SEQUINS Hall of Fame: Gretchen Birbeck, MD, MPH, on Global Neurology and Equity

The Society for Equity in Neuroscience (SEQUINS) has increasingly become a leading platform for conversations around disparities in neurologic care, workforce diversity, and strategies to improve equity across clinical practice and research. As part of its upcoming annual meeting, the organization recognized several leaders in the field through its Hall of Fame program, honoring individuals whose careers have shaped efforts to improve access and outcomes in neuroscience.

Among this year’s honorees is Gretchen L. Birbeck, MD, MPH, the Edward A. and Alma Vollersten Rykenboer Professor in Neurology and Research Director of the Epilepsy Division at the University of Rochester School of Medicine. For more than 3 decades, Birbeck has conducted clinical care and research in sub-Saharan Africa, primarily in Zambia, where she continues to lead epilepsy care initiatives at Chikankata Hospital in the country’s rural Southern Province. Her work has focused on neurologic disorders in resource-limited settings, with research spanning epilepsy-associated stigma, neurologic morbidity, health services, and interventions aimed at improving outcomes for underserved populations.

In a recent Q&A with NeurologyLive^®, Birbeck reflected on being named a SEQUINS Hall of Famer, her longstanding work in Zambia, and the broader evolution of neurologic care equity worldwide. She also discussed lessons learned from practicing in resource-limited environments and the importance of ensuring access and equity remain central as neurology enters an era of increasingly advanced therapeutics.

NeurologyLive: What does it mean to you to be named a SEQUINS Hall of Famer?

Gretchen Birbeck, MD, MPH: It is such an honor to be named. I wear a lot of hats—neurologist, clinical trialist, epidemiologist, administrator, educator, etc. The common thread that I hope is consistent across all of these roles is my goal of ‘raising the floor’ where care and outcomes are suboptimal. Being named as a Hall of Famer reassures me that this common thread is not imagined, even if the connection between what I am doing on a day-to-day basis doesn’t always highlight this foundational value.

What initially drew you to neurology and global health, and how have those interests shaped your career?

My love for neurology came during my premedical undergraduate studies at Indiana University when I discovered that in Biology class, I would be dissecting worms but in the Neurosciences classes offered through the Department of Psychology I would be learning about neurotransmitters in humans. The human neurotransmitters won my interest, hands down. It wasn’t much of a contest.

My path to global health was a bit more circuitous. I was in medical school in the early 1990’s and ‘global health’ as we know it today really wasn’t a thing. This was before PEPFAR and all the global engagement in the healthcare arena that followed.

Physicians from the US who went to Africa to work were almost exclusively missionaries at faith-based institutions. I landed in Zambia for the first time in my final year of medical school having organized the rotation with some difficulty. But I wasn’t there based upon any interest in global health. I was there because I wanted to see how a physician could practice medicine when there wasn’t an MRI machine down the hall. Having grown up in a very remote, medically underserved area, I could not connect my medical school experience at the University of Chicago with my personal insights into how far removed from advanced medical care many people are. The international rotation was possible because one of the graduates of my medical school ~5 years ahead of me was the senior medical officer at this large bush hospital. So, I went with curiosity and a fairly single-minded purpose for what was supposed to be a 6-week experience. What I was rather astonished to realize was that THIS was where I was meant to be working. I stayed for 12 weeks and barely made it back to Chicago for graduation. Thirty-two years later, I still have an epilepsy clinic at that hospital, Chikankata Hospital in Mazabuka, Zambia.

Much of your work has focused on neurologic care in resource-limited settings—what have been the most impactful lessons from that experience?

A deep respect and appreciation for the knowledge, insights, capacity and resiliency of people that usually get labeled as ‘vulnerable’. This isn’t to say they are not vulnerable—but that label can also be very disempowering and dismissive. Most of the foundational lessons I have learned about how to be a better physician, researcher, educator and human has come from working closely with people who are disadvantaged in some fundamental way.

How have you seen disparities in neurologic care evolve over time, particularly in epilepsy and stroke care globally?

Yes. As private services within Zambia have improved and expanded and concierge care in India has become accessible to those with insurance or some resources, the care for this population has greatly improved and is probably comparable to that of an insured American in at least a modest-sized US city. Unfortunately, the neurological care for the average Zambian didn’t budge much UNTIL the past 2-3 years.

Founded by neurologist Dr. Deanna Saylor of UNC, Zambia’s University Teaching Hospital (UTH) started a Neurology Residency Training Program about 8 years ago. The trainees and training are excellent. The initial goal was to retain the first cohort or two of trainees at UTH so they could take over leadership of the program and make it sustainable and not dependent upon neurologists from high income countries. But about 3 years ago, UTH trained neurologists started getting placed in District hospitals throughout the country. It is transforming care and access to advanced services. They are not only excellent clinicians, but they are amazing advocates for their patients navigating and negotiating what is needed including transport and transfer to UTH when indicated. UTH has recently opened a stroke center with multidisciplinary care and thrombolytics! Watching this ongoing transformation is one of the most satisfying experiences of my career.

What are the most important steps the field must take to improve access and equity in neurologic care moving forward?

There is so much excitement and enthusiasm for the phenomenal advances being made in neurotherapeutics and the emerging potential of precision medicine. Without diminishing this positive energy, we have to assure that access and equity issues are positioned front and center with policy makers, administrators, and providers. Advocacy and research aimed at elucidating insights into issues of access and equity must expand in step with neurotherapeutic advances. Otherwise, disparities will only worsen.

Transcript edited for clarity.