Global Health Faculty Fellow Dr. Wang shares reflections and insights from her career in global health as she transitions from a career in Stanford’s Emergency Medicine Department to a deepened focus on social justice, health equity, and refugee and immigrant health.

Interview by Jamie Hansen, Communications Manager at the Stanford Center for Innovation in Global Health

Throughout her career as an emergency medicine pediatrician and professor, Global Health Faculty Fellow Dr. Nancy Ewen Wang has sought to reduce health disparities and improve access to quality healthcare, both locally and globally.

In her 26-year career with the Stanford Emergency Medicine department, Dr. Wang co-founded the Pediatric Emergency Medicine Program and developed a robust NIH-funded inquiry into the quality of and access to pediatric trauma care. She also founded the Stanford section in Social Emergency Medicine. This field uses an emergency medicine perspective to identify and address the social factors that contribute to disease. She extended the Social Emergency Program with the Stanford Health Advocates in Research in the ED (SharED), an undergraduate program that screened ED patients for social needs, and taught global public health on the Stanford undergraduate campus. She has worked clinically and educated trainees and faculty globally, including at sites in Chiapas, Mexico; Borneo, Indonesia; and Galapagos, Ecuador. Recently, she was appointed as Faculty Director of the new Racial Equity to Achieve a Community of Health (REACH) Scholars in Health Equity MD/Masters Program, which is committed to developing a cohort of physician-leaders with the skills and resources to promote social justice and health equity.

Now, after retiring from her clinical emergency medicine position this March, she is continuing to develop this program while also deepening her work addressing health equity and the well-being of vulnerable populations – particularly immigrants and refugees to the US.  In a new role as medical advisor to the U.S. federal court’s Juvenile Care Monitor, Dr. Wang will monitor U.S. Customs and Border Protection juvenile priority facilities in the Rio Grande Valley and El Paso sectors to assure compliance with the recent 2022 Flores Settlement. She’s also co-leading El Encuentro, a project funded through the Stanford Impact Labs. El Encuentro, which means “the encounter,” is developing and evaluating model programs that provide integrated, multidisciplinary, trauma-informed services for unaccompanied children and other “newcomer” families – those who have been in the U.S. less than three years.

Dr. Wang spoke with us about her career in global health and these new initiatives focused on the health and well-being of immigrants and refugees.

I will never forget my first encounter as a fifth-year medical student on rotation in the public hospital in Comitan, Chiapas in Mexico. My first patient was a chauffeur who had just been admitted for severe and painful muscle spasms and respiratory distress, due to presumed tetanus. I was stunned that I just had to cross the border to see someone with a vaccine-preventable disease that my attendings and I had never encountered before in the US. 

During residency, I participated in international medical programs where well-intentioned medical professionals traveled to other countries, set up temporary clinics, and dispensed free medications with very little connection to the local community. It was not hard to see that our clinics were of questionable utility and possibly undermined the local health system. 

Later, as junior faculty, I worked in a public hospital in Santa Cruz, Bolivia, where I witnessed a heartbreaking lack of resources and access to timely care. I remember a patient with an ongoing heart attack – which requires prompt treatment.  The family had used all their money for the long trip out of the jungle to the hospital. But the hospital would not do anything until the patient’s family bought all the supplies and medications needed, including even the ECG leads!

These experiences shaped my transition in global health from providing direct care, to supporting reputable organizations and working with local communities to build their capacity.  A co-resident and I started “International Medical Options,” a nongovernmental organization where we educated medical students and other medical professionals about trustworthy organizations to work with, and compiled medical opportunities. We hosted conferences, bringing in speakers like Paul Farmer and Jeffrey Sachs. This was in the early 90s and I think the field of global health has evolved so that these concepts are now widely understood and routinely practiced. 

I decided that I would focus on building local capacity. I taught advanced life support for adults and children at the request of partners in Oaxaca, Mexico —  with a focus on sustainability and training the trainers. This led to partnerships in other countries such as in Ecuador and Indonesia. I worked for many years with Health in Harmony’s ASRI Clinic in Borneo, Indonesia — an innovative model that links conservation with health. This clinic provides health care and simultaneously “saves the rainforest with a stethoscope.” I supported their local physicians in their clinical care, gaining research and publishing experience, and obtaining observerships in the US.

When I had children, I shifted some of my global work to teaching international public health at Stanford and conducting research on disparities in access to care locally, underscoring that we don’t have to cross borders to find deep inequities for immigrants and native-born people in access to quality health care. In other words, local is global.

In 2017, when the federal government created a humanitarian crisis at the US-Mexico border enforcing a family separation policy, I had the unique opportunity to join a team of lawyers (the Flores counsel) as a child welfare expert using my medical expertise to support legal efforts to improve health-related conditions for children in shelters and at the border. 

Around the same time, a Stanford town hall led to the creation of the Families at the Border initiative. I joined this group and have stayed involved over the years, working with partner organizations like Refugee Health Alliance on projects related to child health and well-being in Tijuana.

As conditions at the border worsened to include severe overcrowding,  “kids in cages,” and tragic deaths, the Flores Plaintiff counsel alleged hundreds of violations of the 1997 Flores  Settlement Agreement  “to keep immigrant children in a safe, sanitary, and least restrictive environment”. Mediation began in 2018 and finally settled in 2022. The agreement required reform in many aspects of child detention in Custom and Border Protection facilities, including the creation of a medical system.  The agreement also called for a Juvenile Care Monitor through December 2023 to ensure that the agreement was being enforced. My colleague Paul H. Wise was appointed as Juvenile Care Monitor.  Now, the role has been extended for six months and I have been appointed to a modified version of his role, as the Medical Advisor to the new Juvenile Care Monitor, Andrea Ordin, JD.   

While many false narratives place blame on immigrants for coming to this country, it’s hard to blame a child for being brought here — or argue against their right to dignified, safe treatment. For me, it’s reassuring to be involved in a way that I can make an impact, but is also very technical and pragmatic. My role is to use my expertise and experience as a pediatrician expert to ensure that children are treated according to the health and medical provisions of the Flores settlement, including receiving quality medical care if needed.

I have the privilege of working with the court to make sure that the government is not only doing what they agreed to do, but implementing the terms of the settlements with children’s best interests at heart. I’m guided in this by my training and approach to all my work: that everyone deserves the right to quality healthcare.

I remember meeting a 13-year-old boy with his 4-year-old brother who wouldn’t talk, and seeing how the older one took care of and advocated for his brother. They had come from a very poor town in Guatemala, and had traveled a long way. The older boy told me that only he knew how to communicate with his little brother; and that they were heading to a place called San Francisco, where they would live with their mother and be able to go to school. In this work, you can get pretty down, pretty fast. This memory keeps me going: Seeing how strong, resourceful, and caring the children are, and knowing that the reason kids migrate is for hope and family.

I feel privileged to have had the unique opportunity to see these kids and hear their brave, heartbreakingly honest and sometimes funny stories, and I feel motivated to always keep with me what they have shared and to continue my future work on immigrant health and well-being.

Through our work with children at the border, my colleague Ryan Matlow and I began to think about what happens when children are finally allowed across the border to reunite with family in their destination communities. After experiencing often traumatic journeys and detention, what happens next for these children? How can they best be supported as they begin this new chapter of their lives in an unfamiliar place? These questions crystallized in our New England Journal of Medicine commentary, When Undoing is Not Enough, which states that undoing the very harmful Trump-era immigration policies should not be seen as “enough.” It suggests ways to mitigate this trauma and to facilitate children and their families to build new lives in this country. We were fortunate to receive a Stanford Impact Labs Fellowship to help us move these ideas from research to action.

After the fellowship concluded, we received a Stanford Impact Labs grant to pilot a program called El Encuentro in collaboration with community partners in the Bay Area who serve immigrants. We have three main goals: to support immigrant-led organizations to identify their needs and work towards their identified solutions; to help organizations implement and evaluate early-stage community programs; and to bring together a multi-disciplinary community of practice in immigrant health.

To achieve the first objective, we’re collaborating with a group called Ayudando Latinos A Soñar-(ALAS) in Half Moon Bay to evaluate the impact of their after-school cultural arts program, which builds on the strengths and culture of the immigrant community rather than approaching immigrant health from a scarcity mindset. We also recently received a grant to help them build their own community research program. For the second objective, we’re working with Catholic Charities Santa Clara to assess the impact of their “footsteps” program where community guides use their lived experience to help newcomer families navigate the often siloed resources that they need. Lastly, we have held ongoing convenings of Bay Area multidisciplinary providers (health, and mental health, legal, educational and social services) to identify ways we can work together and measure our collective impact on the overall health and well-being of immigrant children and their families.