Humility, flexibility, and resilience: applying global health experience locally

The COVID-19 pandemic profoundly affected health institutions, plunging well-resourced health systems into an unfamiliar state of relative resource limitations. The U.S. leads the world in healthcare spending per capita, creating an environment where many U.S.-trained and -based physicians are accustomed to working with near limitless resources. The pandemic forced us to address an emergent threat with limited resources.

Further, the pandemic has both revealed and exacerbated inequities caused by structural injustices, including racism and poverty, causing disproportionately higher rates of morbidity and mortality on communities of color and lower socioeconomic statuses. The pandemic has also highlighted our global interconnectedness and realization that global cooperation and equitable access to vaccines will be required to control current and future surges and variants.

Many U.S.-based physicians with global health experience (GHE) have unique and relevant insights and skills that they have been able to apply to both domestic and international settings throughout the pandemic.

This global health “toolbox” includes skills such as resourcefulness and innovation, flexibility and adaptability, finesse in working within resource limitations, experience ensuring ethical allocation of scarce resources, cultural humility, expertise in disaster management, and a health equity lens through which to view health outcomes.

This skillset led to many U.S.-based physicians with GHEs being called upon to take pandemic leadership roles at their U.S. institutions. Physicians who have completed GHEs often describe learning to approach problems with both flexibility and humility, the cornerstones of solving problems in an unknown environment.

In a recent paper, a group of U.S.-based physicians reflected on how the tools and skills gained through GHEs better prepared them to respond to the pandemic within their home institutions in the U.S. The authors discussed how their global health lenses helped them approach three key questions amidst the pandemic:

• How can our health system function with new limitations on essential resources?
• How do we work at high intensity and volume, on a new disease, within new and evolving systems, while still providing high-quality, patient-centered care?
• How do we help personnel manage an unprecedented level of morbidity and mortality, disproportionately affecting the poor and marginalized, including moral difficulties of perceived care rationing?

The pandemic also serves as a powerful reminder that often the most innovative solutions arise from resource limitations. As U.S.-based physicians, we have much to continue to learn from colleagues in low- and middle-income countries who have remained on the front-lines providing essential health services and delivering life-saving care in resource-deprived settings throughout the pandemic.

U.S.-based physicians can use a strength-based lens to appreciate the expertise and ingenuity required to continually adapt to pandemic challenges in global settings and apply relevant lessons in our own settings. For example, we can learn from decades of epidemic control experience responding to the HIV crisis, such as Botswana’s recent public health victory in eliminating maternal-to-child transmission of HIV.

Though many GHEs for U.S.-based medical trainees have been paused indefinitely amidst pandemic-related travel disruptions and concerns about safety; we argue that global health education—such as opportunities for medical trainees through the Texas Children’s Global Health network—will be even more important for the next generation of physicians. To prevent and respond to the next pandemic and to elevate the health of all, we need more physicians who understand global dynamics, focus on equity and social justice, and are able to rapidly adapt to unexpected and difficult situations including resource scarcity and situations that exacerbate structural violence.

By Dr. Cameron A. Price, medical resident in pediatrics at Baylor College of Medicine, and Dr. Heather Haq, assistant professor in the Department of Pediatrics at Baylor College of Medicine and the chief medical officer for the Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital