By Natalia V. Galarza, MD and Kristina Diaz, MD
Global health has been identified as an increasing field of interest in medicine. As Koplan et al, mention, it can be thought as a notion, depending on current events. A definition for global health has never really been reached by consensus, and so it seems that global health can be adapted to the necessities of the location and time.
Many definitions touch on the fact that global health should improve health and achieve equity for all people and protect against global threats that disregard national borders.(1,2) It has deep connections with public health, blurring the boundaries between public health and global health. Within these connections, we have “border health” as a unique part of public health, with many characteristics being shared with the broader “global health.” For family medicine residency programs that are geographically located near the United States-Mexico border, the teaching of border health is embedded seamlessly in the medical resident education, so much that we tend to diminish its importance and gravitate toward other subjects of public and global health. It is easy to overlook the unique populations that we have in our own communities and focus on those that are more conventional and shared with other residency program or educational goals.
Laura Bujold, DO, MEd
The office is about to open when my office manager—I’ll call her Sally—walks up to me and says, “Did you see the pumping space I made for you?”
“No,” I respond. Sally and I walk in the door to an office that holds two nurse triage personnel. There is a rod with a shower curtain hanging that exposes a 3 x 21/2-foot area at best. One of the “walls” is the bookshelf and the other two walls are the corner of the office. The fourth “wall” is the shower curtain. Sally says she bought the supplies herself, smiles, and then leaves.
I run to grab my pump and pumping bag while panic consumes my confusion. There is no room for my pump. Even in a true office space, I could barely manage enough room for the pump, tubing, flanges, bottles, paper towels, water, and nursing bra, let alone the cooler for the milk.
I move quickly—my first patient will be here soon. I search the office for a small table and I find one in the bathroom; I put it immediately outside the homemade cubicle. I put my pump on the table. The electrical cord to my breast pump doesn’t reach any of the outlets. My heart skips a beat. My patient will be here any minute. I move the table toward the closest outlet. With the breast pump’s electrical cord completely extended and the tubing stretched, my pump is plugged in but it is sitting about 1 foot outside of the cubicle.
In order to breastfeed and meet patient access demands, I am dividing my lunchtime throughout the office day to pump. However, this dedicated pumping time frequently gets booked with patients. When I ask for the patients booked in my pumping times to be rescheduled, I am told “Oh, you can’t see them?” or “Are you sure?” or “But there isn’t another time available in your schedule.”
Renee Crichlow, MD
In the last couple of years, I have been a co-teacher in an undergraduate program part of whose mission is to increase underrepresented in medicine (URM) students in our medical school. There are many reasons I have chosen to do this and to fully understand, I thought it would be important to share a little bit of my student career history.
To begin, nothing in here is about bragging. It’s really about sharing a story that may be similar to what others have seen.
My high school was a very high performing public school: we had 13 National Merit Scholars in the year I graduated, and I was one of them. (Except at that time in 1985 my award was called National Merit Outstanding Negro Scholar. I’m not joking. That’s exactly what it was called in 1985.) I mention this because it’s an indication of the fact that I would have been considered a very high-capacity, high-potential performer for college.
For many reasons that I won’t go into, there was no family support for me either financially or socially to enter college. So I found a way to get to college by myself. Eventually, I decided to stay in the town that I grew up in and went to school at Oklahoma University.
In order to afford food and books, I had to work night shifts at Hardee’s, closing the restaurant quite late. I didn’t have a car so if my friend couldn’t pick me up I walked back to campus. I worked multiple nights each week and carried a full credit load. I would say my grades there were mediocre at best. By the end of the first semester, it was clear to me that I was very bored staying in the same town that I grew up in. I went to the large pile of brochures that I’d been sent after winning National Merit Outstanding Negro Scholar award and I chose to apply to Boston University because it had rolling admissions and would accept me based on my ACT and SAT scores alone as my GPA was not very impressive. I ended the year with about a 3.2.