Uniting global and local, clinical and strategic perspectives on the frontlines of the COVID pandemic

By Cecily Sotomayor, MD, MS Candidate in Global Health Sciences

Cecily Sotomayor during the day without a mask and then wearing a medical mask at night

“There has never been a better time to be a global health fellow;” I’ve heard this said more than once in the past few months. Now in the throes of the COVID-19 pandemic, I couldn’t agree more.

Before coming to UCSF, I did my emergency medicine residency at Maimonides Medical Center in Brooklyn, NY, which has recently received a lot of media coverage for its heroic efforts to treat an overwhelming influx of COVID patients. Maimo, as we fondly call it, is the definition of “global meets local.” Residents of Borough Park are as diverse as they come, from the Hasidic Jewish population to a burgeoning Russian population and Fujianese-speaking Chinese population. Maimo’s diversity and richness cultivated my interests in various social determinants of health and led me to pursue a fellowship in global health.

My two-year fellowship in the Department of Emergency Medicine at UCSF includes a year as a master’s student at the Institute for Global Health Sciences (IGHS). This past year at IGHS has been challenging: I am balancing a rigorous course schedule with working as a first-time emergency medicine attending physician on nights and weekends, and working on various fellowship projects during my virtually non-existent spare time. But the experience has undoubtedly prepared me to be a global health advocate during these uncertain times.

As a master’s student in global health sciences, I’ve been able to view the COVID pandemic through a more wholistic lens than I would have with solely my clinical training. For example, in our Foundations of Global Health class, we learned the intricate international cooperation required to achieve control, elimination, and ultimate eradication of communicable diseases. In the Communicable Diseases class, we learned about pandemics — specifically how respiratory transmission, social mobility and indolent infections can lead to far-reaching disease progression. Most recently, our Comparative Health Systems class taught us that all health care systems are vulnerable to inadequate infrastructure, poor funding, and lack of transparency. The strength of a country’s health care system and public health initiatives correlates with its ability to contain COVID cases.

When I’m not in class, I work at Zuckerberg San Francisco General Hospital (ZSFG) as an emergency medicine attending physician. I’ve had the opportunity to put some of my learning into action. In addition to diagnosing and treating COVID-19 patients, I work on a variety of in-hospital projects as part of the ZSFG COVID Task Force. We’ve streamlined COVID health care provider Q&As, provided weekly literature reviews of emerging scientific findings on COVID diagnosis and management and helped brainstorm disaster management plans for the department.

Currently, I’m working on a systematic review of COVID airway management literature that incorporates my professional interests into my master’s capstone research project — my planned project on developing emergency care in Tanzania was suspended due to travel restrictions.

I’ve also helped to support the team in San Francisco tasked with developing alternative care sites within the county to free space within the health care system to prepare for a patient surge. I have helped to develop modular medical equipment lists for disaster planning. Recently, I worked a shift in a San Francisco field care clinic, which offers expanded urgent care services and helps to improve access to care during the pandemic. I am particularly excited to have the opportunity to be trained as a Medical Health Operations Area Coordinator (MHOAC), a role in which I can review and submit requests for medical resources across county lines.

I also had the opportunity to work with the UCSF World Health Organization (WHO) Collaborating Centre for Emergency and Trauma Care, whose mission is to support the work of WHO to improve emergency care systems worldwide.  I have had the opportunity to engage with an international team to help develop a triage training module based on the WHO’s Interagency Triage Tool to teach triage through a recorded presentation.  This training will soon be used here in San Francisco and as part of alternative care site training for health care providers.

Yes, I continue to grapple with the fear of potentially dwindling supplies of PPE; the concern for our future population and economic health; and the guilt of living in a progressive city that “flattened the curve” effectively, while my New York colleagues and friends have heroically fought a biological weapon every day.

But I’ve learned during these past few months as a master’s student, we can use the suddenly-imposed health, economic, and societal hardships caused by the SARS-CoV-2 virus as a catalyst for change, and we can mobilize through collective agency to address the COVID pandemic on a unified front and global scale.

Being a global health fellow during a pandemic has certainly kept me busy, but it has also been incredibly rewarding and meaningful.