea worm. Considered a neglected tropical disease, the Guinea worm is a particularly devastating disease that incapacitates people for extended periods of time. People are infected with the Guinea worm through contact with contaminated water. Guinea worm infection can have significant consequences, causing those who are infected to become unable to care for themselves, work, grow food for their families, or attend school. Traditional removal of a Guinea worm consists of winding the worm around a piece of gauze or small stick and manually extracting it — a slow, painful process that often takes weeks.
Learning about Guinea worm made me realize how a lack of access to clean water, something that I took for granted in Canada, could lead to devastating consequences. At this young age, I did not know how I would create change, but I knew that I wanted to work with those in settings where resources were limited. I already knew that in my future career I wanted to work to improve the health of people around the globe.
Reflecting back, I think that this highlights the importance of having a passion for global health. My personal experiences in global health, where I have been part of making positive change, have made it some of my most rewarding work.
Tip 2: There is no one right path into global health. It is O.K. to take the winding road.
After I completed my Bachelor of Medical Science, many people assumed I would go right into medicine, but I was not thinking about becoming a doctor at that time. Instead, I continued my studies, by completing a Master of Science at the University of Toronto, focusing on Plasmodium Falciparum, the parasite that causes malaria. I continued to enjoy reading about tropical medicine and going to conferences such as the American Society of Tropical Medicine and Hygiene.
After finishing my Masters, I considered continuing my studies with a PhD, but I also started investigating other ways to become more involved in global health, through postgraduate diplomas, such as the Diploma in Tropical Medicine and Hygiene, or master’s programs in Global Health Policy or epidemiology. As I considered my options, I realized that I wanted to work more directly with people, as I found that learning about the stories of patients through clinical cases excited me. It was then that I decided to study medicine and focus on medicine in global health. In the end, it took an extra 3 years of school, but I found my path and my passion and the extra experiences and knowledge which I developed along the way have guided me.
For students and others who want to become more involved in global health, it is important to recognize that there are many avenues to become involved, including work in clinical or laboratory research, Government, Non-Government organizations, public-private partnerships and volunteer opportunities. You may explore one path and then choose another; it is O.K. to take the winding road.
Tip 3: Be open to adventures and uncertainty.
For my medical studies, I decided to take a leap of faith and study medicine at the University of Queensland (UQ) in Brisbane, Australia. This was an opportunity to leave my comfort zone in Canada and live in a different country. I had also learned that UQ was supportive in international training opportunities, which was important for me. But the decision to move to Australia was also difficult, since training overseas would make it harder for me to return to Canada to practice medicine in the future. Despite the uncertainty, my decision to study at UQ was the right one, and lead to many interesting opportunities. During my medical training, I was able to volunteer in Lima, Peru, work with aboriginal communities in Queensland, and gain experience in New Orleans with people affected by Hurricane Katrina.
My experiences illustrate how working in global health can, at times, lead to periods of uncertainty. It is during these times you grow and can explore different areas of global health which may interest you.
Tip 4: If you don’t ask, the answer will always be no.
I realized that every contact you make can be a contact and supporter for life. Your mentors want you to succeed- do not be shy or hesitate to reach out to an old colleague for help.
For many people, knowing how to get started in global health is the hardest step. I learned to reach out to contacts and asked for help. I was able to set up a medical elective in Lima, Peru, by asking my former master’s supervisor to help me find opportunities in tropical medicine. At first I was hesitant to write to my supervisor, but when I did, my supervisor was pleased to hear I was continuing in my journey in Global Health and connected me to a physician at the Instituto de Medicina Tropical Alexander von Humboldt in Lima Peru, where I was able to spend 6 weeks volunteering and learning.
Tip 5: Start your international experience close to home.
After completing my medical degree at UQ, I went to on to complete Internal Medicine residency training at Emory University in Atlanta. Given the demands of the first few years, it was challenging to organize any international training experiences, but I was able to arrange an elective with the Navajo Nation in Arizona, which provided me with valuable insights into some of the similarities in the challenges affecting populations much closer to home.
Tip 6: Concentrate on developing the skills you will need to contribute meaningfully. Find a niche.
As I progressed through my training, I was fortunate to have the opportunity to go to Addis Abba, Ethiopia and volunteer at the Black Lion Hospital. Before going, I reflected on my role in global health; I wanted to make a positivie impact, but avoid “voluntourism”. Voluntourism refers to a situation where medical volunteers may believe that are helping but are actually having unintended negative impacts and their work may be a net drain on local resources.
At the Black Lion Hospital, a public hospital with no palliative care services or supports, it became clear to me that I had discovered my niche. I could see firsthand how palliative care in resource-limited settings could have an incredible impact of patients’ lives, and I knew that this was what I wanted to do.
Since that time, I focused on learning how to provide palliative care in a global health context. I searched for opportunities to learn, and found one of the few specialized fellowship programs that would allow me to focus my training on palliative care and global health at Harvard University. I was able to complete this fellowship, and then I went to Uganda to spend more time learning about the practice of palliative care in resource-limited settings.
Everyone has a unique skill set. Whether it be training, a different language, or life experience; you are a unique individual, reflect on how you can contribute to the global health field and highlight this when looking at various opportunities.
Tip 7 Take every meeting. No introduction is too small.
Through an informal conversation in the halls of Toronto General Hospital, while sharing my passion for global health and palliative care, I learned about a physician in Ottawa, who then connected me to Dr. Megan Doherty, and then to PallCHASE.
My philosophy of “take every meeting” and “share what you are passionate about”, led to a research collaboration with the Global Institute of Psychosocial Palliative Care at the University of Toronto. I am now working towards starting a Palliative care and global health program at the University of Toronto. My dream has come true!
I encourage you to take every opportunity for a meeting, you never know where it may lead. I have also discovered the power and benefits of informal conversations with those who have worked in or influenced your field of interest, including interdisciplinary sectors such as international education, public policy, and anthropology. These experiences can provide tremendous learning experiences and you never know when opportunities may arise.
by Kayla Wolofsky, MD, MSc, FRCPC
Division Of Palliative Care & General Internal Medicine
Department Of Medicine, University Of Toronto
Toronto General Hospital, University Health Network