I am an Emergency Medical Technician (EMT) in California, with a further wilderness medicine certification from the National Outdoor Leadership School (NOLS), making me a Wilderness-EMT (WEMT). I have a strong interest in pre-hospital and emergency medicine and I am currently volunteering with the following organizations.
Stanford Emergency Medical Service (StEMS)
StEMS is a volunteer group that provides EMTs for the Stanford campus community. We provide volunteer emergency medical coverage for all major and most minor events on campus, and we also teach CPR for free to anyone who wishes to learn. I have been a member of StEMS since 2014, and a crew chief(a)A senior member who leads teams in the field since 2016. My teammates elected me president of the group in June of 2016 and I served a one year term in which I focussed on increasing unit accountability and expanding both the unit size and our ability to respond. I am currently the county liaison(b)I work with the county Emergency Medical Authority and other organizations to expand the influence and recognition of StEMS.
StEMS has allowed me, as a junior provider within the US medical system, to give direct care to patients as a volunteer in a way that I could not have in any other context before starting medical school. This has given me a tremendous opportunity to learn from my patients, and to learn to provide care in very strenuous situations. It ignited an interest in emergency medicine for me, but more importantly taught me how to deal effectively with scared and stressed out patients and family members. It turns out that caring for very sick patients is the easy part, managing their friends and family is often much harder.
Bay Area Mountain Rescue Unit (BAMRU)
The motto of the Bay Area Mountain Rescue Unit is ‘anytime, any place, and in any conditions’. We are a close-knit search and rescue group that responds to missing people all over California. I have been with BAMRU since 2013 and it was BAMRU in part that helped me to discover medicine, via my introduction to wilderness medicine, and put me on the path to medical school. With BAMRU I have responded on searches for missing people ranging from missing hikers in the mountains on the border of Oregon to missing older people in the hills close to my home. I also learned how to operate a technical rescue system, track missing people, and to work as a small part of a big team of talented volunteers. I learned to love that kind of team atmosphere, where everyone is dedicated and passionate and we all work together to find and rescue someone who needs help.
Santa Clara Valley Medical Center (SCVMC)
I also volunteer in the SCVMC Emergency Department(c)My volunteering at SCVMC is organized by Student Clinical Opportunities for Premedical Excellence (SCOPE), a Stanford based nonprofit that places volunteers in SCVMC. Here, I have no medical responsibilities, but just bring food, water, and blankets to patients. While my training makes me want to intervene, which can be frustrating, it is immensely rewarding to be able to simply sit and converse with patients without the level of urgency that defines the emergency physician. SCVMC’s ED is home to some of the poorest and most underserved members of the Bay Area’s community, and it is an honor to work with them.
Something that I learned from working with SCVMC’s patients is just how pervasive and destructive mental health issues are in our community. These mental health issues, ranging from minor to very serious, had a profound influence on the health of the patients I worked with, sometimes causing direct harm, but more often simply making care and planning for the future so much more difficult. When these issues are combined with the limited access economically disadvantaged people in this country have to healthcare, so many patients end up back in the emergency department again and again, just because they were unable to fill a prescription, unable to follow the doctor’s advice, unable to find primary care, unable to convince family and friends (if they even have any) to help them. These same issues affect many other patients also, not just those suffering with mental health disorders, however, the magnitude of the problem for those suffering from mental health disease was just truly heartbreaking. The more often I did shifts at SCVMC, the more I saw the same people back again, over and over, unable, for many reasons, to find the care they needed outside of the emergency department. There are no easy solutions to these problems, and I do not plan to study psychiatry, however, I believe that all health care providers need to think seriously about how mental health disorders lead so directly to economic disadvantage, drug addiction, and even homelessness. Any solutions we find to these problems must involve resources outside of medicine, but they will also have to involve conversations about how to most effectively take care of these patients in the hospital with kindness and without judgement.
I am currently preparing for medical school and considering how I can combine my interests in academic research with my desire to continue to help those who need it the most. While I have yet to decide which direction I will go, I am most interested in infectious diseases/global health and emergency medicine as these fields seem to very effectively integrate care for the disadvantaged with avenues for interesting academic research.
Infectious Diseases and Global Medicine
The evolution of infectious diseases fascinates me deeply, but beyond the science lies a world of suffering. While we have made huge progress in the global treatment and eradication of infectious diseases over the last several decades, preventable and curable infectious diseases still kill millions of people every year, with simple diarrheal illness claiming the lives of 1.3 million people every year [1,2] and tuberculosis and malaria claiming the lives of a further 1.3 million and 440 thousand people respectively(d)These numbers come from the WHO 2000–2015 statistics  . Even closer to home, infectious diseases generally claimed the lives of 43,000 people per year in the US(e)About 7,000 of these were from HIV/AIDS (which is greater than the numbers of deaths from car accidents or gun violence). Some deaths by infectious disease are to be expected, but the numbers worldwide remain far too high, with a disproportionate amount of morbidity and mortality globally affecting those under the age of 18 [1,2], rather than the older members of society. While there still remains a lot of work to be done, many of these diseases can be effectively diagnosed and treated by an infectious diseases (ID) physician. I believe that working as an ID doctor remains one of the greatest ways to make the most difference in the lives of those who need it the most, both globally and locally, and it also is a field where combining research and clinical care is both feasible and sensible.
Emergency medicine is a field uniquely positioned to serve an extremely diverse population of patients, with the perhaps the most diverse array of maladies in medicine. This is particularly true in the United States where the emergency department is one of the few havens for the uninsured and the under-insured, in addition to being a frequent admission route to the hospital for the insured. Furthermore, the sick from all ethnicities, cultures and orientations come through the emergency department when they are at their sickest. In other areas of medicine, this is often not the case, people tend to segregate themselves and choose providers by whichever identity matters to them this most. This exposure to patients from every background, when they are the sickest and most in need of help, combined with the sheer diversity of maladies served by emergency providers, makes emergency medicine a truly inspiring medical specialty.
I believe strongly in Paul Farmer’s concept of “Physicians as advocates for the poor”. While the poor of the United States have unjustifiably limited access to care (often being limited entirely to the emergency department if they have any access at all), the poor in the majority of this world have virtually no access to even rudimentary care. This limited access is made substantially worse by equally limited access to money, clean water, sufficient food, adequate policing, and to the education required to effect the greater political environment. The World Health Organization in 2004 stated in a report that “In low-income countries, relatively few risks are responsible for a large percentage of the high number of deaths and loss of healthy years … generally … by increasing the incidence or severity of infectious diseases” , of these risks malnutrition was the most important. This confluence of hardships is one of the most difficult international issues to manage or improve, particularly for someone hailing from a former colonial power, there are just so many interconnected problems. However, I believe it is possible to not just temporarily fix the symptoms of abject poverty, but to actually effect permanent change, it will just take time and dedication.
Physicians are uniquely positioned to contribute substantially to improving the conditions that lead to abject poverty. A population beset by illness and malnourishment is not in a position to innovate, to create political change, or to substantially change its own reality. Ill-health and malnutrition can lead to real development defects as well as a general malaise. While improvements in access to healthcare and food alone are not enough to permanently change a community, they are essential components enabling that change. For that reason, I believe it is incumbent upon medical providers to consider the ways that we can most effectively alleviate the easily preventable but not prevented healthcare problems that plague the poorer parts of our world. Sweeping in as savior doctors to ‘save the natives’ for a few weeks makes very little difference in the long run and runs a very legitimate chance of inspiring anger at patriarchal, elitist colonists. A far better approach is to put energy into affordable, durable, and scalable solutions that help to alleviate suffering in partnership with local communities. Great examples of this are free medical education platforms and research into ways to lower the costs of medications and decrease or counteract the spread of drug resistance in cost-effective ways. One of the things I hope to do during medical school is pursue a global health elective to learn more about the ways that I can help in the future.
Wilderness medicine is the hobby that gave me my love of medicine, and I intend to maintain it as a hobby throughout my future career. I love the wilderness, particularly wild mountains. These places are necessarily isolated, and so they should remain, but this isolation creates a unique medical need: how do you provide adequate healthcare in an environment hours, days, or even weeks away from advanced medical resources? This problem is compounded by the nature of the wilderness itself, and by the activities people undertake in these places. The wilderness brings harsh weather and difficult terrain, and the people in these environments tend to do things that make severe trauma much more likely. Thankfully there is a suite of skills available that makes managing risk and caring for the sick and injured in the backcountry much more feasible. I am already a Wilderness-EMT, and I am also pursuing a fellowship in the academy of wilderness medicine through the Wilderness Medical Society. I already teach Wilderness First Aid, as well as tracking techniques for following lost people, and I intend to continue teaching, and to continue building my own skills, throughout my future medical career. Because wilderness medicine is really fun, and extremely useful at that(f)Plus the techniques of wilderness medicine can be easily applied to the context of practicing medicine in any resource limited setting, such as poor inner cities, war-torn areas, and remote communities..
Footnotes [ + ]
|a.||↑||A senior member who leads teams in the field|
|b.||↑||I work with the county Emergency Medical Authority and other organizations to expand the influence and recognition of StEMS|
|c.||↑||My volunteering at SCVMC is organized by Student Clinical Opportunities for Premedical Excellence (SCOPE), a Stanford based nonprofit that places volunteers in SCVMC|
|d.||↑||These numbers come from the WHO 2000–2015 statistics |
|e.||↑||About 7,000 of these were from HIV/AIDS|
|f.||↑||Plus the techniques of wilderness medicine can be easily applied to the context of practicing medicine in any resource limited setting, such as poor inner cities, war-torn areas, and remote communities.|