Dr. Elizabeth Triche '09 practices on a Pacific island with sun, sand — and a host of challenging health problems
In the United States, the far-away island of Saipan is probably most familiar to aficionados of World War II history. Part of the Northern Mariana archipelago, it was the site of a 1944 battle that cost the lives of thousands of American and Japanese soldiers and helped end the war in the Pacific. Today, Saipan is the capital of a U.S. commonwealth; as in nearby Guam, people born there are American citizens. The island is a striking mash-up of the developed and developing worlds, says pediatrician Dr. Elizabeth Triche '09 — which makes it a compelling place for her to practice medicine. "It's this weird dichotomy of beautiful ocean, resorts — we have a water park — and then abandoned strip malls, people living in corrugated metal huts," says Dr. Triche, who works at the island's only hospital, Commonwealth Healthcare Corporation. "But we have a dialysis unit, because we're part of American medicine. We take Medicare and Medicaid. I have a neonatal intensive care unit. We have one general surgeon who's always on call — but we have no specialists."
Located about 6,000 miles southwest of San Diego, Saipan has some 51,000 residents, a third of whom are of Filipino ancestry. For the indigenous people — the Chamorro and Carolinian ethnic groups, which comprise about a quarter of the population — the importation of Western lifestyles has been devastating to public health, Dr. Triche says. "World War II was the turning point — before that, they walked everywhere and lived to 80 — but we brought them Spam and hot dogs and canned goods, and it's been killing them ever since," says Dr. Triche, an avid dancer who teaches Zumba classes at a local gym to encourage exercise. "People are very over-weight, and diabetes is at crisis levels — like 35 percent of adults. I have a 3-year-old patient with high blood pressure."
Dr. Triche arrived on Saipan in February 2014 on a two-year contract with the hospital, and she plans to renew for at least one additional year. Because her colleagues have similar arrangements, she says, "The number of physicians varies wildly"; there can be as few as two pediatricians on staff or as many as six. "It's feast or famine," she says. "Everyone seems to sign contracts at the same time." While severely ill or injured patients can be referred to off-island hospitals, including those in the Philippines and San Diego — the latter requiring multiple flights and 24 hours in transit — Dr. Triche treats a much wider variety of cases than her mainland colleagues do. "It forces you to be incredibly adaptable, to think outside the box," she says. "I end up being the intensive care doctor, the neurologist, the person taking care of someone who's dying from diabetes or has a brain bleed — whereas in the United States, a specialist would immediately step in."
Still, Dr. Triche notes that Saipan has more medical resources than many of the places where she's studied and practiced. A native of Miami, she traces her passion for treating underserved populations to a post-college Peace Corps stint in Honduras, where she tried in vain to use her basic first-aid skills to revive a young man who'd drowned in a river. "The only medical person in my tiny town was a woman with an eighth-grade education who was an auxiliary nurse and just gave antibiotics for everything," she recalls. "And I thought: Oh my God, I may be the highest-trained medical person here."
During medical school, Dr. Triche spent two months working at a hospital in Tanzania and took a year off to earn a master's in international public health from the University of Sydney. As a pediatrics resident at University of California, San Francisco, she was on a special track focusing on advocacy for underserved populations, work that brought her to Guatemala and Swaziland. After residency she spent a year and a half in Ethiopia, helping train pediatrics residents in an effort to stem that country's medical brain drain. During her tenure, she notes, the program graduated its first three residents — "so we put ourselves out of a job," a global health worker's fondest wish. In her current post, Dr. Triche has helped address the chronic shortage of medical professionals on Saipan by recruiting several physicians and a physician assistant to the island. She notes — with a nudge to her fellow Weill Cornell Medicine graduates — that practitioners can commit to as little as a month of service. "Liz is really trying to make a difference," says Dr. Madelon Finkel, a professor of clinical healthcare policy and research who was one of Dr. Triche's Weill Cornell Medicine mentors. "She's a terrific inspiration for students who are thinking of combining clinical medicine with global health. She's compassionate — as hopefully all medical students are — but she takes it to the next degree, where she's willing to live in some pretty underserved areas. She walks the talk. I'm delighted at how she's turned her interest and passion in global health into a wonderful career."
Island time: Dr. Triche enjoys Saipan’s natural wonders.
While Dr. Triche's medical work is demanding and stimulating, her off hours are the stuff of many a Northerner's island fantasies. Her apartment has a balcony with a hammock and an ocean view. Although Saipan sees its share of extreme weather — Dr. Triche's first home was heavily damaged in a typhoon that clocked 200-mile-per-hour winds — the island enjoys one of the planet's balmiest climates. In fact, it holds the Guinness Book record for most consistent temperature, with the mercury hovering around 79–89 degrees Fahrenheit year-round. "People keep asking me, 'When are you going to start your real life?' — basically, 'When are you coming back?' Dr. Triche says. "But my real life feels like other people's vacations. Not that it isn't stressful sometimes, but this is what life should be. Here, people care about spending time with each other; no one cares what kind of car you drive or what clothes you're wearing. It's lovely. It's the pace of life that I enjoy, and it highlights the things I think are important. Every morning, I wake up and see the water and the view, and I know I'm needed. I do the best I can, and I'm learning and growing. So this is better than a vacation."
—Beth Saulnier
This story first appeared in Weill Cornell Medicine, Vol. 15, No.1.