In honor of the 100th issue of Blood Advances, I was asked to write about the impact of new media, including open access online journals such as Blood Advances, on global hematology. My own global perspective has been shaped enormously by my global health volunteer work with the American Society of Hematology (ASH). As I will discuss here, like the global health outreach that many of us do, open access publications also play a critically important role in public health, and in hematology, on a global scale.
My interest in global health was significantly shaped by a formative experience that some might (incorrectly, I would argue) not even put into the category of “global health.” Starting during my pediatrics residency training and extending into my pediatric hematology/oncology fellowship and my first years as a bone marrow transplant attending, I volunteered for a week each summer in southern Georgia (the US state, not the Eurasian country) setting up camp (and bringing along my own 2 children) in the cities of Valdosta and Bainbridge, with a project led by Emory University School of Medicine’s Physician’s Assistant program, and supported by the Departments of Medicine, Family Practice, and Pediatrics at Emory. This long-standing project, which returns to these 2 cities year after year, provides medical care to the migrant farm worker community that picks the vegetables that we all count on for our dinner tables. These men, women, and, yes, children are part of that group of essential workers who make up our food supply chain. This experience was transformational: it opened my eyes to the realities of the modern day slavery of the migrant farm worker and underscored the costs in lives and health of the racism and xenophobia that still mars our national approach to foreign workers and universal health care. At the same time, it also engrained in me the deep satisfaction and feeling of connection and community that come from reaching out across language and cultural divides to provide health care.
Although the Emory Farmworker Project provided my first opportunity to become deeply involved in global health, it was very focused on general medicine and pediatrics. I was not sure, at that time, if there would ever be a global project I could participate in that was focused on hematology. That proved to be an unnecessary worry, because, at about the same time that I began working in migrant health, ASH initiated several major projects in global hematology and oncology. In 2008, I signed up as a potential volunteer at one of the sites for ASH global volunteers, through a collaboration between ASH and Health Volunteers Overseas (HVO). The following year, ASH-HVO gave me a 2-week placement in a small pediatric hospital in Siem Reap, Cambodia, called the Angkor Hospital for Children (AHC). Since then, I have been back to Siem Reap and to AHC so many times that I have lost count. I developed deep collaborations and friendships with many of the physicians at the hospital, hosted several at my home and my hospital in the United States, and witnessed the very first Cambodian children receive chemotherapy for their cancers. ASH has offered me, and numerous other volunteers like me, wonderful opportunities to become deeply involved in global health. The ASH-HVO collaboration has 5 sites around the world: 2 in Cambodia (Siem Reap and Phnom Penh), 1 in Uganda, 1 in Peru, and 1 in Tanzania. Pre-COVID, we sent volunteers to all of these sites regularly (and we will again when travel is safe). Many of these sites have established strong, decades-long bonds with members of ASH, including regular case conferences that link past volunteers with our colleagues across the globe. ASH has also established a highly successful clinical trials network for leukemia in adults (first named the IC-APL for the International Consortium on Acute Promyelocytic Leukemia, which has now evolved into ICAL for the International Consortium on Leukemia) and recently established a related pediatric network, called the Children’s International Consortium for Acute Leukemia (C-ICAL). ASH has also made a major investment in sickle cell disease through the Global Sickle Cell Disease Initiative, which seeks to expand screening, care, and awareness for SCD worldwide. Among its many commitments, ASH funds an innovative grant mechanism, called the Global Research Award, where applicants from around the world can apply for research fellowship funding. All of these programs (and others) seek to spread knowledge and expertise in hematology throughout the globe, and to link ASH members with colleagues from high-, middle-, and low-income nations.
The ASH global initiatives that I have highlighted each focus on person-to-person dissemination of scientific and clinical knowledge, which, in their totality, move the field of hematology forward on an international scale. Related to this dissemination of knowledge, and given the central role that the reporting of scientific discoveries and clinical progress makes in the care of adults and children with hematologic diseases, when we think of global health, and ASH’s commitment to the tenets of global health equity, we must also think about the ability of our colleagues across the world to access our journals. In the United States, especially at academic institutions, near-universal access to journals is a reality. However, in my travels to many of the countries served by ASH’s global programs, I have witnessed over and over again the burden that the lack of access to scientific journals places on our international colleagues. Thankfully, in the last 5 years, I’ve witnessed the other end of the spectrum: the huge positive difference it makes in a country like Cambodia or Peru (and countless others) for our colleagues to have instant access, without cost, to Blood Advances and other open-access journals. In a world where internet access and cell phones are now ubiquitous, the ability to view, without cost or institutional sponsorship, all content in a journal like Blood Advances, can be transformational. Here’s a vignette from Cambodia that illustrates the situation well: Often on our weekly case conference calls, one or more of the physicians will be calling in from their homes, on their cell phones, because their cell service beats the hospital’s internet service hands-down. These cell phones are the great democratizer for our colleagues: they can zoom into a case conference, and now they can connect with Sci- and Heme-Twitter or with the ASH annual meeting, and, of course with Blood Advances. I have heard many times in the past 5 years that the availability of Blood Advances and of its online content—not only the regular articles and editorials but also the Community Conversations and Blood Advances Talks—brings my global colleagues closer to the latest advances and to their colleagues worldwide. Therefore, as we celebrate our 100th issue, let us also celebrate what this means to our colleagues around the globe. Open access Blood Advances offers all of us the ability to connect, to access the latest advances in hematology, and to contribute to our international community of medicine. Happy 100th issue, Blood Advances. May this journal continue to contribute meaningfully to ASH’s global health goals in the issues to come.