The Stoneman Grant in Action: Dr. Jonathan West reflects on providing cancer care in Saipan 

Jonathan West, MD, MA, found himself inspired to pursue medicine by his father, who is a pediatric oncologist. “I sought a career like his,” West said, “one that was meaningful and presented an opportunity to solve complex, life-threatening problems for others. It is a privilege to address problems for patients that impact their quality of life and ability to interact with the world while also providing life-saving care.” West was born in Boston but spent most of his childhood in the San Francisco Bay area before moving to Southern California for his undergraduate education at the University of California at Santa Barbara and for his medical school education at the University of Southern California.

Bridging global health and specialized care

As a medical student, West met Neils C. Kokot, MD, an expert in transoral robotic surgery and microvascular reconstructive surgery. Kokot was instrumental in West’s decision to pursue otolaryngology and the sub-specialty ofhead and neck surgical oncology, as West came to realize that given his strong interest in oncology and surgery, otolaryngology presented a unique opportunity to satisfy both of these interests. Simultaneously, West also has a passion for global health, and as a medical student, he had the opportunity to help organize free clinics in Tijuana, Mexico through the nonprofit Healing Hearts Across Borders, which has provided medical care to under-resourced communities in Tijuana, Mexico since 2001.
Now a fourth-year medical resident, West has continued to reflect this dedication to global health as a recipient of a grant from the Stoneman Family Global Education Program, which provides funding for one medical resident or fellow per year to pursue an international clinical rotation or global health research project, supporting impactful work around the world. West explained, “As a PGY4 resident, I received the grant to travel to Saipan, a US territory and island of the Commonwealth of the Northern Mariana Islands. I conducted clinical research on long-term quality-of-life and functional outcomes after treatment of advanced betel nut-related oral cavity cancer.” For those who are unfamiliar, the betel nut (also known as the areca nut) is a naturally-occurring psychoactive substance commonly used in the Pacific Islands as well as Southeast Asia. Betel nut chewing is often deeply culturally ingrained and may sometimes have religious significance, but unfortunately it has carcinogenic qualities as well and is associated with a higher risk of oral and esophageal cancers. Daniel Kwon, MD, one of the attending doctors in head and neck surgery, treats a high volume of patients from Saipan with this type of cancer, patients who require specialized tertiary level, multidisciplinary treatment at hospitals like USC. West observed, however, that following surgery and radiation at USC, these patients would return to Saipan and have limited follow-up conversations or care with USC providers. As West noted, “This deficiency in our care prompted Dr. Kwon and me to explore options for a global health trip to follow up on our patients and identify other ways to optimize their care.”

Empowering patients through follow-up care

Receiving a grant from the Stoneman Family Global Education Program gave West the exciting opportunity to design and implement his own global health project, which enabled him to conduct much-needed follow-up on patients treated at USC and to identify actionable changes that could improve their care in the future. “The logistics were quite challenging,” West acknowledged, “given the physical distance (6000 miles) and time difference (17 hours) between LA and Saipan. We began planning with providers in Saipan more than a year in advance and encountered a variety of scheduling issues along the way as we attempted to coordinate clinic visits for these patients that would correspond to the week I was there.”

West ultimately spent a week on the ground in Saipan, seeing patients each day in the clinic who had been treated at USC over the previous four years. He was able to follow up with 23 out of 48 of their patients. “I interviewed them about their experiences, performed physical exams and administered surveys that focused on quality of life, functional status and their ability to speak and swallow. I also spent time shadowing in the clinic and meeting with hospital administration to discuss ways to solidify the clinical and research relationship between USC and their hospital.” West was heartened by the gratitude patients expressed for the fact that a doctor from USC had traveled all the way to their home, and West was able to learn more about their experiences being treated at USC, their lives in Saipan and the ways that they thought the system could be improved. “One notable interaction was with a new patient from Rota, a nearby island, who had recently been diagnosed with buccal cancer [a cancer of the inner lining of the cheeks]. He understandably had a lot of questions about the treatment process and being referred to USC for care. It was rewarding to be able to provide him the reassurance and answers he deserved. Later on, I was fortunate to help with his case at USC, which offered him much-needed provider continuity during his treatment.”

During residency, West has, at times, found it easy to lose sight of the ideals of medicine and why he decided to pursue this field, but participating in international trips has given him a chance to gain a new perspective on his professional values and the US healthcare system while contributing to the field in a tangible way. “This trip solidified why I have a passion for head and neck surgical oncology and will be an experience I reflect upon for years to come,” West said. “I think that even if someone doesn’t incorporate global health into their career, it’s important to have these experiences to be a well-rounded physician who provides high-quality care to patients.” After he finishes his residency, West is thrilled to be pursuing a Head and Neck Oncology and Microvascular Surgery Fellowship at Mount Sinai so that he cancontinue providing these patients with the best care possible.

Speaking more specifically about the grant he received from the Stoneman Family Global Education Program, West gives this advice to potential future applicants: “Do it. It’s a wonderful opportunity to diversify your training and explore an area of otolaryngology that interests you. More importantly, the program offers a chance to make a meaningful contribution to those in need. Don’t hesitate to reach out to me if you have any questions about my experience.”