Medical and Public Health Responses to Disasters and War

My name is Jennifer Leaning. I am a physician and a public health doctor. I have worked in emergency medicine clinically for many years. I’ve also become increasingly engaged in first of all medical leadership management in a number of different settings and then came to the Harvard School of Public Health about 13 years ago. I teach a range of issues here at the School of Public Health and in the Faculty of Arts and Sciences. I also conduct research, for the last two and half years have been running the university-wide FXB Center for Health and Human Rights.

In the last 30 years, I’ve increasingly been focused on how the medical and public health community responds to disasters and war. I’ve participated in or led a large number of human rights investigations in war settings or post-conflict settings. The problems that I work on circle on the general questions of how do people suffer in crisis, how can the international humanitarian community respond in adequate ways, and increasingly, how might we anticipate these crises so that we can forestall them or mitigate them.

As an undergraduate at Radcliffe, I found myself very interested in history. I concentrated in History and Literature, particularly modern European history and lit. I originally thought I would be a historical or a historical demographer, but I was also young and restless, and perhaps not sure what I wanted to do.

At this time, very significant things were happening on the world stage. Many African countries were coming out from under colonial rule and declaring independence in the 1960s. I was very interested in taking part in those early phases of nation building. After my sophomore year, I decided to go Tanzania for a year through a program called Volunteer Teachers for Africa through the Phillips Brooks House. Young leader from the liberation movements in Africa were sent by their parents and peers to receive a good education so that they would be prepared to take charge once independence had been attained. I taught English primarily at a school outside of Dar Es Salaam for that year.

It was a fascinating experience. I came back with a strong sense that the most important issues in the world related to public health, sanitation, and water. I still had two more years of college to complete, but I decided that afterwards I wanted to study public health rather than attend history graduate school. So I did my master’s degree at the Harvard School of Public Health for two years, and then realized I wanted to go to medical school. I did a post-bac year to complete my pre-med requirements and then went to the University of Chicago. I thought I wanted become an internist, but I was also interested in high risk OB because I had a lot of experience delivering babies during my time at HSPH.

I came back to Boston and did my internship at Mass General, initially in internal medicine. I became extremely interested in emergency medicine – MGH has an extraordinarily fast-paced emergency medicine department – so I worked there and loved it. I completed my residency and constructed my own fellowship year in emergency and internal medicine. Then I worked in emergency medicine at Mt. Auburn Hospital and at the Brigham.

I loved it, but I because increasingly interested in a number of things related to the anti-nuclear war moment that burgeoned in the ‘70s and the human rights issues surrounding war. So for the last 35-40 years I have worked both as a clinician and human rights investigator. Then in the last 13 years, I have become a full-time academic at Harvard, engaged in studying these problems in a more structured and systematic way.

I teach a number of courses. I teach one on disasters at HSPH, and then I co-teach a course on international humanitarian law and crises. I also teach a course for undergraduates with Jim McCarthy on the environment and forced migration. For 10 years I used to co-teach a freshman seminar on human rights with a close colleague, Jackie Bhabba, who is a human rights lawyer, but we stopped doing that.

Then I have a number of research projects and I have also run the FXB Center for Health and Human Rights for the past two and a half years. Before that, I ran and co-directed the Harvard Humanitarian Initiative. As a director, you are involved in fundraising, strategy, meeting with staff and faculty, and figuring out a coherence course of work for your center. The FXB Center now focuses on the violations of adolescents’ and children’s’ human rights in crisis settings, and how we can improve their health and well-being by addressing some of the negative forces that cause them to suffer.

So I have a very stimulating day. I meet with key faculty, key staff, and individuals across the university to work on issues that relate to curriculum development or programs of study. I am on a series of steering and executive committees, too, so I spend a lot of time crossing the river (laughs).

The people that I work with have varied points of view, education, and training. The faculty at Harvard differ a lot from people in fundraising or from the policy community. I interact with various elites in the United States and around the world, that is thinkers, writers, leaders of NGOs, people of significant wealth, and faculty. I also deal with local people, refugees, very poor people, people in townships, and that is pretty essential in order to maintain a sense of reality of what is going on.

Upsides:
I spent a lot of time in the life of ideas trying to assess what is going on in a broad area of concerns around the world and figuring out what we as a center or university, or I as an individual researcher or policy person, can do to address these issues, inflect them, raise awareness, and improve the situation for vulnerable populations. So I have to stay very alert to changing events and have a sense of the history and trajectory of different areas of the world. And then I work with a team to figure out what we are going to do. I work in the world of ideas, but also in the world of discussion, insights, and strategic options.

I actually find the fundraising work interesting, which I hadn’t thought I would like. Donors who are interested in the world of children, adolescents, crises, war, and grave poverty are very accomplished people with strong ethical and moral notions of what needs to be done. So it is fun to talk to them about what we are doing and intriguing to hear what their world views, comments, and critiques are. I learn a great deal.

The biggest challenge for me was how to integrate medical practice with a growing interest in what is going on in the rest of the world and an eagerness to participate in some of those major crises. I had to interrupt my course of study to go to Tanzania and do something completely different. You couldn’t enroll as a junior at Harvard and have the experience I had for a year.

Being an emergency physician is incredibly demanding – you have to maintain your skills, competence, and connections with people in your hospital and on your team. The struggle has been having a line of work that is usually structured, located in once place, and that requires you to be available all the time, and then engaging into forays around the world. I go to conferences and lead human rights investigations where I am a learning a great deal about what is happening around the globe. So it has been an issue of maintaining and acquiring competence in a series of different spheres and managing the ergonomics of time.

– The Face of Battle, John Keegan
– The Age of Extremes: The Short Twentieth Century, Erich Hobsbawm
– Bloodlands, Timothy Snyder

For undergraduates, my advice is to be very informed about one discipline. There are majors and minors and this and that, but don’t get completely distracted by now all the interdisciplinary, cross-disciplinary options you have, because it carries the risk that you will be conversant in a lot of areas but not deeply knowledgeable in one. It is good to know something very well. I advise students to write a thesis or a big lap project – have a culminating experience in their discipline – so that they leave university with a real sense of intellectual accomplishment.

For students thinking about going to medical or public health school, I have various ideas. I basically believe that if you want to work on global health or international humanitarian issues, it is not essential to go to medical school. People who go to medical school so that they can participate in global health, and are not deeply interested in clinical medicine, are doing themselves a disfavor because it is a long detour. And we need doctors right now in this country, so they are taking up space in a medical school. So if you go to medical school, you need to think about whether you want to be a clinical doctor or a research doctor. If you want to go to into public health, then I suggest getting some experience in this area and then getting a master’s degree at a good public health school.

For students who are debating leaving medicine, I suggest finishing residency first. The world is looking for superbly trained doctors, so you won’t be marketable if you have just done one year of clinical training.

So I guess the theme is be coherent about what you learn. Don’t be afraid to change pathways, but once you are in a pathway, finish it, and you can move on after. My general sense is that life is long and the first 35 years are extremely important. Those are mixed messages, I know. You need to get really well trained in your first 35 years of life and then there are many directions you can take.