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Hospitalist Training Helps Phuoc Le, MD, MPH, Fight Global Health Inequality


Left: Typical Ebola educational mural in Monrovia, Liberia. Inset: Left; Dr. Phuoc Le doffing personal protective equipment at CDC Ebola training in Atlanta prior to departure. Right; Rural Liberian healthcare workers doing exercises as part of hospitalist-led Ebola trainings.

Left: Typical Ebola educational mural in Monrovia, Liberia. Inset: Left; Dr. Phuoc Le doffing personal protective equipment at CDC Ebola training in Atlanta prior to departure. Right; Rural Liberian healthcare workers doing exercises as part of hospitalist-led Ebola trainings.

Phuoc Le, MD, MPH, was born a year after the Vietnam War ended and was five when he and his family fled Vietnam by boat to seek asylum in Hong Kong. At a refugee camp there, he had his first contact with a functional public health system and, within days, was cured of the parasitic disease that had made him ill since he was a toddler. Later, as an undergraduate at Dartmouth College in Hanover, N.H., he realized he had been one of the health disparity victims described by medical anthropologist Paul E. Farmer, PhD, MD, in his books.

“For the vast majority of people, it doesn’t turn out the way it did for me,” says Dr. Le. “As much as I’ve been blessed with, what I expect of myself is to focus on health disparities and have it be my life’s work.”

Dr. Le’s personal mission led him to co-found the Global Health Core within the division of hospital medicine at the University of California San Francisco, which aims to train hospitalists to work in resource-poor settings. The program recently was honored with the 2015 SHM Award for Excellence in Humanitarian Service.

Dr. Le, assistant professor of medicine and pediatrics at the University of California San Francisco (UCSF), where he co-directs the Global Health-Hospital Medicine Fellowship, recently spoke with The Hospitalist about his work.

Question: What was your first trip as a physician abroad like?

Answer: I was a resident at Harvard [University in Cambridge, Mass.] in 2007 when I went to Haiti with Paul Farmer and a few other residents involved in the [nonprofit] Partners in Health. I’ll never forget that the trip from Port-au-Prince to the hospital was only about 120 miles, and it took eight hours in a four-wheel drive vehicle to get there. They didn’t want us residents to suffer that trip, so they got a bunch of volunteer pilots to fly us in a single-engine plane, which took about 20 minutes.

We got there, had lunch and dinner, and it was during dinner that the group coming by vehicle finally arrived. It just dawned on me. These are things you don’t have a visceral feeling for until you see them. These people were tired because they had driven all day. What if I had been a patient and had to travel 120 miles and was sick? Would I have lasted eight hours to go that small distance?

This is just one example of many structural problems that need to be addressed. The same conditions are impeding the progress in [controlling] Ebola in West Africa. I was there in November. The problems that led to [the] Ebola [outbreak] were absolutely predictable and avoidable if the global community had paid more attention to this injustice before Ebola started—or responded much earlier. It could have saved lives [and] money, and we probably wouldn’t have had the huge scare in the U.S. that we did.

Q: What compelled you to go to Liberia just as the Ebola outbreak began?

A: To me, there was no question in my mind that I needed to go. It was a situation where I had the expertise. I’m a physician, a public health expert, [I’ve] worked in places with tropical diseases and have experience responding to emergencies like the cholera epidemic in Haiti and the Haiti earthquake. We also had a relationship with an NGO [non-governmental organization] in Liberia for several years. My colleagues and I at UCSF started the nation’s first global health hospital medicine fellowship, and our fellows had been going to Liberia for the last three years. For us, it was a matter of solidarity.

Q: You trained at the CDC prior to your trip. How did that training prepare you?

A: During those three days at the CDC, we were taught how to put on and take off personal protective equipment every day, and so we understood how difficult it was, especially in searing heat. It is very challenging, and we were able to teach those skills in Liberia.

Q: In a paper recently published in the Journal of Hospital Medicine, you call on hospitalists to join the ranks of global health hospitalists. Can you explain?

A: Whether it’s Navajo Nation in Arizona or rural Haiti, the healthcare needs of the poor are very similar. Global health hospitalists play an important role in capacity building, running a health system, improving quality while reducing costs, working in teams to provide holistic care for the inpatient, and improving transitions to the outpatient setting.

Q: How do the skills learned in resource-poor settings apply back home?

A: Let’s say you have a patient with tuberculosis, which is very common in places like Liberia, and you suspect fluid in the lungs. [In Liberia], you would insert a needle and remove the fluid. In the U.S., a lot of providers would not be able to remove the fluid without getting an ultrasound and multiple other studies. Those costs add up. Global health hospitalists are very well versed in the skills of ultrasonography because there are no ultrasonographers in the field working with us.

Q: You said it was in Haiti where you began to notice volunteers arriving with good intentions but without needed skills. What exactly did you learn?

A: I spent a lot of time there, responding to the earthquake and also the cholera epidemic in 2010. I came across dozens of healthcare volunteers who had passion and commitment but really came ill prepared, not through any fault of their own, but because they never had an opportunity to learn the skills needed to be effective in the field. For example, take a nurse from an ivory tower hospital and suddenly put her where she doesn’t have IVs to work with or the right type of fluids or tubing. Well, suddenly she feels like her efficacy has gone way down. That could easily lead to a lot of frustration and potential burnout.

Stephanie Mackiewicz is a freelance writer in Los Angeles.

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