Leana S. Wen, M.D., M.Sc., is a resident physician at the Harvard Affiliated Emergency Medicine Residency at Brigham & Women’s/Massachusetts General Hospital. A Rhodes Scholar and graduate of Washington University School of Medicine, Dr. Wen is a global health activist with a strong interest in public health and policy. She has been a fellow and consultant to the WHO, Brookings Institution, Eurasia group, and China Medical Board, researching on issues ranging from access to medicines to global health workforce to comparative health insurance. She wrote a regular blog for the New York Times with journalist Nicholas Kristof, and travels regularly between four continents for research and speaking engagements. From 2005 to 2006, Dr. Wen served as the national president of the American Medical Student Association.

HA: Dr. Wen, thank you for joining us for this interview.  You are familiar to many of our readers as an AMSA leader, as well as a writer through your blog, Two for the Road, in which you write about your journey through Africa with author and journalist Nicholas Kristof.  Can you talk about the challenge you faced, as a medical student and a writer, in having to distinguish between these two roles during your travel?  

LW: First of all, thank you, Hana, for inviting me to this interview. It’s a great honor to be invited by Global Pulse, a journal that is read around the world. I’m glad that you ask me to speak to the perspective of a physician-in-training, because that is what I consider myself – a young physician at the beginning of her career with a passion in global health.  As readers familiar with my writing with Nick Kristof know, I thought that I would have a conflict between the role of a writer and that of a physician-in-training when I first started working with him.  There was one particular experience that I found very challenging. There was a woman we met in a village in the Congo, Yohanita, who was dying of starvation and sepsis, and even though I was there in the role of a journalist, my first reaction was to help the patient, because that's the obvious thing to do as a medical professional.  I thought it was a serious conflict at the time, and I wrote about that in an article for AMSA in The New Physician. Reflecting back on that experience, though I began to think that these two roles were not nearly as in conflict as I had thought.  I had started out with this notion that what I should be doing as a writer is to remain at a distance, that I should be impartial, even in cases where as a physician I should clearly be helping the patient.  Then, I came to realize that actually the opposite was true: that in both roles, our goal is to advocate for the patient. In journalism and in medicine both, the broader goal is to help people who are like the patient Yohanita, by elucidating the whole history, treating the patient, and treating—fixing the system, In this case, it is to understand that what lay behind that woman in the Congo being so sick was the conflict and instability of her country.  Advocating for a resolution of that conflict, and for her safety, was just as important in my role of a physician as of a writer.

HA: Many people who write about global health issues are driven by a passion to correct an injustice, or the desire to tell an under-reported side of a story. As a writer, could you share your thoughts on how to remain professional and balanced while writing about issues on which it is difficult to remain impartial? 

LW: I actually think that impartiality is not the aim to which I aspire, and it is certainly not the aim when we talk about a particular patient – we do not want to be impartial towards the patient, in fact our goal is to advocate on behalf of that one person and to treat them in the best way possible.  As a journalist writing about global health, the same principles apply.  This is something you see in the work of Nick Kristof: when people ask how he decides what stories to choose, every time the answer is that he looks for the stories that make him not be impartial. He wants to find stories that grab people's emotions, that really take them by surprise and make them say, Oh, I should pay attention to this issue.  It is not a question of saying, Let's take the most balanced perspective of this issue, the pros and cons of interfering in the conflict in Congo, or the pros and cons of Darfur.  He wants people to say, No, there is a problem, and we should care.  So I think that impartiality is not the goal to strive towards, either in medicine or in journalism.  Advocacy to correct injustice is the goal.

HA: In addition to Nick Kristof, who are some other writers who think like that, and whose work you have been impressed by?

LW: In general, I'm impressed by people who show a lot of passion and invest a lot of soul in their work, and this is reflected in fiction as well as nonfiction. One of my favorite writers is Abraham Verghese, who wrote Cutting for Stone and The Tennis Partner. He is a frequent speaker at AMSA conferences and a great humanist, and I'm impressed by a similar approach that he takes towards practicing medicine and writing, which is to choose stories as a way of demonstrating key aspects of human nature and what we can do. Another physician-writer that I greatly admire is Dr. Bernard Lown. Not only did he invent defibrillation and pioneer the use of lidocaine in cardiac arrest, he is also a moral leader and the founder of IPPNW (International Physicians for the Prevention of Nuclear War). His books, The Lost Art of Healing, and Prescription for Survival, are two that I highly recommend.

HA: As a doctor and advocate, is there anything you've written about that you see yourself working on in the future? What is one thing you wish the wider public and other media would pay more attention to? 

LW: Something that is common to advocates and leaders of AMSA is that everybody is passionate about so many different issues – domestic and global – but ultimately the theme is about correcting global health injustice, global health inequities.  We can choose to focus on any of these issues, and accomplish change in any of multiple ways. One issue that I will speak to in particular is workforce.  As access to health care is limited in so many places, I think we are finally beginning to recognize the shortage of health workforce affects virtually every country, including the US, but certainly more dramatically in the developing world.  There are several components to this issue that I continue to learn about and work on, for example how to mobilize community health workers, how we can best task-shift, and generally how to best utilize the potential of health workers in resource-poor settings, to adequately staff the global health workforce.  

A closely related issue is the global brain-drain.  On one hand, we want to encourage people to fulfill their dreams.  It is difficult to say no to encouraging immigration to find better opportunities because my parents and I are immigrants, and we came into this country to pursue better opportunities; I certainly wouldn’t want to limit any person's ability to move. At the same time, we have to develop sustainable policies in the developed world.   It’s true that the US is facing a severe healthcare workforce shortage, something like 100,000 missing doctors by 2020. When we talk about health disparities in the U.S., part of the problem is that American health professionals don't choose to practice in rural or urban underserved areas.  Historically, we have reduced the domestic shortage of physicians and other health care professionals by recruiting from abroad.  But the solution should not be to poach the health workforce of other countries that desperately need their own health workforce.  On the side of the developing countries, also, better policies are needed to retain people without limiting their freedom of movement.  I wish U.S. physicians-in-training and media today would pay more attention to this: the need to recognize not just the health workforce needs of our own country, but also the need worldwide, and how the two are connected.

HA: You served as AMSA's National President in 2005-2006. What was your experience with AMSA prior to that? Can you tell us about some of the projects that were important to you and left a lasting impression?

LW: I started by getting involved with AMSA as a pre-medical student, then ran for a national leadership position as a first year medical student; throughout my time with AMSA I was involved with a large number of projects on the local, regional, and national levels. I felt strongly—and continue to believe—in the motto of AMSA: that there is more to being a doctor than medical school. There is so much more one needs to know: one needs to understand economics, to understand community and culture and diversity, and to practice professionalism.  There is so much that the current medical school curriculum does not teach, and maybe cannot teach: perhaps these are things we have to find out on our own through experience, through interacting with each other and with different communities.  So I think the very concept of AMSA is one that I'm a big believer in, and I felt strongly enough about it that I wanted to help lead the organization as the National President. 

There are two distinct features of AMSA that inspired me over the years. The first is that it is completely student-run: all the national leaders are students, and some take time off to work for AMSA full-time.  Students shape the national agenda of AMSA. This is a type of leadership opportunity that just isn't available at other organizations.  The second thing about AMSA is that the goals it advocates for are focused on patients and not on the profession itself – and this, I think, significantly distinguishes it from the AMA and from professional organizations who exist to lobby for their own interests rather than actual patient care.  

As for specific projects, one that mattered a lot to me was the PharmFree project. When I first started at AMSA it was a concept that was not particularly in favor. I remember being at my first AMSA conference and Bob Goodman, founder of the No Free Lunch campaign, gave a talk that was followed by plenty of boos and hisses. I think the general attitude has shifted significantly since then, so that we now value the teaching of professionalism and independence more highly than we did at the outset. The evolution of the PharmFree campaign over the years and the impact it has had on major academic centers and the thinking of physicians across generations illustrates that we, as physicians-in-training, can and do have a voice in major reform.  I hope that AMSA will continue to lead the way in medical education reform beyond this, and more global and systemic health reform as well.

I wanted to mention, too, that the Global Pulse is something that really kicked off in the last several years!  At the time that I was AMSA President, it was already established and well-publicized by Julio Bracero and others.  They have done an amazing job with the outreach! I meet people at international conferences who have heard of AMSA and the work that we do through the Global Pulse!  This is another reason I am very happy to speak with you today.

HA: What do you think is the importance of the Internet, viral media, social networking, and other new connectivity resources, to the movement for global health equity? Any concrete examples from your experiences?

LW: While I was writing Two for the Road (the blog with Nick Kristof for The New York Times, a lot of people wrote to me to ask how exactly do we make a difference?  A lot of people ask that question, and of course the answer depends on who you are, what are your interests, where you are in life. . There is one particular girl who I advised through the blog, who asked how she could make a difference if she had to go straight through college and medical school. I remember that I wrote to her and advised her to not necessarily go straight from college to medical school, to do something else first, to build up other skills. Travel; do something else she was passionate about! She decided she would join the Peace Corps and work in Senegal for two years, and she has since then had a phenomenal experience, teaching about prevention of HIV/AIDS and mobilizing the local community, building a library and advocating for better education. . . . We stayed in touch, and hearing about how she was inspired, based on that one very simple communication, was in turn very heartwarming and inspiring to me.  To me, this is what illustrates global connectivity: that we can do something very simple, like write a note to someone online and have them read it, and that will really inspire them to change their lives and the lives of other people as well.  Our global connectivity is so new and so amazing. It is something that medical students should capitalize on.

HA: As a young medical professional, what are some obstacles to involvement in global health work that you have encountered personally? 

LW: There are some practical obstacles, like finances, finding the resources to support global health work. Another practical obstacle that everybody faces as a medical student is time. There is a little time at the beginning of medical school between first and second year, and then a little more time during fourth year, and not really time during residency, so how is one supposed to find the time to do global health projects? The third obstacle that I hear about is, what can students and physicians in training really do? Are we just going as medical missionaries, are we doing this as medical tourism – you know, what good is it really doing not just for us, also for the particular environment we are in?  

I would like to address these three points.  The first thing, about finances: grants are available, but you have to find them and work for them. The time issue is another practical concern, and I think the way to address it is to work around it and create the time -- it is not something that is automatically there, and like the money, it takes effort to find.  Still, plenty of students are able to take time off before, during, and after medical school.  I took a total of 4 years off in my medical training to do international work and pursue policy opportunities, and it is not something everybody chooses to do, but it's certainly something that you can do if you have the commitment and the passion for it. More and more students are choosing to do it during the parts of medical education where before they would have done clinical research or basic science research.  

The final issue is that of medical tourism and what can physicians-in-training really do.  One way to approach that is by thinking beyond what one person can add to their host community in one month – because you're right, if you just look at what we bring to that society at that one point in time, maybe we don't bring very much, and it is not very sustainable.  But what Nick Kristof and other people have said is that what the student gets out of that experience is measured not so much in their achievements at the time, but in what perspective that person gains throughout their life.  Going abroad and seeing how medicine is practiced somewhere else can really change a person's whole career, in ways that I'm sure you and the readers of GP can attest to – change it in ways that inspire us to a lifetime of being better doctors and advocates – and perhaps that alone is a good enough reason to do it.  Of course, we also do good to the individuals we interact with when we are working. And ultimately it’s about making a difference one patient at a time, as well as advocating for their communities.

HA: What advice do you have for health professional students in training who want to preserve their enthusiasm and ideals through the length of training? 

LW: I think it's very common to see medical students who are very excited about this kind of work in their first year, and then end up losing that enthusiasm, in part because of lack of time and in part because of lack of role models.  And on a practical level, the things we do every day are not about advocacy, they’re about focusing on the patient in front of us.  I think there's nothing wrong with that, we need to be trained as clinicians first and foremost, but beyond that we need to keep our passions too.  As I said before, I believe it is very important to seek out opportunities to travel.  It is also very important to seek out role models, and there are people who do the kind of work we are interested in, global health and advocacy. We have to take the initiative to find them and keep up with them.

Most of all, I think it's important to keep things in perspective: to know that the problem of the patient in front of us is something that needs to be seen in context.  You don't have to be abroad to see the context, and you don't have to be in DC to engage in patient advocacy – it can be on an every-day level. You can figure out why an asthmatic child keeps coming back to the hospital with asthma attacks: sometimes it is not because the parents aren't paying attention or because the asthma has become resistant to tons of drugs – it may be because the parents can't afford the prescription. Taking that extra step, that extra interest, is something that allows us to become better doctors for our patients, and it's something that can sustain the momentum of professionalism, and the momentum of the work we do at AMSA, GP, and beyond.