Q & A with Dr. Allison Berndston

Global Health: Creating Long-Term Improvement (and Making Long-Term Friends Along the Way)

UC San Diego's Dr. Allison Berndtson has devoted much of her career to training and collaborating with surgeons and surgical care facilities around the world. Having a particular interest in global health, Dr. Berndtson -- an assistant clinical professor in the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery -- has provided education and clinical care in Ghana, Colombia, Haiti, India, Mexico and Mozambique, and was a founding member of the annual Abuja National Trauma Conference in Abuja, Nigeria.

Dr. Berndtson is currently an instructor and course coordinator for the medical student trauma evaluation and management (TEAM) course at UC San Diego School of Medicine, and a designated instructor in Advanced Trauma Life Support (ATLS), Advanced Trauma Operative Management (ATOM), Advanced Surgical Skills for Exposure in Trauma (ASSET) and Disaster Management and Emergency Preparedness (DMEP). She has been invited to speak nationally and internationally on topics such as trauma systems development, resuscitative thoracotomy, trauma evaluation and management and advances in major trauma care.

Here Dr. Berndtson discusses the career trajectory that led to her specialization, as well as the challenges she foresees in global health moving forward. She also dispels some myths many people have about global health and global surgery.

Q: What made you interested in pursuing global health as a specialty?
Dr. Berndtson: I grew up in Boulder, Colo., which is a really worldly place, but you're not actually directly exposed to inequalities there -- you just hear and talk about them. In middle school, I had a teacher who thought that teenagers should travel and see the world. We went to Kenya for two weeks the summer after 9 ^th grade, and we mostly did safaris and trinket shopping in Nairobi, but we also visited private schools and some of the villages, and it was completely eye-opening. It was the complete opposite of growing up in Boulder. When we were driving out of Nairobi, there were kids on the street begging, kids who had been injured and kids huffing glue out of tin cans. I came away from that trip knowing that I wanted to do something that would help that level of disparity. Once you've been exposed to some of the inequalities in the world, you just want to help.

Q: Was there a pivotal moment in your career that made you realize you wanted to specialize in global trauma?
Dr. Berndtson: It was more of a continuum. It wasn't until late in medical school that I started pursuing global health. Global health wasn't on many people's radar at the time. I did a one-month rotation in my fourth year of medical school with a group of medical students and residents setting up mobile tent clinics in small towns in the Himalayas in India. We saw people who had arthritis, heartburn, jaundice, and burns. I was the only student going into surgery, so they made me see all the burn patients. I didn't do any global surgery until I was chief resident at UC Davis. It was just around the time when residencies were starting to have residents abroad. I used part of my vacation time to work in Haiti. They were still affected by the earthquake that had happened in 2010, but we also treated a lot of gunshot wounds and other traumaticinjuries. Mostly what I do now is education and research.

Q: How do you stay positive when you see so much suffering?
Berndtson: Not sinking into despair is a learned skill. You have to keep in mind that you're really trying to help that person. If you get too upset, you can't help them effectively. In the moment, you have to put your feelings aside, take care of the patient and do your job. If it bothers you, you take care of it later. Some things get to you more than others. Over time, wounds themselves are not a big deal, it's much harder dealing with patients' suffering and when patients have had loved ones die in the same accident.

Q: What do you think are some of the biggest challenges in global health?
Berndtson: The answer will be different depending on if you ask someone in public health vs. someone in surgery vs. someone in family practice. From a public health standpoint, we should vaccinate everyone, give them folic acid and clean water and focus on infection control. In terms of surgery, the developing world has a lot of issues with some of the more advanced care. In the U.S. we take intensive care units (ICUs) for granted, but in a lot of hospitals around the world not every bed has a monitor or ventilators. Truly a limiting factor is access to care beyond the absolute minimum, and not just access in terms of physicians, nurses, technologists. Even when they have those resources they're often siloed in bigger cities and towns, just like in the rural areas of the U.S. That is just going to become more and more stark as the urban-rural divide increases. For patients who are critically ill the lack of pre-hospital care is going to be a major problem.

Q: What are some myths people have about what it's like to work as a trauma surgeon in the developing world?
Berndtson: Oftentimes, global health is not what people think it is. When people think of global health, they think of Doctors Without Borders and, especially for surgery, they think of one-off mission trips where you do a bunch of operations. Those have their place, but that alone is not sustainable. The ultimate goal should be to have these countries provide healthcare on their own with their own surgeons and their own physicians who understand their own cultures. We can teach them and we can help them do quality improvement, but we also need to help them do these things themselves by learning basic research skills where they can gather the data, analyze it, to see what is causing morbidity and mortality and develop a cost effective way to address it themselves. They won't be able to prevent disease if they can't figure out where it's coming from.

Q: What is your advice for someone interested in pursuing global health?
Berndtson: Fortunately, it is getting easier and easier to get involved in global health. More people are recognizing it as a way to be a good global citizen — it can be a good collaborative relationship that both sides can gain from. Participants can find people in their medical school programs and get to know them, talk to them about why they do global health, what they're interested are and find a way to get involved — whether it is clinical care, research, quality improvement or education — to see if they're interested in pursuing global health.

Q: What are the personal and professional benefits to working in global health?
Berndtson: I think there are a lot of benefits to these long-term partnerships. We are currently working in two or three places long-term. Getting to know the people there is enjoyable, but it also helps both sides with collaboration. I also have personally developed a lot of relationships with the people in the countries I work in. That's one of the things that's rewarding for me. I exchange weird case photos with one of the surgeons from Ghana and we also share videos of our families at the holidays. Another of their surgeons stopped here and toured our trauma bay while he was in southern California and I encouraged the head surgeon of the National Trauma Hospital in Nigeria to apply for the American Association for the Surgery of Trauma's international visiting fellowship, which he later got. Seeing actual systems level change is a very slow process, but I make lots of friends along the way, and we're starting to see that the things we're doing are beginning to have an impact.