Lifelines: A doctor’s Journey in the Fight for Public Health
Leana Wen, MD
Review: Ellen Heller July 25, 3021
Dr. Leana Wen’s memoir, “Lifelines: A doctor’s Journey in the Fight for Public Health” is an incredible, inspiring story of a brilliant, courageous, and passionate doctor’s quest for saving lives and providing an equitable system for health, housing, food and education of people in need.
As she writes,” Public health is a powerful tool for wellness, success, and social justice. Hunger and safety, poverty and women’s rights, are all public health issues.” Dr. Wen’s life’s story reminds us that one person can make a large impact on improving life for others notwithstanding formidable challenges along the way. As we move through the devastations of a pandemic and political crisis, “Lifelines” provides a motivating and reassuring reason to work together to improve and save lives.
The book is really a “tale of two stories”. The first is of a poor, immigrant child making her way in the world, and the second is of the crucial role of public health in addressing poverty, crime, racism—and, of course, health issues.
Dr. Wen was born in Shanghai, China. She was raised by her paternal grandparents in a one-room apartment where the kitchen and washroom facilities were shared in a hallway with a dozen families. For most of her early childhood, her mother lived in a distant city studying for her undergraduate and graduate degrees in English. Her father was a political dissident whose rebellious activities during the Cultural Revolution led to his being caught, jailed, and abused. When Leana was 8, her parents left for the United States when her mother was accepted into graduate studies. The family arrived with only forty American dollars.
The book describes the dire circumstances the family had to overcome. In the 8th grade when Leana was 13 years old’ she passed the Early Entrance Program and entered California State University “with the sole intention of earning a degree and making money to help” her parents. She was graduated summa cum laude and with the determination to become a doctor. Two professors encouraged her dream, and ultimately, she was accepted into 13 medical schools. She accepted Washington University in St. Louis with a full tuition and living stipend. Dr. Wen excelled and became a Clinical Fellow at Harvard Medical School and a Rhodes Scholar. During that time, as President of the American Medical Student Association (AMSA), she learned that being a doctor “is also about advocating and fighting for our patients.” She decided on emergency medicine as her specialty as she knew she wanted to work in health policy and “see the problems of our health-care system firsthand.” The book details her early work in international health in Rwanda and winning Nicholas Kristof’s annual “Win-a-Trip” award in 2007. She also came to recognize that “social determinants of health” like poverty and living conditions play “the “major role, in determining a person’s health and wellbeing.” She “began to see” that if she wanted to be the most effective advocate for her patients, she needed to have formal training in health policy and “learn the discipline of public health to influence the social factors that determine health and well-being.” She states, “It was the field of public health that looked to assure the conditions in which people can be healthy. It was public health that focused on prevention of diseases…in the first instance. It was public health that urged policy makers, health professionals, and patients alike to regard education, housing, food, and transportation as health issues, too.”
The part of the book that best exemplified this for me was the chapter describing her work as the Health Commissioner for Baltimore City. That is where I had the opportunity to witness her dynamic and innovative leadership. Her summary in the memoir allows one to appreciate the successful programs she implemented while “doctor for the city.” She describes her years at the helm of the country’s oldest health department as her “dream job” where she could use an approach based “on science and community-level advocacy and rooted in the principles of social justice…” Dr. Wen was a leader in addressing the significant increase in overdose deaths from addiction. At this point in her life, she and I had the opportunity to meet at a Heroin Task Force convened by the Lt. Governor. As s a senior judge, I had been presiding over a felony drug court initiative at the Circuit Court for Baltimore City. Both of us had given testimony on the problem of the opioid crisis. She approached me and observed that both of us had given the same messages: (i) Addiction is a disease and not a crime and (ii) Treatment works. We immediately became friends. She suggested to me (and I accepted) her offer to come to the court and personally educate and instruct the participants on the opioid antidote naloxone. In August 2015 Dr. Wen addressed a crowded courtroom, and personally demonstrated how to use naloxone and patiently answered all questions. The Baltimore City Adult Drug Treatment Court became the first court in Maryland (and perhaps the country?) to train its participants on the use of naloxone. It is now established policy in that court to instruct all new participants on its use to prevent an overdose. Of course, as she describes in further detail, she instituted a city-wide education campaign, had legislation passed that permitted her to issue a city-wide prescription for naloxone and a standing order that after training, outreach workers on needle exchange vans could give naloxone directly. The book also describes other major programs to address the opioid crisis under her leadership including a centralized 24/7 crisis phone number; a high-tech dashboard showing vacancies in treatment programs; a fentanyl task force; and the building of a Stabilization Center, among the first in the country, dedicated solely for addiction and mental health emergency treatment.
Another achievement described in the memoir is Dr.Wen’s response to the death in April, 2015 of a 25 year old African American man, Freddie Gray, from a broken neck and other injuries while he was in police custody being driven in a van. Baltimore experienced a major uprising which Dr. Wen describes: “the world saw Baltimore burn-thousands of cars on fire, hundreds of stores being looted, and crowds of angry youth rioting onto the streets.” The Health Department became a “lead agency” to respond to the violence, and she began communications with all of the City’s hospitals to ensure each one had a security plan as well as a strategy to get staff to and from shifts. She also triaged medical emergencies for patients with doctor’s appointments the next day and arranged transportation for the most critical with needs like chemotherapy and dialysis. Dr. Wen describes the need to make prompt decisions, which resulted in an emergency website being set up to publicize health information. In an emergency, you “need to be the ‘Swiss Army knife’ for every situation.” One her responses was creating a 24-hour phone hotline so that anyone with prescription needs could reach the Health Department to ensure the people would get what the needed. They spread the information to senior-citizen buildings and more than 150 churches. The details of this program as well as the emergency Mental Health and Trauma Response Plan and the emergency food and basic supply program are striking.
In summary, the book is “alive” with details, dramatic episodes, and a myriad of genuine public health responses that alleviated and prevented further harm. It certainly meets Dr. Wen’s intention of showing “the crucial impact of public health on our everyday lives.” As she often states, “ Public health could save your life today”.