The first graduates of New Jersey Medical Schools global health distinction program talk about what theyre thinking and feeling as they careen into the medical profession during the COVID-19 pandemic.

When Asmi Panigrahi was accepted to New Jersey Medical School, she was eager to become a doctor who would help patients in ways that extend beyond medicine. She applied and was accepted to the schools Distinction Program in Global Health, joining its inaugural cohort and embarking upon a curriculum that would enrich her medical worldview to incorporate social determinants of health and principles of health equity.

She knew it would be tough to balance the medical school requirements with the global health program, which includes field experiences, didactic learning, leadership expectations, and a capstone project. And she would embrace the schools host city of Newark, learning how its most vulnerable residents need more than access to quality health care in order to lead productive lives.

But she never could have imagined what the world would be like during her final term at NJMS, when she made the hard-earned transition from medical student to M.D.

The COVID Class

Panigrahi and her NJMS classmates, including three other students in the global health distinction programs Class of 2020, graduated in April, during the peak of the COVID-19 pandemic. And Newark is within an epicenter of activity: 34 percent of the nations 1.6 million COVID-19 cases are within the tristate area of New Jersey, New York, and Connecticut, and 35 percent of those cases have been in New York City, which is Newarks neighbor to the east.

This twist of fate has prompted the first-ever graduates of the medical schools global health distinction program to reflect upon their time at Rutgers and what lies ahead. Two of these new doctors, Panigrahi and classmate Nemesis Y. Hazim-Liriano, talk about what theyre thinking and feeling as they careen into the medical profession at a time when everyone is concerned about global health.

Asmi Panigrahi, M.D.

This is a major milestone in your life, and youre experiencing it through the filter of an infectious disease pandemic. Whats on your mind?

Panigrahi: As one of the 30,000 newest physicians entering our nations workforce during the coronavirus pandemic, I am reminded of the privilege it is to be joining a profession that is, in its essence, wholly dedicated to healing.

Has your understanding of global health changed since you started medical school?

Panigrahi: Yes, definitely. Ive realized that there are innumerable roles that physicians ultimately take on in the global health space, from drafting international policy to conducting biomedical research to leading short-term medical missions to practicing long-term overseas, just to name a few. Attending medical school in the incredibly diverse Newark community revealed to me, time and again, how global health also encompasses local and community health, especially in todays increasingly globalized world.

Nemesis Y. Hazim-Liriano, M.D.

How has the pandemic influenced your outlook for this next chapter of your medical education and career?

Hazim-Liriano: Ive been a commissioned officer in the U.S. Army since 2016. When the military match for residency training took place last December, I was so excited to start work as an orthopaedic surgery intern. Given the current circumstances, Ive had to mentally prepare myself to work in whatever area we may be needed. As medical students, though, weve always had to find ways to integrate ourselves wherever we can help. I found my niche helping the COVID team at University Hospital in Newark with interpreting in Spanish and doing follow-up calls for patients that have been tested and discharged.

Looking back on your medical school experience at NJMS, what lessons will you draw upon as you begin your residency?

Panigrahi: I am so deeply grateful tothe entire Newark community andall of my patients throughout medical school who have taught me the most important aspects of my medical education. Though social determinants of health has increasingly become a buzzword in health care, the reality of caring for patients in Newark instills far more than any textbook or journal article could attempt to impart when it comes to issues ranging from access to health care to housing stability to immigration status. Advocating for patients was a daily act that I witnessed my peers, seniors, and attending physicians engage in, and advocacy is viewed as an essential component of patient care. That has deeply influenced me and will always be a part of my own practice of medicine.

How will your global health mindset influence your medical practice?

Hazim-Liriano: Ive learned that sustainable global health can work in many ways, and that includes working with global populations right at home. For instance, providing language support to all non-English-speaking patients, hosting health screenings and workshops within local immigrant communities, and mentoring younger students from underrepresented minority groups so that they, too, can help bridge the gaps that lend to these populations being disproportionately affectedby not just COVID, but by many of the chronic illnesses we commonly see. This pandemic has brought some of those concerns to a brighter light, and I hope that it drives change in insurance policies and access to care.

Case Study of the Century

Nearly 200 NJMS medical students graduated in Aprilvirtually and a month early.

We were looking forward to being at graduation to congratulate this first cohort as they received their diplomas with the Distinction Program in Global Health notation on it, says Harsh Sule, associate professor of emergency medicine and, along with associate professor of surgery Ziad Sifri, a founding director of the distinction program. Sule and Sifri also are core faculty members of Rutgers Global Health Institute.

In the shadow of this pandemic, it is essential that all health workers have a basic understanding of global health and its very real impact on their own immediate surroundings, Sule says. Global health is not just about helping people in other countries, a common misconception. It has security implications for the U.S. and the world, and it is intertwined with many other factors, such as food insecurity, poverty, unemployment, and mental health.

Both Sule and Sifri have been juggling their academic responsibilities with their clinical roles as physicians at University Hospital. At the height of the outbreak, Sule was working with emergency department teams to manage a large volume of COVID-19 patients, including several in critical condition. As director of the emergency medicine residency program at NJMS, he makes sure there is adequate clinical coverage by resident physicians in the emergency department while also ensuring their safety. Sifri, part of the hospitals frontline trauma team, assesses and manages patients presenting with acute trauma and unknown COVID-19 status. He also was part of a surge team that managed critically ill patients in a flexible intensive care unit space. (Read more about University Hospitals transformation during the pandemic.)

If there is one thing the pandemic has shown us, Sule says, its something those of us in global health have discussed for a long time: the world is interconnected, and health issues, especially infectious diseases, do not respect borders.

Congratulations to the four medical students who graduated from New Jersey Medical School with a Distinction in Global Health. They graduated on April 13, and their medical degrees will be conferred officially on May 31 as part of the Rutgers University Commencement virtual celebration.

Nemesis Y. Hazim-Liriano

Capstone project: Distribution of Aedes aegypti Arboviral Infections in the Dominican Republic

Residency: orthopaedic surgery, Tripler Army Medical Center

Thobekile Ndlovu

Capstone project: Medical Students and Pre-Departure Orientations: Are Medical Students Adequately Prepared for Global Health Experiences?

Residency: global child health pediatrics, Baylor College of Medicine

Asmi Panigrahi

Capstone project: Incorporation and Implementation of WHO Medical Donation Guidelines Within the International Relief Community

Residency: internal medicine and preventive medicine, Kaiser Permanente San Francisco and University of CaliforniaSan Francisco

Nicole Silva

Capstone project: Portuguese-Speaking Populations: Local and International Outreach

Residency: neurosurgery, University of North Carolina School of Medicine

COVID-19 data sources: CDC.gov, NYC.gov

Link:
The Real World of Global Health - Rutgers Today