A Doctor’s Journey

I’m a senior faculty member in the Division of Infectious Diseases at University of British Columbia (UBC). I have been affiliated with UBC and Vancouver General Hospital (VGH) since 1977. My career in medicine has been deeply influenced by a longstanding commitment to understanding and combating infectious diseases, and I am pleased to share some insights from my professional journey with you.

Growing up in Manitoba I was immersed in a community-oriented environment where public health and social determinants of health played a significant role in outcomes.  My parents, both served in the Second World War, instilled in me a deep sense of responsibility toward others.  These are values that continue to guide my professional and personal life.  I contemplated pursuing a career in ministry, driven by a desire to serve and care for others, however, I ultimately chose the medical path after reflecting on the potential for making a tangible impact via healthcare.

In 1968, halfway through my medical degree, my interest in Infectious Diseases was sparked when I met Dr Allan Ronald.  A renowned Canadian expert in Infectious Diseases, his contributions have profoundly shaped Infectious Diseases research and treatments in Canada. Dr Ronald’s specialty in ID, especially the social and environmental factors influencing the risk and outcomes of infections, left a lasting impression on me.

While in medical school, I spent two months at a pediatric hospital in Jamaica. This experience exposed me to the devastating toll of vaccine-preventable diseases, such as tetanus and diphtheria, along with other diseases for which vaccines have since been introduced, such as meningitis. These infectious diseases caused many young children to suffer and, too often, succumb to preventable illnesses. Witnessing these tragedies reinforced my resolve to focus on infectious diseases and vaccination programs—an area where preventive medicine truly can save lives.

I was the first Infectious Diseases physician in the UBC Department of Medicine. In those early years, I got to do it all; I worked alongside colleagues in microbiology, public health, and pharmaceutical sciences. This dovetailed well with my research interests in sexually transmitted infections, particularly urethritis and cervicitis, and infections due to Chlamydia trachomatis. I have run research labs, clinical studies, worked with national and international groups, and had close involvement with what was then dubbed The Canadian Infectious Diseases Society. My interests and opportunities led to being invited to sit on numerous national committees dealing with infections in both humans and animals, as well as bioterrorism.

Twice I have been seconded to working with the provincial government: to help oversee the first waterborne outbreak of toxoplasmosis, and to help retain and further develop the UBC BCCDC, to ensure it remained a valuable provincial resource. Concurrently, I worked closely with the UBC Institute for Health Promotion Research and sat on the Academic Advisory Committee of the National Institute of Health of Mexico.

Once again I became more actively involved in international work; I spent a month in rural South Africa doing primary care seeing many of the same issues that I had when I was a medical student in Jamaica. I made multiple trips to Guyana, assisting with the development of governmental programs for HIV, STIs, and TB, as well as supporting management guidelines and laboratory services. I also collaborated with UBC and international colleagues on public health issues in Mexico, Cuba, and, most extensively, Ecuador.

On reflection, one of the major ironies is that in the 1968 era, several prominent individuals predicted that there would be no ongoing role for infectious diseases, assuming that new antimicrobials would solve all problems with infections. How incredibly wrong they were, as we see bacteria like Neisseria gonorrhoeae going from being penicillin sensitive to becoming increasingly resistant to first-line agents. We are encountering Gram-negative infections for which there is no effective treatment (yet). Consideration of antimicrobial-resistant pathogens always enters our treatment recommendations.

Infections come and go; pharyngeal diphtheria has disappeared; HIV is on the wane due to the development and application of treatments and preventive programs, changing its prognosis to a chronic disease. When SARS made its appearance, I went to Toronto to assist in the initial investigations and management, and continued extensive work with what is now PHAC. Then we saw (and continue to see) the rise of COVID.

Medicine and infectious diseases have transformed over the decades. Advances in medicine have created the need to manage infections in seriously compromised hosts, leading to a well-developed sub-specialty in antimicrobial stewardship: Transplant Infectious Diseases.

Whilst the Infectious Diseases Division has always been involved in infection prevention and control, the role of ID physicians in addiction medicine, DEI efforts, and our ongoing commitment to international health work towards lessening the risk of developing an infectious disease through new diagnostic capabilities.

I have dedicated my career to advancing understanding and treatment of infectious diseases, with a particular focus on public health strategies aimed at preventing and controlling infections, Social determinants impacting disease risk and outcomes, as well as Research and education directed at improving patient care and community health.

Unfortunately, many advances are being undercut by misinformation, intolerance, a rise in anti-science beliefs, and controversy about vaccines; these are supported, flourishing, and potentially affecting policy under the influence of ideological groups and governments. Being in the public eye, in an important advocacy role, carries risk.

As you contemplate and pursue your studies and careers in medicine, I would encourage you to recognize the profound impact that social and environmental factors have on infectious diseases. Your work can contribute to reducing health disparities, promoting equitable access to healthcare, and advancing preventive strategies that can protect vulnerable populations.

The field of Infectious Diseases is ever-evolving; it offers challenges and opportunities. If you embrace the lessons of history, the importance of community, and the responsibility we all share in safeguarding public health, you can impact meaningful change. My own journey has been shaped by early inspiration, global experiences, and a lifelong dedication to improving infectious disease outcomes. I hope my reflections serve as an inspiration and inform your own path in medicine.