August 23, 2021, 3:37 p.m. David Mitchell — Shailey Prasad, M.B.B.S., M.P.H., spent three and a half years caring for people in a remote, tribal area of southern India, setting up a clinic and small hospital after graduating from medical school in 1990. What he experienced there put him on a path to address health equity on a global scale.
“We saw a lot of pathology — infections, anemia, maternal-child health issues, all of that,” Prasad said, “but what struck me was that I felt that there were many situations where we could have done better if there had been some intervention.”
His interest in prevention spiked when a large cholera outbreak hit his native country in 1992.
“It was interesting because we didn’t have a single fatality in the particular region where we worked, whereas the surrounding regions all had significant mortality,” said Prasad, a professor and vice chair for education in the Department of Family Medicine and Community Health at the University of Minnesota Medical School. “Prior to the outbreak, we had had a lot of education about safe drinking water and hygiene-related issues in all the small villages in that area. We didn’t do it with a great deal of planning. We just did it because we felt that was important. That gave me pause to say, ‘Yeah, there is more than the clinical medicine needed to take care of communities.’ That’s when I started looking for more public health training.”
Prasad was accepted to a preventive medicine residency and moved to the United States with the intention of spending one year in a transitional program. In his early days in Detroit, Prasad had many conversations with David Leach, M.D., about his interest in bridging clinical medicine and public health.
Leach, then the director of medical education at Henry Ford Health System who would later serve as the longtime executive director of the Accreditation Council for Graduate Medical Education, gave Prasad a career-altering piece of advice: “You need to look into family medicine.”
“I was like, ‘What is family medicine?’” Prasad said. “This was before you could access information on the internet easily. Family medicine as a discipline did not exist in many parts of the world then, and it’s still very early in India. So, he took me to visit the family medicine program in Detroit.”
Leach suggested that Prasad do a family medicine rotation, and if he enjoyed it he could join the residency program. His one-year transitional program ended 11 months early.
“I absolutely fell in love with the premise of family medicine: comprehensive care, continuity of care, community-based care,” he said. “All of those were really dear to me. A model that goes beyond the four walls of the clinic was what I was looking for.”
After residency, Prasad spent 10 years in Picayune, Miss., near the Louisiana border, where he observed “remarkable similarities” between practicing medicine in the rural South and remote areas of India. And he has continued to care for underserved patients, and to research their needs and outcomes, at the University of Minnesota, where he also is the global heath chair.
“Some of the challenges related to social isolation, depression, alcoholism, medications and access are similar,” he said. “There are a lot of similarities between the practice of medicine in a rural underserved area here in the U.S. and in underserved care anywhere in the world. In urban Minneapolis, geographically we might be close to some of the latest and greatest health technologies, but from an access point, we still have huge challenges.”
Prasad said family medicine can be the essential bridge between public health and clinical medicine but added, “We need to do more of that bridging.” He is addressing these challenges on multiple fronts. Prasad is the executive director of the Center for Global Health and Social Responsibility, which supports and coordinates research and global health activities at the University of Minnesota’s six health science schools. He is a co-principal investigator of the Northern Pacific Global Health training program, a consortium that trains global health scholars from the United States and nine other countries. And he is the co-principal investigator for the CDC-funded National Resource Center - COVID19: Refugees, Immigrants & Migrants.
The CDC tasked the university with creating a program that could collect, develop and disseminate linguistically and culturally appropriate health communications and education resources for health departments and community organizations working with refugee, immigrant and migrant communities that have been disproportionately affected by the pandemic.
“It was supposed to be a one-year project,” Prasad said, “but the work has gone so well that the CDC is funding us for one more year.”
Prasad’s efforts in global health and education have taken him to the University of Cape Town, South Africa, where he was a visiting professor in 2018 and remains an honorary professor. And he is a visiting professor at Udayana University in Indonesia. During the pandemic his “visiting” has been virtual, but he said working online rather than making rare in-person trips has actually increased his interactions with the schools.
“In Indonesia it’s interesting because family medicine is really fledgling there right now,” he said. “It’s very early, so it is about setting up the models for how do we start the process of developing a residency, and when we start residencies what will it take for us to keep them going?”
Prasad will be one of the speakers Oct. 21-22 during the AAFP’s Global Health Summit. He plans to address the issue of sustainability in global health efforts. He said the United States and other Western countries have been criticized for approaching global health with a “charity model, which is not shown to improve conditions. It just perpetuates dependency.”
“There have been a lot of conversations in the global health sphere about decolonizing global health and moving away from the models of, ‘Oh, those poor people have nothing, so we need to parachute in and drop a bunch of medicines,’ and that’s it,” he said. “Unfortunately, our discipline is complicit. So, the conversation I was moved to present is, what does real engagement for the long term mean? Family medicine is probably much better than other clinical specialties in the U.S. about being community engaged, being relevant to populations and things like that. COVID has taught us that we need to work way beyond the clinical models.”