On Wednesday September 27th, the first class of emergency medicine residents graduated from the Hôpital Universitaire de Mirebalais in central Haiti. I heard the pride in her voice as Regan Marsh ’99 described the program and these students. Regan was the first (co-)chair of emergency medicine at this hospital opened by Partners In Health (PIH) in 2013. She marveled at the upcoming festivities as she reflected on the program’s inauguration in fall 2014, three years earlier. Days after the residency program began, leaders at PIH had called and asked her to leave for Sierra Leone and PIH’s Ebola response there. It was an “overwhelming ethical crush,” she explained: she felt that while she didn’t want to leave these interns or the dire need at the teaching hospital, she couldn’t watch Ebola ravage countries with no health infrastructure to stop the disease either. In this Spotlight, we catch up with Regan’s journey through (a pre-GHP) Princeton, medicine, and this moment in her career.
Regan graduated from Princeton in 1999 with a degree in ecology and evolutionary biology (EEB). Her first year at Princeton was also the first year that “HAART” (now called ART, multidrug antiretroviral therapy for HIV) became commercially available. These drugs catapulted the ideas of “global health” into the national and campus dialogue, she says. Though no formal structures around Global Health existed before GHP was established in 2004, she remembers being drawn to ideas around health justice and access to care at Princeton, throughout her P55 fellowship, and then at the Perelman School of Medicine at the University of Pennsylvania.
Around the time GHP was being created at Princeton, Regan read Tracy Kidder’s Mountains beyond Mountains as she applied to residency programs. A biography of Paul Farmer and his organization, this book introduced her to PIH and piqued her interest in the Harvard emergency medicine residency program. Her interest in PIH grew at Harvard: her residency program had a strong global health focus (unique for the time), and her early mentors had or were actively working with Partners In Health or other global health organizations. After finishing her residency, she wanted to use her skills in a global health setting. She joined the PIH team in Malawi in the summer of 2008.
As an emergency medicine doctor, she was a good compliment to Malawi’s team of one pediatrician, one infectious disease specialist, and one internist. She described her time there as “an incredible experience for me understanding the fundamental tenants of the PIH model.” She worked in a rural area with virtually no health system, focused on HIV and TB care, and worked in/built capacity in the public sphere. She loved the work. “I really saw how [health system development] can work and, frankly, how it doesn’t work if done poorly.” Her experiences in Malawi brought her back to Harvard, this time for a Master in Public Health.
Regan followed her love of emergency medicine and health systems development to become an attending physician at Brigham and Women’s Hospital; an instructor in emergency medicine at Harvard; and director of clinical operations planning and then co-director of emergency medicine at the Hôpital Universitaire de Mirebalais. She was balancing these roles when asked to drop everything and go to west Africa.
As she described it, the moral obligation in West Africa was two-fold: she wanted to help the patients suffering in overcrowded, understaffed, dangerous hospitals, and she want help public health leaders use this opportunity to build up a stronger, more sustainable health system moving forward. She explained that “PIH’s strength in emergencies is to recognize the underlying potential and social determinants of disease.” The work she was doing in Haiti was needed in west Africa and the situation was dire. After much debate, Regan left for Sierra Leone. As the medical director of PIH’s work, she played a crucial role in the Ebola response and then in PIH’s work with the government to rebuild the health system after the epidemic. She returned to her previous responsibilities in June 2016, but PIH remains in Sierra Leone and Liberia with over 800 Ebola survivors still in their care.
Today, Regan is based in Boston as PIH’s Director of Clinical Systems. She says that she’s found her niche in health systems delivery. Her advice to GHP students reflects her own story: “love what you do, and figure out how to use that enthusiasm, passion, and training to think about justice and access.” She may not realize how perfectly these words reflect the goals and guiding principles of the Global Health Program today. I’d like to think of Regan as a GHP graduate, simply ahead of her time.
Best Photo Work Category: Teeto Ezeonu '19 - Morning Hike
About this photo Teeto said:
This picture illustrates a typical hike back from the designated trapping site for the day. On this particular day, we were hiking back from Bear Cliffs, our farthest and most elevated site, which usually took 15-20 minutes. Each day, the six of us who were working with the Mouse Crew rotated such that five people went trapping every day. Each morning we took approximately 15 clean traps each (75 traps total) up to the two grids of the site where we were trapping and checked/replaced the 64 traps at each grid for mice. During peak season, we usually caught about 22 Peromyscus mice every day and a plethora of other by-catch including chipmunks, flying squirrels, voles, etc. The traps we used were Sherman live traps which allowed the mice to stay in an enclosed rectangular box with grain seeds once it tripped the trap. After collecting measurements and samples, the mice were released near their home sites each day. This picture captures a period of time on the mountain of heavy rain in the afternoon and at night. This, consequently, made it foggy during our morning hikes (and often reduced the number of mice caught that day). These mice will provide an abundance of data for research on parasite infection and specifically on interactions between nematodes and the Hantavirus, commonly observed in these mountain mice.
Honorable Mention: Work Category
Driving in Mpala - Carly Bonnet '19
Sunglasses - Asia Kaiser '21
In the Lab at the NCRC - Fares Marayati '19
Best Photo Leisure Category: Maria Malik '19 - Lemur Friends
About this photo Maria said:
I was in Madagascar doing thesis research when I took both of these photos. I spent the most of my time there surveying health centers and learning about the impact of cyclones on public health infrastructure and infectious disease incidence. Two days before I came back to the US, I went to Andasibe-Mantadia National Park and the Vakona Private Reserve to see some lemurs and other cool animals that can only be found in Madagascar. Since I'm concentrating in EEB, I was super excited about this trip and at the prospect of being able to see lemurs in their natural habitats. The picture of me with the lemur was taken at Vakona Private Reserve. The reserve has a small collection of islands that each hold different species of lemurs depending on whether they can coexist and their specific habitat needs. One of the islands that my guide and I canoed to had a small family of ring-tailed lemurs that were very friendly to humans. As we were rowing along the canal, the lemurs saw us and all six of them bounced alongside the boat until we docked. They bounce like kangaroos! I didn't realize the guide had put a piece of banana on my head so I was part surprised and part delighted when one of the really brave - and hungry - lemurs jumped on to the canoe and climbed up my shoulder. His friends climbed on to the boat too and I fed them them all little pieces of bananas. They were really soft and cuddly and although they don't like to be pet, they seemed to really enjoy climbing on me.
Honorable Mention: Leisure
Repping GHP in South Africa - Kasia Kalinowska '19
Solitary Boat - Dylan Kim '21
Hide and Seek - Maria Malik '19