Upstate Goes Global

"Emergency physician with academic background. Do you need me?" This was the question that helped David Reed MD map an itinerary for his recent sabbatical in international medicine. His straightforward offer—to help health-care systems in crisis— evolved into a global, 15-month journey for Reed and for the medical students and residents who joined him along the way. Reed and assorted colleagues traveled to Ghana, Haiti, Kosovo, Rwanda, Uganda and Sudan. They cared for patients, taught native physicians, helped build a clinic and personally confronted the gross inequities in global health care. "We chose to work where health care is disrupted due to war, natural disasters or economic disparities," explains Reed. "We were trying to identify the most effective strategies for delivering assistance to disrupted health-care systems." In addition to addressing these issues, Reed and his team are building awareness. "Back here, in the United States, we tend to have our heads in the sand. We rarely see malaria, tetanus or dengue fever.

We do not fully appreciate the need for the most basic health-care facilities and medical equipment. We do not understand that, in other parts of the world, things we take for granted, such as sterile gloves, are washed and reused until they fall apart." Keen Sensitivity At the same time, Reed says, "Upstate students are keenly aware of the correlation between disease and poverty, whether in the United States or abroad. They genuinely struggle with their obligations as physicians in American society. When Harvard's global health crusader, Dr. Paul Farmer, spoke last year at Upstate, the room was packed. I remember one medical student saying, "I have to repay $250,000 in student loans. How do I fit global service into my life?" Reed has wrestled with the same question. He has demanding, daily obligations, caring for patients and teaching in University Hospital's Emergency Department. He lives in Cazenovia with his two children and wife, Amy Laventer, a geology professor at Colgate University. Still, Reed wants to personally participate in addressing global health challenges. One solution has been to volunteer, for two to four weeks a year, at a hospital on the Caribbean island of St. Lucia. "You can reach the island in seven hours," Reed says, "and get right to work caring for patients." Those patients, he notes, range from elderly islanders diagnosed with cancer to drug smugglers shot with M-16s. To date, a total of 20 SUNY Upstate residents and medical students have worked with Reed in St. Lucia.

Reed was also one of the early volunteer physicians on the scene after Hurricane Katrina. "An emergency physician is probably most prepared to respond to the immediate spectrum of trauma and disease that accompany a large-scale disaster," says Reed, who spent a week navigating the flooded streets of New Orleans, searching for stranded survivors. Upstate Endorsement When Reed proposed his recent – somewhat unorthodox – global sabbatical, he received enthusiastic support from his chair, John McCabe MD; his dean, Stephen Scheinman MD; and Upstate’s president, David Smith MD. Reed’s next challenge was selecting from the many international sites in serious need of medical assistance. With the help of colleagues and international relief organizations, he created an itinerary that spanned the globe – but was subject to change, often on short notice. In January, for example, he cancelled a commitment in Kenya due to post-election violence. Even in the relatively stable city of Kampala, Uganda, where heattended a course on Public Health in Complex Emergencies, Reed was cautious. In a letter to colleagues, he wrote, "Over the last couple days, representatives of the rebel Lords Resistance Army (LRA) have been at the hotel holding a reconciliation meeting, trying to find resolution to almost 20 years of conflict. Their presence actually made me a bit more nervous than yesterday’s newspaper article describing four simultaneous disease outbreaks in Uganda: yellow fever, meningitis, bubonic plague and Ebola." But for the most part, Reed remained unruffled by his surroundings. Emergency medicine requires a high tolerance for uncertainty. Even before his medical training, Reed was conditioned to remain calm: he grew up with missionary parents in Colombia, South America, and he spent 11 years as a search-and-rescue helicopter pilot in the U.S. Navy, flying missions in Antarctica and the Sierra Nevada Mountains in California. "I guess I like to help bring order to chaos," he admits. Insights From Abroad But even for a pressure-treated emergency physician, the international sabbatical has been challenging. "It is a long-and-steep learning curve but a very satisfying endeavor," Reed concludes. "And in tangible ways, it helped to expose Upstate’s medical students and residents to global health issues." Reed is grateful for the opportunity to join medical teams in other countries. "On a daily basis, I was impressed by the dedicated humanitarian workers I met in the field. Many have committed years to the effort," he says. "But even more crucial are the local citizens. Long-term success depends on identifying and nurturing local talent. Over time, they will remain most committed to the health-care needs of their region."