The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The CSA Committee on Global Health works to celebrate the volunteerism, philanthropy, and global health impact of CSA members, both locally and internationally. The committee would like to take this opportunity to highlight the accomplishments of Dr. Betelehem (Beti) Asnake, Director of Global Health Initiatives at UCLA.
If you would like to be featured or to nominate a colleague, please email Dr. Ana Maria Crawford, CSA Global Health Committee Chair, at email@example.com
An Interview with Dr. Beti Asnake
Where did you grow up?
Addis Ababa, Ethiopia
Do you think your upbringing influenced you becoming involved in GH? If so, how?
Absolutely. I grew up in one of the poorest countries in the world. The public healthcare system there is unfortunately decades behind compared to those in high income countries. I grew up in a middle-class family with a sister who had severe asthma and a father who sustained a stroke. He later developed kidney and heart failure. Living in Ethiopia, then later in Inglewood, California, my family and I were constantly faced with disparities affecting our health outcomes. I went into medicine specifically to improve healthcare in resource-constrained areas such as in my native country, but also to be a solution to the healthcare inequities right here in the United States.
How do you define Global Health (GH)?
For the longest time, I thought global health meant international health, where you pack your bags, travel to a country with low resources and provide healthcare related service. Now that I work within this realm, I understand it really means improving health and achieving health equity for all, whether right here in California or in Ethiopia. I think this definition is still foreign to many people who think of global health as international health. It’s more than that. It’s hard to really appreciate this definition if you are visiting a site once a year for two weeks and not engaged with the local providers in a longitudinal manner. It is hard to appreciate the complexity of healthcare systems in low-resource settings with these micro trips or engagements.
What do you consider as your first Global Health experience?
My first global health experience was my volunteer service with Remote Area Medicine (RAM) in the Appalachian Mountains in Virginia as a medical student. I would travel to this area twice a year with my small group mentor, who is an emergency physician, to provide basic health care to a population who may not see a healthcare provider for 10-15 years. This really opened up my eyes to health disparities even in a country like America. Many of us immigrants grew up idolizing the US medical system and its healthcare delivery as being one of the best in the world.
What are recent examples of your GH engagement?
I just got back from Addis Ababa, Ethiopia. I was scouting hospitals to establish a formal partnership with our department here at UCLA. We are starting a global health clinical elective and a research global health track for our residents which is very exciting to me. I think our residents will benefit in understanding how anesthesia works in low-resource settings and by getting a glimpse of complex healthcare delivery systems and challenges in low-income countries, especially when it comes to anesthesia.
What GH initiative or project are you most proud of accomplishing?
I was a fellow at UCSF in 2020. I worked with two medical students to create a health equity curriculum for our anesthesia residents. This was an almost reactionary project to the equity movement that was sparked in the summer of 2020 after the death of Mr. Floyd. We all know health disparities exist, but we are never formally taught about them in medical school or residency. We often lack space to discuss these issues. I felt like this is a neglected area of our medical education. We are playing catch up now by educating residents about health disparities, cultural competency, structural competency, cultural humility and other relevant topics. I am excited to say we implemented the curriculum last year within our residency program here at UCLA. This would not be possible without the open sharing platform of UCSF’s Center of Health Equity in Surgery and Anesthesia: https://globalsurgery.org/health-equity-curriculum/
How can Global Health evolve over an Anesthesiologist’s career from residency to retirement?
Looking at my own path I would say it starts with interest early in one’s medical training. Fortunately, there are now programs that offer fellowship training in global health in anesthesia, such as UCSF, so one can get a year of concentrated learning, research and beyond. I am a big advocate of Global Health in anesthesia fellowships because they really give you time and the support of likeminded individuals to find your voice within this field. Much of Global Health comes with establishing connections and being on site with local collaborators. It is extremely difficult to build that network while working full time in academics, with no priming knowledge, and no connections. I commend those who have done that on their own. It is not easy.
What has been your most challenging or surprising lesson learned in Global Health?
One of the biggest lessons I learned is not to make promises you cannot keep. It is easy to be emotionally involved in projects or ideas and promise your local collaborators something you thought could be done, but in reality, you were just trying to “help”. It ends up letting them down and creating a culture of mistrust with not just you, but the entire global community. A surprising lesson is one that comes with my own career path. I did my residency in a program that had no global health in anesthesia except for a couple of faculty members who went on mission trips. When I first expressed my interest in this area, there was obvious resistance to my leaving clinical duty to work abroad or attend conferences when other residents were picking up my shifts. Sometimes it only takes one person to change the path of your career. Dr. Neal Fleming (I hope he reads this), went out of his way to advocate for my global health interest. He was a senior anesthesiologist in the department who understood my passion and what it meant for me. We had little else in common. He is a cardiac anesthesiologist and researcher, an older white male with a big beard. At first, I found him intimidating to even approach. I am a young black woman with an accent and a dream of creating a career in global health in anesthesia. I never imagined when I joined the program, he would be the one championing me and supporting my interests. I am certain, if it was not for him advocating, I may not have been able to attend a key Global Health conference in Boston and do a rotation through the ASA at Cure International in Ethiopia. I would not be where I am today. So there you go. That was a surprising lesson. Do not assume people, who look different than you, do not understand your fight or your passion. Some do, and such allyship is a sweet surprise.
What would you like to share with others regarding the value of Global Health engagement?
There is so much value in this work. I have a personal story and a reason why I got into global health. Some people ask me why they should care about anesthesia in Uganda or Vietnam. At the core of our choice in medicine as a career lies empathy and compassion – this idea of helping others in their most difficult moments in life. There is also fairness and justice. Is it fair that I get to walk out of the hospital after a simple procedure when someone else in a different part of the world or country might die after the same procedure? I usually tell people imagine needing an emergent appendectomy here at UCLA. For a healthy person, it is a same day procedure or discharge home after one day. Recovery time is short. The need for narcotics post-operatively is minimal. Many go back to work within a week. Most importantly, chances of having an adverse outcome from anesthesia is extremely low. It is not the same in rural Africa. Your chance of sustaining an adverse outcome from anesthesia alone is high. Patients die from unrecognized esophageal intubations because hospitals may not have pulse oximeters. The level of training for anesthesia providers is not as robust. Safe anesthesia is just not guaranteed. When you teach these disparities to residents and expose them to these environments, not only does it make them appreciate their own health care system in the US, but also pushes them to innovate ways to bridge these gaps. Whether this is through quality improvement projects, teaching, or research, it pushes them to be leaders of change. Moreover, when you are asked to think about intubating a difficult airway with no video laryngoscope or fiberoptic available, you start thinking outside of the box. These experiences not only make you a better physician but also an innovator in your field. With our residency applicant pool increasingly focused on finding “meaning” and “purpose” in their daily jobs, many ask about global health initiatives. I get several emails a month from medical students, residents and prospective applicants asking how they could partake in the initiatives I am building. There is definitely a strong interest from our trainees. It is a matter of being able to provide them with educational, clinical, and research opportunities which can ultimately alter their career paths. There is not a lot of us doing what we do, so I seize any opportunities to excite residents about global health work. It has been such a privilege for me to be in this field.