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.