Dr. Julian Atim discusses clinical practices with Emmanuelah Mutiso, a nurse in Kenya. © Global Health Labs, Inc
For World Health Day 2023, which marks the 75th Anniversary of the WHO, my call to action is grounded in gratitude to four women of strength. Firstly, to my mother, Rose who lived her life with ingenuity, perseverance, and a profound commitment to family and community. Secondly, to @Michelle Obama and @Viola Davis for writing memoirs that inspired me to lift my own voice. And finally, to a Ugandan nurse, whose care and attention set me on my path to medicine and healthcare innovation. It is also with her where my story begins.
Inspiring My Curiosity
I was 13 years old when the nurse treated me for malaria – a disease commonly experienced by people in the small community in Uganda where I was born and raised. After the nurse learned that a key test was out of stock, I watched her creatively improvise to ensure I still received what I needed.
“How do you keep doing this?” I asked.
“I do the best I can do, while stretching the resources I have,” she replied.
Recently, I shared this conversation and its impact on my life during a Leadership Fireside at Global Health Labs, Inc (GH Labs). The anecdote was also in the context of my broader story. Specifically, how I – a Ugandan girl with 10 brothers and sisters – made my way to medicine and, ultimately, GH Labs, where I lead the Clinical Research function, helping reduce health disparities with technology innovation.
The nurse had inspired me with her passion for finding solutions with what she had available to save the lives of her family, friends, and neighbors. Whether it was clearly communicating the critical importance of follow-up care or providing and educating patients practicing behaviors to protect themselves from diseases such drinking safe clean water, she saved lives. But it was the underlying sentiment of what she shared with me that proved the most formative because the nurse felt that she could have done more if she’d had access to better tools, technologies, and products to diagnose and treat young kids like me.
This experience ignited my passion to be a part of the solution – to join the ranks of doctors and nurses striving daily to deliver the care and treatment their patients need to live healthy lives.
Seeing Things in Context
Nearly ten years after speaking with the Ugandan nurse, I reveled in my journey to becoming a doctor, but that didn’t make things any easier. Time and again, I was reminded of the stark differences between the recommended standards of care in textbooks and what was available at the hospitals and clinics in my community. This was particularly eye-opening for HIV, which was ripping through our community and my own family like wildfire. At the time, as estimated 30% of adults in Uganda were HIV positive.1 A decade prior, my father lost his life to the disease. And when I was a medical student, my mother also navigated the protracted suffering of the inscrutable disease.
I remember studying the latest treatment, trials, and medication for HIV and then coming home to find my mother soothing her neuropathic pain from post herpetic scars (common for people living with the disease) with the sap of a Plumeria tree near our home. I later learned that the Plumeria sap has healing properties that support pain relief. Since my mother did not have access to the care she needed, she used the sap to do the best she could with what she had around her.
Navigating Challenges in Practice
When I began practicing medicine, my community – like my mother – also did all they could with what they had. But it was never enough. As doctors, we did not have the right tools and technologies to treat our patients as effectively as we wanted, and more importantly, as our patients needed.
When I was Chief of my Hospital’s Children’s Ward facing a room of premature infants, I was often forced to make heart-wrenching decisions. Many of these decisions still haunt me, such as having to rationally distribute our limited number of incubators and medical oxygen to the patients with the best chance of survival—and refer my other patients to better resourced hospitals.
It was equally frustrating to care for sick children without the right tools to comprehensively diagnose and treat their conditions. The microscope was our primary tool for diagnosing disease and proved invaluable for testing common conditions such as malaria, TB, and intestinal infections. Still, it required specialized skills and broke down often. It also took a long time for results to be confirmed at the external laboratory many miles away, which delayed our care decisions. For this reason, I often started very sick febrile patients on antimalarials before getting back the lab results.
In time, technological innovation led to the development and wide access of Rapid Diagnostic Tests (RDTs), which are easier to use than the microscope and deliver results more quickly at the point of care. While the impact of RDTs on healthcare delivery is undeniable, including for reproductive health conditions, which can be otherwise difficult to diagnose in lower-level health facilities, my firsthand experience underscored time and again the need for further innovation to harness the full potential of RDTs in under-resourced healthcare settings.
Shifting My Approach
Although the practice of medicine remains deeply meaningful to me, my drive to address the challenges that I experienced compelled me to work in the public sector and then in the private sector because I wanted to address gaps at the systems level, and moreover, at scale. Along the way, I proudly contributed to malaria solutions that included the introduction of RDTs for effective diagnosis, and Artemisinin combination-based therapies (ACTs) and injectable artesunate for appropriate treatment. In addition, I helped shape a range of skills-building mentorship programs that expanded healthcare capabilities with lasting and diffuse systems-level effect.
Frequently, I also witnessed externally funded programs begin to move the needle and forge impact at the community level, only to stumble when the focus and/or priorities of industry or the donor shifted. Such things are understandably frustrating, but I am my mother’s daughter and have never let setbacks dim my light or determination.
Innovating for Impact
Today, in my role supporting GH Labs, I bring all my medical, public health, private-sector, and lived experiences to the table – contributing my skills as a medical doctor and my voice as a community member to ensure patients and healthcare providers are continuously centered in our work to develop innovations that creatively yet sustainably address unmet healthcare needs, especially in low- and middle-income countries.
This year’s World Health Day theme and focus on #HealthForAll could not be more important. Profound healthcare disparities exist – and persist – worldwide. It’s not enough that healthcare providers and patients do the best they can with what they have. To achieve our shared vision of #HealthForAll, everyone everywhere must have appropriate and reliable access to the tools, care, and treatment we need to thrive.
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