Careers in Family Medicine: Global Health

In this installment of the Careers in Family Medicine series, we highlight Global Health.

Many who pursue global health are drawn by different motivations: service, adventure, justice, curiosity, faith, compassion or a mixture thereof. For Dr. Rima, it began with childhood stories of physicians serving in mission hospitals across Africa and the Middle East. Hearing about women doctors who devoted their lives to caring for mothers who might otherwise not survive childbirth left a lasting impression. That early sense of purpose, shaped in part by her Christian faith, and a desire to serve where the need was greatest, eventually led her to Asia. There, she has found the work both rewarding and humbling, more about steady, faithful care than dramatic rescues.

1. What first sparked your interest in global health, and how has your work matched or differed from your expectations?

   So many childhood influences invited my interest in global health despite growing up in a small rural American town. The stories of doctors serving in mission hospitals in Africa and the Middle East captured my attention from elementary school. Hearing of female physicians who committed their lives and careers to caring for women who might otherwise not have received lifesaving care during their pregnancies and deliveries set a high bar for work that truly impacts individuals, families and communities. My work in Asia the past 4 years has been rewarding and stretching but a bit more routine than the stories that I extrapolated into daily life altering medical care from the mentors I observed from a distance.  My country's health system faces significant financial pressures but access to healthcare is quite easy. Just like in America, the rural areas struggle with sustainable staffing and access to higher level diagnostics. Coming from rural America and having worked in remote/frontier areas of America prior to coming to Asia I find many similarities, including that the majority of my medical work focuses on chronic disease/noncommunicable diseases.  

2. For family physicians curious about incorporating global health into their careers, what pathways or entry points would you highlight?

   Seize opportunities for short term service before and during your training but remember that the greatest joys of most work come when you have a long-term perspective. During short term experiences you will most likely notice the differences, the limited access to evidence-based care and the inequities. There are many large group elective opportunities that are much more of medical tourism than really seeing what the life of a global Family Medicine Physician is like.  Explore relational connections where you can be more integrated into a small team/community.  Global health fellowships and Masters of Public Health are great opportunities but you don't need them necessarily to be effective overseas.  

3. What challenges have you faced, whether related to cultural differences, resource limitations, systems barriers, or personal sustainability, and how have you navigated them?

   Sustainability in medicine! That's a major challenge all over the world and possibly especially so for female physicians.  I would say that the pressures are different overseas.  It remains true wherever you are though that finding a role that is a good fit for your personality and interests is important.  I learned so much about culture, communication, local practice of medicine in my first role in this country.  The dual standards toward male vs female physicians might be accentuated here in a culture that remains extremely patriarchal. The challenge of trying to empower female patients to speak up for their own health remains a chronic stressor.  My new role which is a mixture of hospital leadership and inpatient/ER medicine is a much better fit.  In this role I have a voice to impact the direction of the hospital but with that comes increased awareness and experience of the tension of limited resources.  Some of my regular stressors include Q2 call, a limited number of fluent English speakers, being the lone foreigner on our leadership team and one of two foreigners on our physician team and coping with my growing but far from adequate local language fluency.  Resilience in this setting has looked like praying weekly with other women who have experienced similar stressors, ensuring that times of respite away from the hospital are part of the rhythm of life, protecting time each day for faith-sustaining practices, investing in local friendships, and learning to make granola and yogurt so I can have a breakfast that feels 'normal' most days of the week. 

4. What do you see as the unique advantages of being a family physician to engage in global health?

   My country's healthcare system is still an acute care driven system.  My training in family medicine with attention to preventative and longitudinal care brings a very needed intentionality to patient care.  It is an area where I can enhance the skills of my junior doctors easily. The foundational breadth of family medicine training has been a good foundation for being able to help wherever the need is.  In my first role, I did primarily inpatient obstetrics care (an interest previously) and outpatient primary care.  In this role, I'm doing a lot of newborn care, general pediatrics and inpatient medicine and I love the diversity of the work. 

5. What have been your greatest rewards in this role, either personally or professionally?

   I love the multicultural group of friends I have gained over the years.  Right now, I'm texting from friends from Sweden who are coming to work at our hospital for 6 weeks.  Next month the Nepali pediatrician I've worked with in other settings will come to train our staff on NRP and help me figure out what we need to do to better care for preemies.  Hopefully my Swiss friend who is a lab quality control expert (she helped design the national lab QI department) will come and assess our laboratory and help me equip the lab manager to lead his team.  For my holiday I will go trekking with a friend from N. Ireland and my former trekking buddy was from New Zealand.  

   Professionally, I sometimes wonder if I will be able to find as rich and diverse a job when it's time to return to the States.  The opportunity to mentor young physicians, to help keep the hospital's vision to care for the poor and marginalized as a true priority and to be continuously challenged to learn are great benefits.

6. How do you maintain joy, balance, and perspective when the work can sometimes feel overwhelming or emotionally heavy?

   Thankfully, I have not needed to work in an area of conflict, instability or major deprivation but the heartbreak is still there in a frequency that burns. As a Christian, knowing I’m not alone in my grief and that my prayers do not fall on deaf ears has been an important foundation for resilience. Knowing and going to my people, those who will bear with my emotions and remind me of the stories of joy when the stories of sorrow seem to be multiplying is important. Reinforcing to myself that I have a voice and trying to find where I'm not feeling heard is important. Noticing the little things, like a beautiful brook I just happened upon in my walk or a violet in an unexpected place and knowing these are gifts of grace to wounded heart sustains me.  When I can laugh at myself, I'm probably in a reasonably good place. When I notice the laughter is missing, I need to step back and see what I need to do to recenter.  Often a good night's sleep, a good walk and a chance to pray with a friend is all that's needed to recenter.  

7. Any advice for those looking at their first job, or for physicians who may want to pivot into global health mid-career?

   I am really thankful that I worked in remote areas in the US before I moved overseas.  I was more of a timid learner / young physician and getting some experience in my own language in a low resource setting was really valuable.  However, there is a caution there because if you start settling into an American physician's lifestyle during this time it may make the transition harder.  I would definitely recommend a short-term trip to an area you were considering working prior to making a longer term commitment if possible.  And this is really important, you don't know how much you love a place or how appreciated you are till you come back.  

   For someone pivoting, I would encourage that the experience and confidence in your skills that you bring is a huge asset that definitely balances the challenges that may be there in language learning and transition.  Flexibility, patience and teacher’s heart are huge assets in addition to any technical skills you bring.

8. Is there one lesson or perspective you’d especially want trainees or colleagues to take away about the role of family medicine in global health?

   Different isn't wrong, it's just different.  

   &

   Don't try and make any changes in your first 6 months (maybe your first year).  Just be an observer / learner.

Dr. Rima’s story illustrates how family medicine skills translate across borders and systems, grounding global health work in relationship, adaptability, and faith. Her path reminds us that meaningful impact often grows not from grand gestures, but from steady, purposeful presence.

Next week, I’ll wrap up the current series with a reflection on key themes, mindset shifts, and takeaways from the many stories shared. 

Until then, wishing you a joy-filled week,
Tonya