“There is so much revealed about the world through a patient’s eyes – the many systemic challenges in healthcare, areas of societal need, and the human experience. It’s a powerful lens to come to understand healthcare through and as young health professionals working in the trenches, it’s our chance to improve the healthcare culture and system that we inherit.”
Lerly Luo is a first year resident physician in Public Health, Preventive Medicine, and Family Medicine at the University of Manitoba and recent Doctor of Medicine at the University of British Columbia. She is fascinated with healthcare innovation and global health. In her first year of medical school, she co-founded the Global Health Conference at UBC that brought representation from twelve faculties under one roof to examine global health challenges. She co-founded a startup leveraging emerging health tech innovations through the Global Solutions Program hosted by Singularity University at NASA, investigated digital health roles in increasing access to health for marginalized populations at the grassroots level with Access Afya, a social enterprise in Kenya, and has been involved in health and political advocacy provincially, nationally, and internationally. She attended the 2018 World Health Organization Executive Board Meeting and 2019 World Health Assembly on IFMSA delegation representing 1.3 million medical students from more than 100 countries in discussion of global health topics. She is a World Economic Forum Global Shaper, 2017 Stanford Medicine X Emerging Leader, and received the 2018 Canadian Medical Association Award for Young Leaders and Doctors of British Columbia Changemaker Award.
“The most gratifying part of this journey has been learning from people’s stories. It is such a privilege to meet a patient for the first time and witness how much trust can be placed in you. Patients will share their most intimate, scary, and difficult experiences. In listening, there is so much revealed about healthcare, society, and the human condition that data can fail to capture. Another huge source of inspiration have been the stories of my peers. At the World Health Assembly, most of my peers face challenges so much greater than what we face in Canada, yet they are hopeful, driven, and keep fighting to improve healthcare in their countries. To have seen that, how can one not be inspired?
C: A big congratulations to recently graduating medical school. It’s been a heartwarming and inspiring journey that you’ve been on. Especially, following your work and being empowered by the health and advocacy intersection you explore. Since your work has been so accessible, I wanted to jump straight into asking about what inspires your health advocacy and motivates your progression in becoming a doctor.
L: Hands down, the most gratifying part of this journey has been learning from people’s stories. It’s a privilege to meet a patient for the first time and witness how much trust can be placed in you. Patients will share their most intimate, scary, and difficult experiences. At times, patients will share thoughts they may not even be ready to tell their partners or families. Having the privilege to see into patient lives teaches me so much about humanity. Specifically for family medicine we are there for all of it: the beginning and end of life with all the highs and lows in between. Some of the highs include helping to deliver a baby and watching a parent meet their baby for the first time or seeing someone gain control of their chronic disease after a long and difficult battle. There’s something irreplaceable about having the chance to sit across from a patient, to simply be a presence in someone’s vulnerability or pain and through so many human moments.
Another huge source of inspiration has been the stories of my peers. Some of the most inspiring people I have met have been medical students from other schools and countries.
In our IFMSA delegation to this recent World Health Assembly, we represented every region of the world including countries that face higher barriers such as Nepal, Honduras, and South Africa. Learning about the experiences of my peers in health advocacy, medical school, training and work conditions has been mind-boggling. Our delegate from India typically sees 150-300 patients daily in clinic. Our medical student from Morocco has already delivered 200-300 babies and often alone. In Honduras, many medical students need to go to Mexico or Spain for residency because of training system restrictions. Despite most of my delegate peers facing challenges so much greater than what we face in Canada, they are hopeful and driven to keep fighting to improve healthcare in their countries. To have seen that, how can one not be inspired?
“We know the intersections of disciplines to be fertile grounds for innovation. Often, it is the outsiders or beginners within a field that are in an ideal position to think outside the box and ask questions with a different framework of thinking because they are not yet biased by the day to day work, patterns or rules of the field. Global health is a unique space to bring people together.”
C: Since chatting with you last year, one thing I admire the most about you is your ability to recognize the humanity within the medical experience. Your ability to recognize vulnerability and the everlasting impacts of compassion in a doctor-patient relationship. You also bring this level of empathy beyond into health advocacy work. What does global health mean to you?
L: To me, global health is recognizing that health issues extend beyond borders: geographically, politically, and across sectors. These issues that require interdisciplinary approaches and broad collaboration. Consider access to food or electricity, all of these influence a person’s health, the incidence of disease, and availability of health services when it comes to managing and treating disease. When I was elected Vice President Global Health at UBC’s Medical Undergraduate Society, I noticed there were limited opportunities for global health work between different faculties. There were a number of great projects between medicine and engineering such as the Arbutus Drill Project and the Global Health Initiative. However, I was surprised that there weren’t more collaborations when global health is so cross-cutting. There is a need to bring together diverse fields in order to address global health issues holistically. This is what inspired the idea to start the Global Health Conference.
Our conference had two key goals. First, to allow those who come from diverse sectors influencing global health to share challenges and ideas. We know the intersections of disciplines to be fertile grounds for innovation. Secondly, to bring together students who knew very little about global health together with those immersed in the field. The benefit of this is two fold. We wanted the students to be able to walk into the conference knowing nothing about global health and walk out inspired by the possibilities to take action but furthermore, the inexperienced students were in a unique position to offer a fresh lens of innovative and creative ideas. Often, it is the outsiders or beginners within a field that are in an ideal position to think outside the box and ask questions with a different framework of thinking because they are not yet biased by the day to day work, patterns or rules of the field. Global health is a unique space to bring people together.
“Healthcare is beyond medicine. Healthcare is inseparable and interwoven in the fabric of society, inequities, and policy. That is what drew me to public health. There’s a need to bridge the “on the ground need”, what we observe on a daily basis, with higher level policy and systemic change.”
C: Given that you’re currently starting your residency in Winnipeg, I would also love to hear more about the projects you’ve been a part of, which there have been many. Perhaps, can you share some memorable or big learning moments within your work?
L: Some of the most memorable and meaningful parts of medical school have been the chance to do health and political advocacy on behalf of my peers and patients. I’ve been deeply privileged to be able to do this work provincially with the MUS, nationally with the CFMS, and internationally with IFMSA. I chose to pursue a combined residency in public health and family medicine for the intersection of patient care, policy, and population health.
Attending the WHO World Health Assembly where I was part of a delegation representing medical students from over 100 countries was extremely eye opening and reinforced how interconnected all of these areas are. Healthcare is beyond medicine.
Healthcare is inseparable and interwoven in the fabric of society, inequities, and policy. That’s what drew me to public health. There’s a need to bridge the “on the ground need,” what we observe on a daily basis, with high level policy and systemic change.
Another big learning moment was observing that the most in need populations often receive the least healthcare services. This doesn’t make sense. However, consider the semi-permanent housing slum populations in Nairobi. Most of our patients there lived off $2 per day. How can we provide healthcare to someone who cannot afford a blood test? One incredible project was working with a social enterprise in Kenya called Access Afya creating a new model of healthcare to serve slum populations. There, the focus was investing in affordable point of care healthcare testing and operating through chains of micro-clinics for a more sustainable and accessible model of healthcare.
“Some of my remote patients didn’t have access to running water or electricity. This is BC. When we live in Vancouver, we have an idea of what Canada is like, but not that far away you will be surprised by the level of imbalance and health disparities that occur in our own provinces and our own country.”
C: You’ve mentioned that often global health concerns can be drawn from experiences within the local level. What are some of the biggest take-aways from some of the lessons you’ve learned within Vancouver and are applying to your work now? Or even the global projects you’ve had the chance to work on in the past?
L: That’s a great question. There is often a misconception that global health is about international health or healthcare problems in lower income countries, we forget that global health is really just public health without borders. There are so many global health issues that we can find in Canada in our own backyards.
When on a rural medicine elective in British Columbia, I travelled to Port McNeill, a town of approximately 2300 in population at the top of Vancouver Island. There were only three physicians there running the clinic, emergency room, inpatient hospital service, and traveling to service six remote communities including four Indigenous communities. There is so much need in each these communities. Some of my remote patients didn’t have access to running water or electricity. This was BC. When we live in Vancouver, we have an idea of what Canada is like, but not that far away you will be surprised by the level of imbalance and health disparities that occur in our own provinces and our own country.
What drew me toward the combined public health, preventive medicine, and family medicine residency in Manitoba is the big focus and immersion in serving low resource and in need populations. Indigenous health in this province is a high priority. You don’t need to go very far to see poverty here in Winnipeg. On one end of my patio, I can see the parliament buildings and less than 100 meters away in the trees by the river, there is the tent and baskets of a homeless person. Health disparities exist right here.
I can’t understate the importance of addressing problems within the communities that understand these problems most. Being locally based allows us to understand health care issues in our neighbourhoods overtime. We are uniquely situated to contribute to solving these issues because we live here and we can contribute for the long term. There are definitely valuable insights from people who travel to do onsite work but locally based people should never underestimate the work or potential they can contribute to global health.
C: Looking to the future of global health care, what do you believe are the powers of digitalization and artificial intelligence? What are some pitfalls that the medical and health care fields need to be aware of?
L: Such a good question and one we consider often at the Global Solutions Program! Healthcare is constantly changing! A good number of my teachers still remember practicing medicine before HIV/AIDS was discovered and the years of caring for patients back when there was no effective treatment. This is why medicine has such a large emphasis on life long learning. My generation of peers will be working through the digital revolution and emerging technology will create large implications and changes how we practice medicine in the coming decades. Today, 6 out of the world’s 7 billion people have access to a mobile phone when only 4.5 billion has access to a flushing toilet. Mobile technology has become accessible to the most difficult to reach communities, with the least resources, and often most in need of help. Mobile technology has huge potential to advance safer and more accessible healthcare through surveillance, research, both emergent and preventative health. In 2018, the topic of m-Health came to the agenda of the WHO Executive Board for the first time.
Another area to watch is medical genomics and the field of personalized medicine. The cost and time of sequencing the human genome has changed drastically in the last 20 years. The first human genome project was completed in 2003. It was a $2.7 billion multi-country project that took 13 years. The technology for sequencing has advanced so much and so consistently in the years since that we are now close to the thousand-dollar genome that can be performed in a few hours. At this rate, someday not too long from now, personal genome sequencing will be very accessible for us all. This opens many exciting opportunities in better understanding our genetic predispositions to health and disease or responsiveness to different medications. For example, a chemotherapy drug may not be well tolerated by the general population, but highly effective in select groups. However, there’s a lot of ethics that we need to consider. Privacy is a huge consideration. The availability of proper genetic counseling is another. Who will own the genetic information and who may access it? What happens if we can collect the hair or saliva samples of others?
There is also a lot of potential for AI in terms of diagnostics. For example, identifying the patterns of cancer cells on histology and radiography. But I think we shouldn’t forget that diagnosis is only one piece of the picture. The rest of the picture includes delivering the news with empathy, learning the goals of the patient, and creating the next steps of a management plan. None of this is linear or algorithmic. People can change their minds and the progression of a disease can change everything. On top of that, family dynamics and goals are just as important to support. The relationship between a doctor and patient is deeply human. I’ll never forget one of my teachers telling us how a cancer patient didn’t want to use the “C-word” when it came to talking about her cancer. She asked him, “I was thinking about buying a wardrobe for the winter, what do you think?” He replied, “I think.. we can focus on a wardrobe for the fall”. She thanked him. That is all she needed and wanted. Nothing more and nothing less.
It is very difficult for AI at present to understand the human experience, to empathize with suffering, similarly to be creative, to manage people, or recognize how to speak differently to someone with a history of personal trauma. I believe AI has a huge potential to support how we make decisions in particular data driven settings. But clinical expertise sits at the interface of patient preference, changing clinical states and circumstances, and research evidence. It’s an art that is humbling to attempt to be better at everyday.
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