Allergy & Advocacy: The Allergist's Role in Shaping Global Health

Embarking on a career in medicine and global health came with a tide of advice steering me toward the familiar paths of generalization—family doctor, surgeon, OB/GYN, or emergency doctor. As an Internal Medicine resident, I was urged to choose General Internal Medicine (GIM) or Infectious Disease to be “useful.” But what about being an allergist? Was there a role for this specialized field in global health?

This was my struggle as a brand-new fellow in training attending the 2022 Humanitarian Health Conference in Kansas City, USA. It was here that the wisdom of my mentors echoed in my mind. For every person, there exists an intersection where one's passions, skills, and life experiences align with the world's greatest challenges. The journey towards significance is a constant process of looking beyond our little worlds and seeking opportunities to make an impact. The key was to take small steps—steps often shrouded in uncertainty—that would eventually lead towards clarity.

It turned out the first step began at my home base at McGill. Dr. Ghislaine Clarisse Annie Isabwe is an allergist/immunologist specializing in advanced drug allergy at McGill and a graduate of the medical school at University of Rwanda. She shared her desire to give back to her country through educational initiatives for trainees.

I discovered that allergies and atopic conditions were surging dramatically in the developing world, yet on the African continent there was a serious knowledge gap and capability to address this issue. There were scant studies on the subject, particularly concerning food allergies. What studies did exist were often limited to case reports, utilizing varying methods and contributing to a fragmented understanding of the issue.

In Africa, asthma emerged as a significant concern, standing as the most prevalent non-communicable disease (NCD) among children and adolescents. With NCDs poised to surpass infectious diseases in Africa by 2030, the urgency to address asthma in this youthful continent cannot be overstated. However, the reality paints a stark picture—asthma remains largely undiagnosed, contributing to substantial morbidity and mortality. The intersection of poverty, environmental exposures, and stigma compounds the challenges faced by individuals dealing with asthma in these regions.

As the developing world grapples with the rising tide of allergic conditions, the importance of bridging this knowledge gap and recognizing the role of allergists in global health becomes increasingly apparent.

This is where we as allergists can contribute significantly to the health and well-being of populations facing unique challenges. Our role as allergists in global health encompasses education, advocacy, and the recognition of our field that holds the key to improved outcomes and quality of life.

You can read more about my experiences here and view photos here.

We designed an allergy boot camp tailored for senior medical residents at the University of Rwanda. Seventeen medical residents specializing in internal medicine, emergency medicine, otolaryngology, and dermatology enthusiastically participated. Drawing inspiration from Canadian guidelines, the course materials were modified to suit the Rwandan context. We covered didactic topics ranging from primary and secondary immunodeficiency to anaphylaxis and asthma. The workshop on skin prick testing was invariably the highlight of the course! We received great feedback - 94% of respondents rated the course highly (4-5/5) with increased confidence in managing atopic conditions.

The success of our allergy boot camp in Rwanda underscores the importance of continuity in teaching and empowering the next generation of medical professionals. Establishing locally based and internationally standardized allergy and immunology programs is not just a one-time effort but an ongoing process that requires dedication, collaboration, and a commitment to building sustainable healthcare infrastructure.

As we look forward, the focus should shift towards nurturing a continuous dialogue between educators, healthcare professionals, and policymakers. This dialogue can serve as a platform for sharing insights, refining curricula, and addressing the evolving needs of the healthcare landscape in Rwanda. By fostering an environment of collaboration, we can ensure that the programs developed are responsive to local nuances while aligning with global standards.

The unique challenges faced by the Rwandan population can offer fresh perspectives and potential solutions that benefit not only the local community but also enrich the global discourse on allergy and immunology. By empowering the next generation, we lay the groundwork for a sustainable and impactful legacy in the field of allergy and immunology in Rwanda and beyond.

Would you be interested in helping out? What are some of your ideas? Drop in the comments below!

Special thanks to Hawley Jean and Dr Clara Long (R2 Internal Medicine, McGill University) for setting up our poster on my behalf at the McGill Global Health Night / Freisen Lecture 2023.