Two years have passed since UCLA emergency medicine specialist Matthew Waxman, MD (RES ’07), returned from Sierra Leone, where he traveled to treat patients during the Ebola crisis and then spent 21 days in home quarantine after returning to Los Angeles (U Magazine, Summer 2015). Now he has expanded his portfolio of global-health work to another humanitarian disaster.
In August 2017, he went to war-torn Iraq. On the outskirts of a fiercely contested city decimated by anti-ISIS airstrikes, Dr. Waxman spent a month at a Trauma Stabilization Point (TSP) in Mosul with NYC Medics, a non-governmental humanitarian organization funded by the World Health Organization.
As the trip approached, an endless stream of questions buzzed in his head. “Who is ISIS? What is the difference between Sunni and Shiite? Why are we entering Northern Iraq from Kurdistan?” In an effort to better prepare himself, Dr. Waxman studied Arabic with a tutor for three months and read as much as he could about the war and the rise of ISIS. He quickly gained a deep understanding of the historical, social and political determinants of the conflict, steeling himself for the harsh reality of its cultural landscape.
Working for a humanitarian organization like NYC Medics and the World Health Organization, he was required to maintain complete neutrality. “We were constantly reminding ourselves that we were humanitarians, attempting to provide the same care to ISIS, civilians, prisoners and other combatants under trying circumstances,” he says.
In such a politically charged environment, Dr. Waxman learned firsthand the potential for ethical dilemmas when providing humanitarian care. He recently led a group discussion on the matter for first- and second-year students at the David Geffen School of Medicine at UCLA. Reflecting on their understanding of his service, he commented, “I was impressed how the students felt the tension between the humanitarian principles of maintaining impartiality and ensuring safety while delivering care close to the frontlines of a conflict.”
In addition to caring for a diverse patient population, Dr. Waxman and his colleagues faced the challenges of working in an active combat zone. “We lived in an abandoned house that was one of a few homes left undestroyed by airstrikes,” he recalls. He later had to move to another location as the battle shifted. “We slept packed into a room on sleeping bags. When it was safe, we slept on the roof because it was cooler.”
Patients had to be searched before they were brought into the treatment area, and the NYC Medics and Iraqi Army worked together to constantly monitor the TSP and secure the safety of its staff and patients. “We had full trust and confidence in [them],” Dr. Waxman says.
As in Africa dealing with a highly contagious and deadly disease, Dr. Waxman found in Iraq that fear is a constant presence when working to help in a humanitarian crisis. While medical knowledge and experience are necessary in such situations, “understanding the risks and mitigating those risks are key,” he says. “Whether you are serving a crush of patients suffering from viral hemorrhagic fever or taking care of patients with gunshot and blast injuries as airstrikes are going on in the background, both take a level head and focus on why you are there.”
Beyond the purely humanitarian mission of helping those in need, Dr. Waxman notes that working in such dynamic environments benefits the broader scope of medicine. “The opportunity to learn in such settings makes us all better doctors back here in the United States,” he says. “Working in global health can give you a fresh perspective on your own practice when you return, and it can be the ultimate cure for burnout.”
In addition to sharpening a physician’s skills, it also provides opportunities to extend medical knowledge. Since returning from Sierra Leone, Dr. Waxman completed a long-term research project looking at outcomes in patients with malaria and Ebola co-infection. He also has been a visiting professor at the University of Chile and lecturer at medical conferences worldwide. Although he stresses the importance of participating in global health long after one returns home from deployment — “A lot of work happens before and long after being on the ground to improve outcomes in future humanitarian emergencies,” Dr. Waxman says — he feels in-field experience is optimal for growth and perspective.
Toward that end, Dr. Waxman now is working to secure funding for a potential domestic project related to international medical training. He also plans to continue on-site support overseas with the World Health Organization.
“Characteristics and Survival of Patients with Ebola Virus Infection, Malaria, or Both in Sierra Leone: a Retrospective Cohort Study,” The Lancet Infectious Diseases, June 2017