As an infectious disease fellow at Louis Stokes Cleveland VA Medical Center, Lewis Musoke, MD ’16, is combating two pandemics at once—COVID-19, which the world has grappled with for nearly two years, and the still prevalent human immunodeficiency virus, better known as HIV.

Growing up in Kenya, Dr. Musoke was all too familiar with HIV. It was not only in the community but in his household and his circle of friends. That’s why he has committed his career to not only caring for patients afflicted with such diseases but making sure that his community is equipped with the information and resources they need to prevent it.

The St. George’s University graduate shared what he sees as similarities between the two pandemics, and the role he thinks the greater community can play to assist in the fight.

SGU: What do you think is the biggest issue in the HIV community?

Dr. Musoke: There’s a lot of stigma when it comes to HIV, and while we’ve come up with good medications to treat and suppress the virus, we still haven’t gotten to the point where we can sit down and talk about it the way we talk about diabetes or high blood pressure without feeling ashamed. And if you’re not talking about it, then in all likelihood you’re not thinking about it.

This percolates even to the physician level where people are not even testing for it as frequently as they should. We’ve become good in screening for things like colon cancer and breast cancer, but we’re still falling way short of the mark for screening for HIV, and it shows in high prevalent areas where we’re still having a lot of new infections.

SGU: What parallels do you see between the HIV/AIDS crisis and the ongoing COVID pandemic?

Dr. Musoke: The viruses are different but the principles are the same. One of the things that we can learn from HIV is the importance of getting the community engaged and educated. I think a problem that we have in this country and in the world is there’s a lot of misinformation, even at the provider level. It’s affecting our ability to be able to respond.

Back in the 1980s, the lack of education and desire to talk about HIV was what inhibited the progress of treating HIV. But the government shifted and now basically any HIV positive patient in the country, whether or not they have a job or access to healthcare, has pretty much subsidized healthcare through federal funding. My hope is that—as providers, physicians, patients, and the community—everybody understands the seriousness of these pandemics, and that we’re better equipped to tackle it as a whole. You can’t really isolate them to one part of the country. Everyone has to get involved, from all age groups or from all walks of life.

 

SGU: What drew you to specializing in infectious disease?

Dr. Musoke: Growing up in East Africa, you’re exposed to HIV from a very young age. HIV was—and still is—a prevalent issue not just in the community but within your household and circle of friends. What was inspiring to me was how, as drug development and treatment options improved, I started to appreciate the role that community outreach played. Some of the clinical trial data and outreach strategies that were implemented in East Africa ended up being used in the United States and around the world.

What solidified this career path for me was a public health field practicum through Boston University that turned out to be in Kenya. It was in a beautiful area right at the base of Mount Kilimanjaro. I had never lived there, but I had probably driven past it as a child. The purview of the project was to evaluate public health interventions that had been placed in regard to improving access to water. Doing that made me realize the importance of public health, and also that a lot of those health issues were infectious disease related

SGU: How well did you fit in at SGU?

Dr. Musoke: It was clear very early on that SGU was the perfect fit. I went there and knew six or seven people from Kenya, but then you got to meet people from different parts of the world. It was beautiful to learn about their experiences and the different paths they were on. It was a strange sense of almost feeling like I was home.

I made a lot of close friends, and I even met my wife (Chandula Seneviratne, MD ’16). For those reasons and more, SGU has a special place in my heart. I wouldn’t have done anything differently.

SGU: As an international student, did you have the support you needed?

Dr. Musoke: The basic sciences training was rigorous, but you have a lot of support from the Department of Educational Services. If you’re struggling with something, you have a good support system to help you get back on track. And SGU doesn’t create this illusion that it’s going to be easy. They make you work for it, and I think that’s key. In my clinical rotations, a lot of the physicians were very impressed with how hard-working and diligent we all were, and I think that came from training at SGU. I think that if you put the work in and network, you’re going to make it far, if not further than any US school graduate.

– Brett Mauser

Philip Manners, MD ’11, calls hospitalists the “gatekeepers to the hospital,” and as an attending physician at three acclaimed hospitals in the United States, he’s in a unique position to assess and implement the strengths of each department in each location.

“It’s like you’re a project manager for the patient. You really have to know how each hospital department works,” said Dr. Manners, who splits his time between UCLA Health, Cedars-Sinai Medical Center, and Johns Hopkins Medicine. “You have to look at the entire picture and view the patient as a whole. A sub-specialist can provide invaluable input very specific to their field of practice, but it’s up to the hospitalist to collect and assess all the available information, problem-solve conflicting recommendations, and unify the plan. Then the hospitalist can implement a cohesive plan that ultimately provides the most benefit to the patient.”

And in addition to his clinical duties, Dr. Manners is on faculty at David Geffen School of Medicine at UCLA and is a major in the US Army Reserve.

The native Brit shared how he juggles his responsibilities and how his role emphasizes adaptability and communication, no matter where he’s seeing patients.

SGU: What about being a hospitalist have you enjoyed most?

Dr. Manners: I like helping sicker patients. That’s not to say that I like people to be sicker, but I like taking care of people with a higher acuity that require more complex management and a higher level of care. The challenges are greater, but that’s what makes it more rewarding when you have a successful outcome and make a positive difference to a patient’s life.

Even though I trained in full-spectrum family medicine, I find the inpatient side more satisfying. You can really see the difference you make unfold in front of you. It affords you more time with the patient, whereas in primary care, there’s always a battle of time and not having enough of it. With hospital medicine, you have more breathing room to really get your teeth into the patient’s problems.

SGU: What kind of person is best fit for a hospitalist role?

Dr. Manners: To be a hospitalist, you have to be comfortable with patients who do have that higher acuity. If they’re sick enough to be in the hospital, there’s usually a complicated mix of problems and comorbidities. Also, you must be able to adapt to situations that can change quickly. One minute you can be dealing with a patient who is stable and ready for discharge, and the next you can be walking into a rapid response or a code. There are two ends of the spectrum there. Emergency medicine is similar to this, but the main difference with hospital medicine is you get follow the patient’s journey and see the progress they make. If you like the higher acuity, and the continuity of care, then hospital medicine is probably a better fit for you.

 

 

SGU: You were at Massachusetts General Hospital when the COVID-19 pandemic began. What was your role there?

Dr. Manners: I was in the middle of my disaster medicine fellowship at that time so, on the one hand, it was great because I could practice what I was training for, but on the other, the reality of a global pandemic was terrifying. Most hospitals have a small set of rooms that can accommodate airborne isolation, and we started off using those. We were implementing similar isolation procedures like we did for SARS and MERS. With COVID though, it soon became apparent that the isolation rooms were going to run out quickly, as did the PPE.

It’s a huge undertaking to upend a hospital’s entire standard operating procedures. The hospital incident command system kicked in and we essentially had to rewrite how the hospital was going to function. The hospitalists were at the forefront of this because we were the ones who were getting the COVID patients. We ended up converting entire medical and surgical floors into COVID-only floors, and oncology rooms were converted to make COVID ICU rooms. It was fascinating to see it evolve and to be on the front line of that. It was something that you read about, and try to prepare for, but hope you never have to actually experience.

SGU: You work at three locations on two coasts in the US. How is that experience unique?

Dr. Manners: One reason that I like working in large academic medical institutions is that you have access to a large range of sub-specialty care and resources—things that are on the cutting edge of medicine. I’m humbled to be learning from leaders in their respective fields. Being able to see the difference between the three hospitals is also intriguing. In a lot of ways, the job is fundamentally the same. The medicine is the same. But the systems and processes can vary widely. By identifying the things that work well—and don’t work well—at each hospital, I can use that information to refine and improve the care I give.

SGU: How was your experience as an SGU student?

Dr. Manners: I absolutely loved my time on the island. One major benefit of going to Grenada is that medical school became your whole world. You live and breathe SGU. Your classmates become your family. You forge close friendships by going through it together, and I don’t think you would develop those types of bonds and relationships in a US or UK medical school setting.

And then in clinicals, we had the opportunity to experience a large variety of clinical settings, in a range of geographical locations, where we had different resources, different patient populations, and learned different ways to practice medicine. It enabled me to become a very adaptable and open-minded physician.

I always tell people that medical school was the best experience of my life. I would go back and do it all again in a heartbeat.

– Brett Mauser

Related Reading

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• On the blog: What does a primary care physician do?

For Nicholas D. Caputo, MD ’08, the associate chief of emergency medicine at NYC Health + Hospitals/Lincoln in the Bronx, investigating diseases like COVID-19 to learn more about their origins and health effects has allowed his team to more effectively care for critically ill patients that come through the busy hospital’s emergency room.

Dr. Caputo, along with colleagues, have published multiple articles in various medical journals and based on their experiences and patient encounters within the ER, including several related to findings about the COVID-19 disease.

For instance, in the spring of 2020, the team published the first study on awake self-proning for COVID-positive patients as a means to stave off intubation, according to Dr. Caputo. The study was published in Academic Emergency Medicine (the official publication of the Society for Academic Emergency Medicine) and cited in The New York Times.

Earlier this year, his team published the only reported outcomes data for the New York City public hospital system in the Journal of General Internal Medicine, which had some “gut-wrenching findings in regard to inequities and disparities in COVID outcomes,” he said.

Sharing the correlation between research and emergency medicine, and specifically how it helps him approach his job every day, were among the topics that Dr. Caputo spoke with SGU News about in a recent interview.

SGU: How do you apply findings from your research to your role as an EM doctor?

Dr. Caputo: Research allows me to go into each shift with a different perspective. On the one hand, it allows me to deliver care to patients with the mindset of treating their individual situation based on what we know from previous research findings. On the other hand, it also allows me to take those patient interactions and formulate hypotheses about broader issues that other ER doctors may encounter and ultimately help advance the emergency medicine specialty.

SGU: What lessons have you learned from the global health crisis that can be applied to ongoing patient care?

Dr. Caputo: The most important lesson I learned is that a good scientist always keeps an open mind in the pursuit of truth. Keeping an open mind allows one to critically think outside the box, which may lead to a better solution to treatment—and a positive outcome for the patient.

SGU: What appeals to you about emergency medicine?

Dr. Caputo: The biggest appeal to me in emergency medicine is that on any given shift—no matter where you are working—you have the potential to see anything across the spectrum of medical pathology. That’s the great thing about emergency medicine—we truly see it all.

SGU: What responsibilities do you have as associate chief of emergency medicine?

Dr. Caputo: In this position, I help coordinate the daily operations of the emergency department, and oversee the quality review process, performance improvement, and research, among other necessary roles to help ensure the department runs smoothly so we can deliver the highest quality of care, safely to our community.

SGU: You are also an Army Reservist—how does your medical background help you when you are called up for service?

Dr. Caputo: My working in a Level 1 Trauma Center in one of the busiest single-site emergency departments in the country has provided me the experience I need to treat our soldiers on the battlefield who have similar if not even more devastating traumatic injuries. That’s one of the things I am most grateful for in working where I work.

SGU: How did SGU help prepare you for your current hospital role?

Dr. Caputo: SGU gave me the drive to want to do more—to stand out by showing up early, leaving late, and doing research on my own time in order to better myself.

SGU: What was the moment that you realized you’d made the right decision to come to SGU?

Dr. Caputo: When I matched in the specialty I wanted at the place I wanted for residency and where I still work today.

SGU: What if you hadn’t said yes to SGU?

Dr. Caputo: I don’t really want to think about that!

Mixed in with classes, exams, studying, and time to unwind, medical students have to squeeze in all-important sleep. Getting enough sleep, and implementing bedtime habits to do so, is a challenge not only for aspiring physicians but for everyone, this according to Sam Al-Saadi, MD ’05, the sleep medicine director at the University of Pittsburgh Medical Center (UPMC) Carlisle location, and assistant clinical professor of psychiatry for Penn State Health in Hershey.

According to the American Sleep Association, more than 50 million US adults have a sleep disorder, most notably insomnia and obstructive sleep apnea. Dr. Al-Saadi shared his perspective on what people can do to improve their sleep, and also the journey he took to lead the discussion in addressing the oft-ignored health crisis.

St. George’s University: How important is sleep to a person’s health?

Dr. Sam Al-Saadi: Sleep medicine is the secret of all secrets to good health. People have no idea how influential sleep is to the quality of their lives. To compensate, they pick up bad sleep habits, and they don’t believe that they need to fix them. The fact is that when they’re younger they can compensate, but when they get older, it just gets worse and they aren’t able to.

Sleep disorders are associated with each other. If you have one, you likely have another, whether it’s snoring, sleep apnea, insomnia, narcolepsy, or something else. The quality and quantity of sleep impact diabetes, cardiac disease, cerebral circulation, cognitive function, blood pressure, and other systems.

Sleep medicine is a subspecialty that has evolved from multiple specialties. It is a relatively new and evolving field. It started in psychiatry, moved to pulmonology and now includes neurology, ENT pediatrics, family medicine, and internal medicine.

SGU: What are some ways that people can improve their sleep?

Dr. Al-Saadi: Everyone can start by making a few minor adjustments that will make a big difference.

1. Your bed should be for sleeping and intimacy only. Many people use an iPad or phone in bed or watch TV, but these are bad habits that can disrupt your sleep. If you don’t fall asleep within 10 minutes, you should get out of bed and come back later.
2. A fixed wakeup time. Yes, it’s difficult for medical students and residents, but it’s good to have the same wakeup time, which will then dictate when you go to sleep.
3. Be careful with caffeine intake. This can be cultural—you have people drinking tea at night, an energy drink to keep up with studying, coffee, or something with caffeine. The thing is, if you drink caffeine six hours before you go to bed, you still have half that caffeine in your body when you’re trying to sleep. Because of that, you’re more likely to have arousals—when you wake up for less than 30 seconds—that you aren’t even aware of. You may not be aware of these, but you’re likely to be more tired the next day.
4. Limit long naps. Some people take long naps, but then you’re not going to be able to fall asleep later that night. Naps need to be just to catch up and keep you going for that day—no more than 30 minutes.

SGU: How did you make the journey from the UAE to the US and finally Grenada?

Dr. Al-Saadi: I was born and raised in the UAE. My dad was a microwave communications engineer, and my mom worked at the library, so I didn’t have any medical background in my family. When I came to the US at 17, I was on my own, had no money, and my English wasn’t very good. But I worked hard. I was taking courses to take the MCAT while working and supporting my family the entire time I was doing it.

I was a chemical engineering major at the University of South Florida, but when I got out, I just didn’t feel like I was using the skills I had learned. I was more fine-tuning things that were already set up. So I went and got a master’s in biomedical engineering and then when it came time to decide whether to go for an DO or MD, I went for an MD. I chose SGU because it had a lot of rotations in Florida and New York.

SGU: How was your experience in Grenada?

Dr. Al-Saadi: My experience was great. The campus was phenomenal, and I felt safe both on and off campus. We had a good time, and I think the students who came after me had it even better.

SGU: What advice would you give to a student entering medical school?

Dr. Al-Saadi: It’s important to have a plan for what you’re going to do after you graduate. It could change of course, but where you do your rotations will influence your path to residency, not only in terms of location of the residency but the individuals who you get your letters of recommendation from. I recommend that you have a plan, a backup plan, and overall a clear image in your mind of where you want to go with your career and how to get there.

– Brett Mauser