Issue 11 Volume 1
The globalisation of medicine, particularly within the last 50 years, both students and practitioners with an exciting – yet staggering – amount of career and lifestyle pathways. Be it working with Médecins Sans Frontières (MSF) in Africa; coordinating a WHO response to a new, virulent disease; or servicing rural-remote populations in outback Australia; the variety of work within medicine is nothing short of astounding.
Early life and background
Speaking with Professor David Hilmers of the Baylor College of Medicine, this becomes abundantly clear. With rich and varied occupational and academic experience, pathway into medicine is as fascinating as his career has been since graduation. After growing up in a small town in Iowa, Hilmers moved from undergraduate study to flight school, the United States Marines – during the Vietnam War, no less – and eventually graduate school. Here, he studied electrical engineering and mathematics, giving him a tremendous grounding in scientific practice. Whilst he expressed a desire to practice medicine from as early as childhood, Hilmers was serendipitously given opportunities that initially drove him more towards working with N.A.S.A than working in medicine, as astounding as that may seem. Contextually, the United States space program was still maturing following the peak of the Cold War, with Hilmers’ career progression perfectly aligning with the 1980’s selection period.
Moving into N.A.S.A (and eventually, medicine)
Whilst stationed in Japan on his third tour overseas, Hilmers heard that the Marines were offering forward candidates for consideration to the astronaut program. Given that his background was textbook in terms of the desired skillsets – flight/military experience, engineering and mathematics – he placed himself forward. One level after another, he cleared selection and eventually found himself as an astronaut-in-training, something which he considered entirely surprising. After a period of intense long-term preparation, training and eventually four on-orbit expeditions later, Hilmers decided that it was finally time to study medicine. Whilst it would have been incredible to hear more about this journey to N.A.S.A, it is his work following his time in space that really exemplifies the multifaceted nature of medicine and global health.
Medical career and global health research experience
After graduation and specialisation in Medicine/Paediatrics at the Baylor College of Medicine, Houston, Hilmers’ career branched out across all realms of medicine. Encompassing on-the- ground experience in disease outbreak areas, applying his engineering knowledge within a medical context, working with large soft-drink distributors (Coca Cola) and then finally more traditional faculty and hospital work, Hilmers’ practice has been anything but conventional. Discussing all he has done in retrospect, he did find it amusing that his background mirrors his life outlook; a “little bit of variety” being his exact words.
Starting his global health journey by touring overseas to Africa with the Baylor AIDS initiative, Hilmers subsequently went on to see AIDS-ravaged Eastern Europe post-collapse of the Soviet Union, and more recently was the Chief Physician of an Ebola treatment unit in Liberia during the outbreak. Whilst acknowledging the saddening reality of AIDS treatment and outcomes in the early days, Hilmers remarked that the experience was immensely educational and worthwhile. Indeed, it inspired him to continue his work with AIDS sufferers in local Houston.
The Smart Pod
A notable outcome following Hilmers’ return from Liberia, however, was his ensuing attachment to a research team who were in the process of developing a rapidly deployable ‘Emergency Smart Pod’ . This pod is an on-site, versatile management centre and laboratory, with revolutionary potential with regards to disease outbreak and disaster response. Given his background, Hilmers was able to provide highly practical, ongoing advice; this came in the form of refining and redesigning early iterations, and increasing functionality and practicality. The pod, as it stands now, is a feat of modern science and engineering; touting high-tech computer systems with language and literacy programs, screening facilities, crowd control and Ebola-level handling capabilities. Hilmers humorously likened it to a space module. The pods are similar to shipping containers in size, but far lighter and more durable. In fact, they are built entirely from recyclable materials that can withstand extremes both hot and cold, and can be integrated with one another should the need arise. Clearly, the ability to treat, screen and mitigate disaster on-site will strengthen front-line medical workers domestically and abroad.
Coca Cola and micronutrient deficiencies
In terms of more typical research, Hilmers has been involved in a number of studies on health inequalities, with some interesting pieces focussing on effective delivery of micronutrients to nutrient-deficient communities. This work interestingly includes working with Coca Cola, given their not-so-surprising ability to source fresh, clean water for their drinks in even the most remote locations. The importance of this becomes clear with a bit of thought; considering Coca Cola’s highly efficient sourcing and distribution system, there is an opportunity to integrate fortified beverages into their product line. This has enabled access to otherwise inaccessible communities overseas, and disadvantaged communities domestically. This was notable, given the medical community’s overwhelming condemnation of Coca Cola’s soft-drinks in day-to-day practice. It’s a case that speaks to the astounding intricacy of global health work, and the manner with which problems can be solved in the most unconventional of ways.
Life experience and medicine – how does everything relate?
One of the things that became apparent to me regarding Hilmers’ work is an ability to extract the positive attributes needed in previous work, and apply them to his current setting. He credits his military training with giving him a “coolness under fire”, his engineering and mathematics background with a logical thought process, and finally his N.A.S.A flight experience with a systematic, step-by-step approach to problem solving – all experiences that have shown themselves to be invaluable. Therein lies a lesson for all students: take on board every opportunity to grow your skillset, as it will lend itself in ways that may not yet seem apparent This is, in fact, one of Hilmers’ central advocacy arguments for continued work on the International Space Station, that space exploration and experimentation confers benefits to medical practice that are not foreseeable, and vice versa. For example, treatments that are developed to deal with the marked muscle atrophy, bone loss and vision impairment associated with long-term space travel, can then be applied to everyday medical practice.
Going forward – individual practitioners and the profession
So, what advice did Hilmers have for future medical practitioners as we move into our practicing years? Principally, it is important to work in a practice or organisation that allows you to follow your passion. Be that working solely within the W.H.O or Médecins Sans Frontières, or perhaps academia with concurrent research and clinical duties, there is a balance that every person needs to figure out for themselves. Indeed, Australia is unique in the tremendous scope of medical opportunities available. Depending on your location, you can experience tropical disease in the far north states, non-communicable disease in the mid-states, and the reality of disadvantaged communities in rural-remote locations. This does beg the question as to whether global health lends itself more to international health, as it seems to be viewed traditionally, or universal well-being within your own context or circumstance. There are no borders, rules or regulations as to what constitutes “global health”, only the limits of our imagination and creativity. Regardless, if you want to work in global health, the first step is finding an area of medicine you have a burning passion for – the rest will follow as natural sequelae.
As the mid-century approaches, the threat of climate change, antibiotic resistance and the management of ethical conundrums – such as gene editing and healthcare equity – are all very real problems that our generation will have to face. It was saddening to hear Hilmers recall scenes of polluted, diverted or dammed lakes from space, of burning forests and haze hovering over cities, but that is the reality we live in. It does, therefore, imply that we hold at least part of the solution to the problems we face. In what form the specific solution will take, however, only time can tell. It is, however, abundantly clear that in going forward we should learn from leaders like Professor David Hilmers, whose experience is entirely unique and profound.