In the aftermath of the devastating earthquake in Haiti in 2010, doctor-in-training Rachel Bender Ignacio was helping to treat tuberculosis patients in a pop-up ward of tents in Port-au-Prince when cholera struck in the Artibonite valley.
She drove up to volunteer at a hospital, where 1,000 new, severely dehydrated patients were arriving per day.
“The emergency response was like nothing I’d ever been a part of, or was trained to do,” she said. “I don’t think I will ever forget the intensity and trauma of that experience.”
Now, as then, Rachel Bender Ignacio, MD, MPH, has a tendency to serve where and when help is urgently needed.
At Fred Hutchinson Cancer Center, she serves as medical director for the COVID-19 Clinical Research Center, which planned and carried out clinical trials of potential drugs to prevent and treat severe cases.
A physician trained in global health with a master’s degree in epidemiology, she also focuses on HIV/AIDS, as medical director of UW Positive Research, a site of the NIH’s AIDS Clinical Trials Group (ACTG). There she works with local community members to investigate new HIV treatments and potential HIV remission strategies.
Key to proving care in complex, low resource and emergency situations, she said, is not to make “an assessment before you have all the data.” It is guidance that her parents, who are both physicians, instilled in her well before she attended medical school.
"Throughout history, how people care for the marginalized parts of the population and develop cities and their infrastructure is intrinsically tied to who’s in charge and their ethos."
Her parents also provided valuable insights via a cycling trip through Spain and France when Bender Ignacio was still in high school. Together with her brother, they visited sites of cultural import to Judaism, Islam and Christianity. They learned, she said, that “throughout history, how people care for the marginalized parts of the population and develop cities and their infrastructure is intrinsically tied to who’s in charge and their ethos.”
She went on to study Religion and cycle competitively in college. The long-distance rides with her family in Europe, and with her dad near their home in Spokane, Wash., – “insane lengths for a kid”, she said — had prepared her well for both.
Later, while evaluating health services for pregnant women with HIV in Mozambique during medical school, it became clear, she said, that “we can never address HIV without politics, religion, sexism, and understanding people’s conceptions around birth, death, and life events — how it differentially effects marginalized peoples of all kinds and how society cares about marginalized people.
“The complexity of that is what made me know that I wanted to focus on HIV before I even picked a medical sub-specialty.”
Bender Ignacio credits a variety of experiences in high school, college, and medical school for preparing her, mentally and physically, for the demands of work in Haiti in 2010 and 2011, and subsequently for the trauma of COVID-19.
News coverage from Italy in early 2020, where hospitals had begun lining-up green cots for individuals infected with SARS-CoV-2, triggered strong memories of her time in Haiti.
“Again, people were trying to treat hundreds, or thousands, more patients than the clinics and hospitals were set up to do,” she said.
Her experiences in Haiti proved especially valuable as the medical community scrambled to address COVID-19 as it arrived in Seattle.
Bender Ignacio said one of her early contributions was to strip standard aspects of clinical trials that “work just great when you have all the time in the world but aren’t responsive to a pandemic.” By streamlining the process, just eight weeks elapsed between writing the first draft of a research protocol and the arrival of the first patient in a multi-site, randomized trial.
Her leadership role on the board of the HIV Medical Association Board also proved critical as the COVID-19 pandemic unfolded. She advocated for pandemic response funding, infrastructure, and protective gear. Bender Ignacio said it was important to speak out for health care workers and stand up for reproductive rights and LGBTQ rights.
“We consider them both integral and adjacent to being HIV doctors and researchers,” she said.
Her work on the board also helped her to provide rapid feedback on the risk factors amongst people with HIV for getting COVID-19 as well as the predictors of severity of being hospitalized or dying. Along with UW Global Health Assistant professor Adrienne Shapiro, MD, PhD, she co-developed the Infectious Disease Society of America (IDSA) and Centers for Disease Control and Prevention’s Real Time Learning Network guidance on COVID-19 in people with HIV.
Despite the challenges of the epidemics she’s confronted over the past decade, and the disproportionate impact those diseases (and others) have had on marginalized communities, Bender Ignacio sees reasons for optimism. Crises are opportunities for transformation, and battling tuberculosis, cholera, HIV, and COVID-19 have helped bring to the public consciousness, she said, that “racism is a public health crisis - that social determinants of health drive disparities in each of these diseases, and that biomedical research and implementation science need to address gaps in care for those who would benefit most.”
— By Gabe Murphy, May 5, 2023