Medicine in Motion: Three Alums Combat Burnout by Caring for Migrant Patients at Home and Abroad
By G.K. Schatzman
Some facts are notoriously hard to get our heads around. For instance, it is a fact that even in your stillest moment, everything from your atoms to the solar system is in motion. And yet, when we breathe deeply toward sleep at night, we can feel everything settled in its place.
“We” is selective here, of course, for it is also a fact that millions of people around the globe find themselves without even this semblance of stability, their homes turned inhospitable through disaster.
To truly grasp the scale of the migration crisis can sometimes seem a burden beyond bearing. As three alums of Drexel University College of Medicine have discovered, while fixing your mind on a problem can be a pathway to burnout, getting your hands on it can be the antidote.
David Cuthbert, MD ’14, treating a child in the clinic.
David Cuthbert, MD ’14, (right) with College of Medicine classmate Sandeep Segar, MD ’14, who joined him overseas at various refugee camps.
The Journey
David Cuthbert, MD ’14, is board certified in emergency medicine. “Burnout” was a word that gained relevance for him sometime during the height of the COVID-19 pandemic, while vice-chairing a department, raising his first kid and anticipating his second. It was around then that his identical twin, Darren Cuthbert, MD, MPH, floated the idea of doing a nonprofit advisory mission in the Dominican Republic, a country with statistically high motor vehicle accident mortality. In just a few short years, their new, apolitical organization has taken them to Pakistan, Jordan, Guatemala and Ukraine, where they’ve established relationships with local professionals to provide expertise, aid and clinical help. Oh, and Cuthbert has three kids now.
The itinerary may sound exhausting, but Cuthbert says it has been revitalizing. “When you go on a mission, it’s just like starting all over again. It really is a lovely experience.” Naaz Fatteh, MD, MCP ’92, cosigns that conclusion. An infectious disease specialist who has recently spent time in Belgium working with Ukrainian refugees, she has long been aware that the difference between “there” and “here” is a matter of time. In a global world, community health includes attention to migrant health issues.
“Diseases permeate,” she says. “With COVID and mpox and other things that are crossing borders, people realize more and more how important it is that every country has the ability and infrastructure to take care of infectious diseases.”
Susan Levine, MD, MCP ’93, works with immigrant populations in Farmington, Conn., an area outside of Hartford that she says has come to represent people from 68 different countries in recent years. Passionate about advocacy within the U.S. immigration systems, she says there is still something special about taking her work abroad. “Working abroad renews my joy of medicine and keeps me grounded. I love the purity of medicine global health offers, when administrative tasks and sometimes excessive testing are replaced by more reliance on physical exam and history skills.”
Naaz Fatteh, MD, MCP ’92, with son Armaan on a volunteer trip to Belgium.
Cuthbert, Fatteh and Levine can each recall an experience that expanded their sense of the world outside their own geography. Cuthbert cites the aid missions he went on in Afghanistan while enlisted in the Marines after high school. Growing up, his mother had been in and out of the hospital with melanoma and breast cancer, and his father had passed away from lung cancer when he was still a teenager. Despite his admiration for the medical professionals that cared for his parents, he didn’t see medicine as a possibility for himself; growing up lower-middle class, he says, “We were almost, in a way, made to believe that academics wasn’t in our future.” His time in the Marines would plant the seed that would change that when he later went to college.
“We’d have a large speaker on top of the Humvee and amplify throughout a valley that we were here to provide medical care. And people would hike for six to eight hours to come and get care from our physician,” he recalls. It was on missions like these that he learned to speak the local language, Pashto. “I remember I would see how grateful they were to all of us for the care that was provided. And that’s certainly something that I held on to and that probably motivated this subconsciously.”
Fatteh’s connection with people displaced not only geographically but also culturally — far from their own language, food and other little things that build a sense of belonging in a place — is born of her own experiences crossing cultures as a child. “Every summer, my parents would take my two siblings and me to India for the full three months of summer vacation. And I’ll tell you, it was very difficult for us at the time, because there were not any of the amenities that we were used to. We used to take a bag of Doritos and try to make it last for the summer, because there wasn’t any food that we recognized,” she recounts with a laugh. “We complained bitterly.” Now, she takes her own children on aid trips abroad, hoping to replicate that boundary-expanding experience for them even as they struggle with the same kinds of difficulties.
On a trip to Libya after the civil war, Levine says, “I discovered something peculiar about myself, which is that I was oddly comfortable in chaotic environments.” While she continues to be drawn to work abroad, her aid trips to Libya and to Haiti with the International Medical Corps would ultimately inform her work in public health back home, which she sees as “a natural evolution of doing global health work abroad.”
“I had this ‘aha!’ moment a few years ago that this was a really impactful way to teach global health locally,” she says. “And knowing something about global health impacts the care of absolutely every patient, because so many patients have a migration story of one kind or another.”
What is abundantly clear when speaking to all three of them is that working with migrant and refugee populations isn’t simply an extension of their commitment to caring for patients. It is also a source of energy, gratitude and optimism in their own lives, in a time when medical professionals need that more than ever. So, how does doing more work, in uniquely challenging contexts, add up to an antidote for burnout?
The Environment
Overwhelmed care zones like refugee camps, disaster relief areas and low-access communities present unique challenges, but they also offer an incomparable opportunity to connect with a fundamental, authentic practice of medicine.
For Fatteh, it presents an opportunity to step outside specialty silos when the need calls for it. “I don’t normally treat children, but if there were children and the need was there, I would,” she says. “I’m not going to do anything I don’t feel comfortable with, but you could go beyond your normal workday and do things that felt necessary.”
Cuthbert appreciates the reprieve from the more frustrating aspects of the health care system at home. “You can finally just be yourself,” he says. “You’re not being an actor for the system. You’re not being an actor for the purpose of self-preservation, to prevent someone from suing you. You can finally just do what you think is right, and it’s removing all those barriers. It’s very different, and it’s quite cathartic.”
“It’s rediscovering the joy of pure medicine,” says Levine, without the burdens of billing and administrative tasks. “You have a bunch of patients to see, and your primary purpose is just to figure out what’s wrong with them and do your best job as a physician.”
“As physicians, we’re now trained to be typing on the computer and talking to people at the same time. But I feel that difference when I’m leaned in, I’m looking at this person, and that’s the only thing that’s going on,” Fatteh says. “When you’re on these trips, your sole purpose is to be there for these people. I think if we could capture that bubble in everything we do, we’d all be able to be more authentic.”
There are the lessons that one learns from one’s patients, too, Levine adds. “The energy of resilience in the case of refugees is really reassuring, and it settles me when I feel like complaining about a bad day or having too much work to do. When people come and completely, successfully rebuild their lives, and do it with grace, it’s inspiring.”
A group of International Medical Relief volunteers who cared for Ukrainian refugees in Belgium.
The Change
One symptom of burnout is the feeling that your work doesn’t make a difference. The counterpoint to that, Levine believes, is effective advocacy, something she’s striving to teach the next generations of physicians in her own system at the University of Connecticut. The Immigrant Health arm of the university focuses on three fronts: clinical care, education and advocacy.
Clinical care is probably what comes to mind first for most of us with refugee health. When people are displaced, the continuity of their health care is, too. Some of the refugees Fatteh encountered in Belgium had chronic conditions that had gone without treatment for weeks or months because their access was cut off or their medications ran out. Crowded housing situations also tend to contribute toward skin conditions like rashes. Beyond the care of physical conditions, though, Fatteh also found herself called upon to address the psychosocial challenges of displacement.
“It takes a lot of acclimating, and not just to the language. A lot of what this mission does is to just provide that emotional support, the recognition that this is difficult, because people get lost in the shuffle of things,” she says. “These were people who were blowing in the wind, wondering where they were going to settle or whether people would even remember that they’re refugees, because they’re dressed normally and not living in a refugee camp. But they’re still people who are displaced and looking for connection.”
Educating physicians on the health impacts of migration is equally vital. Where we’re from and where we go can be one of the most important aspects of our health care profile. “The immigrant health program definitely has had a ripple effect throughout the rest of internal medicine,” Levine says. “I think other faculty, even if they’re not regularly treating or seeing newly arrived immigrants, have a sort of heightened awareness. They’re thinking and asking about where people are from.”
When you account for the fact that cultural beliefs around health differ not only across national cultures but even across county lines, that question becomes vital. Medication adherence issues, for instance, are almost always culturally influenced, Levine says. “I honestly believe that just being open to different cultures, having some exposure to taking care of people from different parts of the world, whether you do it here or abroad, makes you a better doctor, because you’re open to different perceptions and beliefs about health. It makes you a better communicator, and every internist needs to be a good communicator who is culturally humble. You don’t have to have all the answers, but I think you have to be willing to realize when culture is probably playing a role in something that you’re missing.”
For young physicians, Levine suggests that finding out who you want to advocate for will make for a more sustainable career. “The antidote to burnout, in my personal opinion, is learning about what population of patients you really feel strongly about advocating for, and then learning how to be the most effective in that role, rather than building your career around what you think the lifestyle of a given specialty is going to be.”
Even if stretching your comfort zone at international levels doesn’t seem like the right move for you, there is important advocacy work to be done here in the U.S. The University of Connecticut program, for instance, partners with the university’s law school and with Physicians for Human Rights to radically increase the success rate of asylum applications, up to 90%. “We learned how to get a history from somebody and present that story to the judge, the defense and the prosecution in a way that really tells their story in a clear and convincing way,” she explains — for instance, when an applicant has injuries from gang violence. “A lot of these cases will turn on the clarity of the medical evidence.”
Ultimately, migrant health is a global issue that can and perhaps must be approached from every vantage point. As Fatteh says, diseases permeate borders — “and disease is a manifestation of poverty.” That means that the right allocation of resources can go a long way. And these three College of Medicine alums will be going right along with them.
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