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Julie Herlihy, MD, MPH, in Zambia. Click here to view more of Herlihy's photos. |
With only one hour to spare between her shift in the intensive care unit and one at a primary care clinic, Julie Herlihy, MD, MPH, jets into a restaurant to grab a burrito and snags a seat on a bench. Between bites, the second-year Boston Combined Residency Program in Pediatrics (BCRP) resident at Children's Hospital Boston describes her 7,000 mile journey to one of the world's poorest countries, Zambia, and how she ended up at Children's pursuing a career in global pediatric health. "Zambia is why I'm becoming a doctor," she says. "I had thought I was going to be a high school teacher!"
Herlihy isn't alone in her goal to improve global health for children; forging a career in the field has become increasingly popular among new doctors. Reacting to the surge of interest in 2004, the BCRP created the Global Child Health Initiative, which provides specialized skills and mentorship to residents interested in global child health. Ted Sectish, MD, director of the BCRP, says there was a demand among incoming interns for a more global focus. "These days, interns have a truly global perspective," he says. "They think of themselves as taking care of the children of the world instead of just the children of the United States." When considering who to accept into the highly competitive residency program, Sectish takes into consideration the work the applicants have done in the field. "We're looking for people who are going to go above and beyond," he says.
This is an apt description of Herlihy, who became interested in global health accidentally. While studying education at Brown University, she spent a semester in Zimbabwe, Africa, on an international teaching exchange. She thought she was going to be teaching biology, but ended up addressing locals' basic public health issues by educating them about HIV/AIDS, healthful eating, malaria protection and family planning. She graduated college still feeling the impact of her time abroad and decided to join Project Concern International, an international health organization.
With no medical training, she travelled with the non-profit group to Zambia, a country roughly the size of Texas. The need for basic health care services in Zambia is huge: More than 70 percent of the population lives on less than $1 a day. Coupled with poverty is widespread disease: Almost a million people suffer from HIV/AIDS. Collaborating with a local group called Bwafwano, which means "helping one another," Herlihy helped train community health workers in palliative care and basic pediatric care to help the overwhelming number of people sick and dying from HIV/AIDS, tuberculosis, malaria and malnutrition. "We were really trying to give patients back their dignity," she says, explaining that they would bathe patients, bring them food and give them medicine.
As patients passed away, the group was faced with a new concern: the young children left behind. In response, the group's focus shifted to providing support services for children who had lost a parent or who were suffering from tuberculosis or HIV/AIDS themselves. "Zambia's societal infrastructure has completely lost the parental age group," Herlihy says. "Many of these kids are cared for by their grandparents or relatives that are several degrees removed. It's one thing to make sure they get their medicine every week, but it's another to make sure they're developing well, growing well, having educational opportunities and have enough food in their bellies."
Herlihy desperately wanted to do more to help and felt frustrated by her lack of medical knowledge. "It was hard to work in these communities and see kids so sick without knowing how to address their illnesses," she says. "I realized that by becoming a doctor I could stay more connected to people who needed help." So in 2002, Herlihy entered the University of Massachusetts medical school and three years later began pursuing a Master's in Public Health. Before too long, she was back in the thick of it, leading a team of fellow medical students to Zambia to train clinic workers with Bwafwano in diagnosing and treating HIV/AIDS and other conditions.
On these trips, Herlihy found herself dealing with cultural myths about how people contract HIV and how it should be treated. "The community has so much stigma about the disease," she says. She witnessed unintended repercussions of diagnosing kids with HIV/AIDS, like some families who no longer want to feed and clothe children who had it. "We've seen kids get abandoned once people found out their status," she says. "AIDS really scares people. It's ravaged the healthiest members of their community and wiped out the viable income earners, resulting in total economic and social collapse."
Still, their efforts are paying off: since the clinic started offering pediatric health care, it's grown immensely. In the first year, it had 500 children registered and only one site. Today, there are five sites throughout the country treating nearly 10,000 children and it now has funding from the Zambian Ministry of Health, which supplies medications and vaccines.
Now in her second year in the BCRP, Herlihy is still strongly connected to Zambia, where she travels each year to check in on the clinic. As she goes about her pediatric internship at Children's, Herlihy finds that much of what she's learned in Zambia directly applies to her work here. "I think a lot more holistically about patients and families and what it takes to actually make someone healthy now," she says. "Health greatly depends on societal factors, like employment, family support and access to education. I believe that nothing will work on the ground unless the community or family is 100 percent involved and has full ownership of it. It's the same at this hospital: Unless you have a family on board with a treatment plan, it's not going to hold."
Herlihy plans on dedicating her life to pediatric global health issues and recently helped establish the first pediatric global health fellowship in partnership with Massachusetts General Hospital. She hopes future fellows will come to expand their knowledge like she has—not just about medicine but what being healthy means in a global context. "I don't define health by what disease you have anymore," she says. "I define it by your ability to be a member of society, and to contribute to it."
Children's will recognize World AIDS day on Dec. 5, noon to 3 p.m. in the Patient Entertainment Center.
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