Medical career choices - a personal reflection
Dr Andres de Francisco, MD, PhD, MSc, DTM&H* |

*Deputy Director Partnership for Maternal Newborn and Child Health (PMNCH) The Secretariat hosted by WHO

'Medicine… what else..?’ was my first response when I was asked what I wanted to study. Not an astronaut, fireman or Formula 1 driver, but a Medical Doctor. Why? Well, the fact that my father, uncles, and grandfathers for many generations were in the medical field I guess put a bit of subliminal pressure on my ‘free’ choice. I knew, for example, where the first-aid box was at home and what it contained. I also played with fantastic toys provided by pharmaceutical companies to doctors to promote their products.

I studied medicine in one of the best universities in Bogota. I learned a lot of theory there but really mastered more the practical stuff in the hospital wards, naturally leaning towards the human connection –talking with patients or parents was what I always enjoyed. Seeing inside people focuses one’s own seeking for the meaning of life.

It was also fun. Kids in the pediatric ward often shouted ‘Papa’ when I came to do the rounds and my old professors raised an eyebrow (undeservedly so). The real shock came during my first shift as an intern when I jumped to revive with CPR a young woman, while requesting adrenaline and the lot. When she opened her eyes she told me: “Doctor, please let me go. Everybody should have the right to die. Let me do so in peace”. I could not believe it! Doctors are supposed to save people, not let them die. The authoritative voice of the third year resident ordering me to let her go ended that. She had a terminal kidney cancer. That single event shaped me from the moment I managed to stop crying that night.

‘Tropical Medicine?’ asked my father, an eminent and highly regarded cardiologist whose patient list had included the Presidents of Colombia. While my parents were very supportive, they imagined me specialising wearing a swimming costume with a noisy sound system on my shoulder walking down a lost paradise beach. After much interaction, it was obvious that this would be a promising career. I went to London to specialise in Tropical Medicine.

The quantum moment for me happened when I understood that a diagnosis and the clinical, curative or preventive course of action are equally complex for a community as for an individual patient. That realisation, alongside the boredom of future eternal night shifts in hospitals and the possibility of interacting with people on a larger scale, lead to my decision to go into Public Health. I completed a Masters in Public Health and subsequently moved to The Gambia where I ran a field station for the British Medical Research Council in a remote area in Basse. I designed and ran a research programme for four years to understand and reduce childhood mortality using a community-based surveillance system to implement and measure the impact of interventions. I then married, had a child and completed my external PhD in Medicine. Excited about Public Health, I moved to Bangladesh where I ran a large community-based Reproductive, Maternal, Newborn and Child Health Programme at an international centre working in remote areas covering a population of half a million. I stayed there for ten years and had a second child during this time.

Research became, for me, the vehicle to shape policy through the provision of evidence. But the use of such evidence by policy makers did not impact the community as much as I had dreamed. Seeking to transform minds, I moved to an emerging initiative of promoting priority-setting for research into neglected diseases. We coined with colleagues the ‘10/90 gap in health research’ at the Global Forum for Health Research, to explain that less than 10% of funds for research were invested in 90% of the world’s  health problems. This concept exposed vast inequities in the allocation of funds for health research and raised the need to support research for neglected diseases. We then established initiatives destined to leverage action and funding for neglected diseases. Keen to promote the use of evidence, I moved to the Partnership for Maternal, Newborn and Child Health at the World Health Organization in Geneva to promote alliances between civil society, governments, health care professionals, academics and the private sector to jointly tackle health problems. This neutral platform of constituencies now encourages partners to pursue joint projects to improve the health of mothers and children.

Dealing with the human aspect of a patient, a community, or that of disparate constituencies is not that different. Bringing elements together to leverage action on a common agenda is the most effective catalyst for positive health outcomes.

It does not matter which field of medicine you choose, as long as you pursue concrete actions to enhance human life.  I guess you end up knowing what the right thing is to do.