Improving Brain Health Around the World with Farrah Mateen, MD, PhD

• Growing up in Saskatchewan, Canada, and traveling internationally with her family as a child and discovering the profound impact geography and inequality have on health were experiences that inspired her passion for global health.
• Mateen says she took a somewhat unconventional journey into medicine, entering medical school at age 19 in Canada and later training at the Mayo Clinic and Johns Hopkins. She combined neurology with a PhD in international health to answer global questions that she thought more physician-scientists should explore.
• Working with Syrian and Iraqi refugees in Beirut exposed her to the growing burden of neurological disease in humanitarian settings and reshaped her research priorities toward improving care for displaced populations.
• From epilepsy programs in Guinea to collaborations with the WHO and UN Refugee Agency, Mateen says partnerships, local capacity building, and culturally informed care can dramatically improve neurological outcomes.
• In her role at the Havey Institute for Global Health, Mateen is leading the new Center for Global Neurology. She says there is a lot that can be done to improve brain health around the world as new technologies and biomarkers advance.
• Her advice for the next generation of global health leaders is to stay flexible, listen to local needs, and let the communities you serve help shape your work.

[00:00:00] Dr. Robert Murphy: Welcome to the Explore Global Health Podcast. I'm Dr. Rob Murphy, Executive Director of the Havey Institute for Global Health here at Northwestern University Feinberg School of Medicine.

[00:00:21] Dr. Rob Murphy: Today's guest, Dr. Farrah Mateen, has built a career in global neurology, conducting research in more than 30 countries and now leading the Center for Global Neurology here at the Robert J. Havey, MD Institute for Global Health. The center's mission is to improve brain health worldwide through research, education and partnerships across the globe. Alongside her role as director of the center, Dr. Mateen is the Charles L. Mix Research Professor of Neurology at Northwestern University Feinberg School of Medicine, and she's chief of the Division of Multiple Sclerosis and Neuroimmunology. Today, we'll talk about her journey into global health and neurology, from growing up in Saskatchewan, Canada, to working with refugee populations in the Middle East to building a career dedicated to improving neurologic care for people around the world. Dr. Mateen, welcome to the show.

[00:01:10] Dr. Farrah Mateen: Thank you for having me.

[00:01:11] Dr. Rob Murphy: Let's start with your growing up in Saskatchewan, Canada. Tell me what your childhood was like there, and were there any early experiences that you think first piqued your interest in medicine?

[00:01:23] Dr. Farrah Mateen: I was born in Prince Albert, Saskatchewan, which is one of the more northern cities, and I'm an only child.

The longer story is that my mother, who was born in Germany, originally was going to be a flight attendant on Lufthansa. And then she met my father, and she said she wanted to travel. And he said, "Marry me, and we'll travel and our family will travel." So I was fortunate enough to get to travel early in my life, including back to where my father's family was from.

So he was born in India before the partition of India. And so we went back to different parts of the Indian subcontinent to visit some of my family and also got to travel just in general to see different countries, including what's now called low- and middle-income countries, and was really inspired by seeing the major inequities between what I saw in school and what I was seeing when I traveled.

Also, Saskatchewan has a very high proportion of First Nations populations, which in the U.S. would be called American Indian populations. And I started learning about different health outcomes based on where you're from or what race or ethnicity you are. And that started leaving a major impact on me as I was going through my early years.

And I really loved human development, human geography. I always wanted that to be a major. Part, if not my career. And actually medicine came second to that. I wanted medicine to be part of my career in international work.

[00:02:47] Dr. Rob Murphy: Early on in your academic journey you started a biochemistry degree at the University of Saskatchewan, and then made the decision to enter medicine. How did that switch happen? What drove you to that pivot?

[00:02:58] Dr. Farrah Mateen: Yeah, well in the University of Saskatchewan when I was there, you could enter medical school after two years if your grades were high enough. And so after my first year of undergrad, I wrote the mcat. And so people who write the it's the medical college admissions test. And at the time you could only write it twice a year. I think it was April or August. And so I thought I'd write it after my first year and see if I, you know, could swing it. And there's a certain score threshold and I just squeaked in on one of the categories. All the categories have changed now. And so I thought, well, I'll apply. And then I got in. And so I thought, you know, if I don't do medicine then maybe I'll do law school, but I'm gonna give medicine a try first. and maybe if I would've got one more question wrong, we wouldn't be talking, I'd be a lawyer somewhere. But thankfully I passed the MCAT and I got through the interview and medical school admissions then and in Saskatchewan, much different than I see my students applying for now. Now it's like a production, it's many months, but when I was applying, it was very much based on grades and interview and to some extent reference letters. In my interview, I think it was 30 to 40 minutes. And you know, one page essay and there's no secondaries, none of this. Extravaganza that I think students then have to go through now only applied to one medical school, my medical school at University of Saskatchewan. And didn't know what was going on in the US and all the many schools and activities that it takes to get in. So, I, you know, I think I was very lucky in some ways that I was in a place too. To take that opportunity very early in my career. So I entered medical school when I was 19. And I, you know, I'm happy I did. I never actually got an undergraduate degree which I'm sure we'll talk about later because it led to me going to a PhD in public health much later.

[00:04:37] Dr. Rob Murphy: So in 2005. You came to the United States and this was to do a neurology residency at Mayo Clinic. So a where did neurology come in? Why and why Mayo Clinic?

[00:04:49] Dr. Farrah Mateen: I had no intention of ever moving to the United States. At that time I thought I would stay in Canada. And also when I ended up going, I thought it would be temporary, but of course now it's been 20 years plus. So, the story there, which, potentially a public health story, was SARS one, which of course nobody remembers the SARS one virus because SARS two or COVID is such a, you know, dominant factor in society now. But SARS one was its precursor. It was important when I was looking at a residency, and it was more important in the eastern seaboard in Toronto, but they made the decisions about when the Canadian match happened for residency versus the US match. And every year, the Canadian match used to happen first. But my year, which was the years of SARS-1—this precedes Zoom for interviews and selections—the Canadian match happened after the U.S. match, and I happened to have a lot of very good neurology mentors, both in Saskatchewan, but also when I went on elective to Dalhousie and happened to work with multiple people who had trained at the Mayo Clinic. And so when I went to gather my reference letters, one of my mentors said, "Well, why don't you apply to the Mayo Clinic?" And I thought, "Wow, I'll never get in there, but sure, I'll ask if they would take me," because I hadn't written the USMLEs, which is the U.S. precursor exam to get into a U.S. residency. And they said, "You know, we would consider interviewing you if your application's strong enough, even if you haven't written the USMLEs." And so I went down to the Mayo Clinic, my only U.S. interview. I enjoyed it and met a lot of great people. And actually, the Mayo Clinic geographically is not too far from Saskatchewan. It's about a two-hour flight and a lot of driving, but it's as close as Toronto, for example. And I matched there, and then the U.S. match happened first. So I went and then I wrote all my USMLEs very quickly within a few weeks. It was, you know, really exciting. I never thought I would. Get in. And then I got to go to this, you know, world class institution where there were more than 90 neurologists. And in Saskatchewan at the time, there were three academic faculty neurologists. And so the opportunities just opened up in terms of, you know, subspecialties and training. And Saskatchewan has extraordinary neurologists and they're very, very good. But to be a trainee and to have exposure to so many. Different types of neurology and to have exposure to new research. I always wanted to do research. What they didn't do is public health, Rob, but they didn't do global health and they recognized that wasn't something that they were expert in, even though they were expert in everything else in neurology, but. The good news was they said, if we can't offer it here, we will let you do an elective or we will let you pursue that and support you in your career interest. And I was very lucky at that time that Mayo, basically self-identified as saying, this is not our expertise, but we want you to, to succeed and spend your time doing what you think you're gonna do for your career. And I don't know that institutions have that same flexibility as they used to, but I really benefited from it back then.

[00:07:42] Dr. Rob Murphy: After your residency, you went to Johns Hopkins for a neuroimmunology fellowship. And the PhD in international health at the Bloomberg School of Public Health. What was the vision you were trying to create for yourself during this time?

[00:07:56] Dr. Farrah Mateen: Yeah, and I would mention a very important little piece that was in the middle or sort of contemporaneous with my residency was a fellowship in ethics, which happened to be at Harvard Medical School. I did it during my residency and at the time I worked with Amartya Sen, who is a development economist. This is part of the electives that you could do if Mayo couldn't offer global public health. And so at that time, I got to spend time with Amartya in Cambridge and learned some of the more human development and human public health economics. And was lucky to have that as a counterpoint to my medical training. And so when I went to decide what I wanted to do next, I always thought I'd do an MPH because in Canada the residency for neurology is five years, but in the US the residency's four years. So I thought I'd do four years plus an MPH, it would be efficient, I'd be done in the same time. And then people started asking me, what do you want to do the master's for? And I said, well, I want to do research. And they said, well, you're not gonna get to do too much research in a master's. Why don't you consider a PhD? And then going all the way back to the fact that I hadn't had an undergraduate degree and there's so many classes I didn't get to take because I started medical school so early, I really wanted to have time to do research and learn from people in a more liberal fashion. And so the idea at that time I was a finished, sort of graduated neurologist, was to do neurology and global public health and to do all those things that I thought hadn't been done, humanitarian emergencies and neurology, and talk about, you know, access to diagnostics and even. What is a neurologist like? What's the definition of a neurologist? How many neurologists are out there? Where are the training programs like mapping, epidemiology? All of that was very important to me at the time, and people were doing work in different areas, but my experience was that everybody extrapolated from what they were doing. Particular place and making it a global situation. I thought, well, we don't really know what's going on globally in neurology, so let's do more work on this. And so I was fortunate to work with Bob Black at Hopkins as my PhD advisor. I was, you know, a Canadian citizen and I had all these visa issues because I'd been in the US for so many years at that point. And nobody wanted to touch the complicated neurologist from Canada who wanted to do global health. And Bob, as many people may know, is a diarrhea and zinc and child health expert. I've been an adult neurologist by this time. And so, he was kind enough and generous enough with his time to really mentor me in public health related to neurology, even though he had said he spent two weeks in a neurology elective as a medical student. And that was his extent of neurology. Neurology at that time, I really wanted somebody who could teach me public health, not necessarily neurology.

[00:10:33] Dr. Rob Murphy: In late 2010, you went to Beirut to consult on chronic disorders and refugees for a humanitarian organization. You've said that experience really changed your total perspective. What did you see there that ultimately altered the trajectory of your career path?

[00:10:50] Dr. Farrah Mateen: What I realized was, well, first of all, the world is changing from a neurology standpoint. All the literature we had was about very low-income, tropical, very young populations, and in Beirut, where I was working with Caritas, an NGO at the time, there's a middle-aged population with chronic disease. It was also a real lesson in flexibility. So originally, I was trying to work in Syria with Iraqi refugees, and then the Syrian crisis happened around exactly that time, and I went to Beirut to work with Syrian and Iraqi refugees. And the desperation is still memorable even to this day—you know, people who are really in a humanitarian disaster but also had neurological disease and a variety of other diseases. And Gil Burnham, who was at Hopkins at the time and is emeritus now, set me up with this. He remains a real intrepid pioneer in humanitarian emergencies, but there was never a lot of neurology being researched. And he's like, "Yeah, that's a great idea." You know, he tried to give me those connections. And so I started working with the UN High Commissioner for Refugees, which was also based in Beirut, and then continued to work with them later in Amman, Jordan. And there, there aren't neurologists in that setting really from the humanitarian agency perspective. So I started trying to work with engineers and other people who are collecting data. So I was able to both meet many people and then also do epidemiological research. As well as eventually provide some recommendations for their care. And so that for me is very inspiring and really makes me still very interested to this day to think about how we can improve the situation for people really living with neurological disorders. There's more to think about there. You know, some people who have neurological disorders never get to be a refugee. They don't have the capacity to travel, either they're poor, they're immobile, et cetera. Other people get neurological disorders along the way. And then there's also the incidence of new neurological disorders as people age. But there's a lot of, you know, head trauma. There's a lot of spinal cord trauma. I got to see this in real time. And then also the, you know, the chronic manifestations, epilepsy, if you know, even just neuro, pediatric, birth related injuries and a lot of things that are both preventable and treatable.

[00:13:01] Dr. Rob Murphy: Through your work with the WHO and the UN Refugee Agency based in Beirut and all your partners around the world, you've now worked in more than 30 countries. What has that global experience taught you about the biggest barriers to neurologic care globally?

[00:13:17] Dr. Farrah Mateen: Well, I've been first of all, very fortunate to be sort of welcomed into so many different settings by so many different people and that has really enriched my career, but also my life. And what I realized is some of the problems are very universal. The. Engagement for neurological disorders, the investment in neurological disorders, the suffering, all of those things are, you know, generally felt across many countries. And you know, there's different health systems approaches. And so I started thinking more and more about why some people do well and some people don't do well. Who do we never hear from? A lot of our literature in neurology, almost all of it comes from very wealthy places. We're always getting the best practices. But then the other side of things is like, what are the minimum standards or what are the humanitarian needs? Like what is a human right in terms of, you know, brain health is what we call it now. And so a lot of the, you know, a lot of places have no neurologists. There's one person struggling to provide care. It might be a psychiatrist, might be a generalist who's taken up this torch. And now we're lucky that some people can connect with each other in like, south south collaborations or we have better partnerships, but, you know, there's a lot of neurological disease, first of all, everywhere. It's one of the leading causes of morbidity and mortality. And a lot of it is really addressable. So one of the most important parts for me is that there are things to be done. So I feel like some problems in the US healthcare system are not fixable. Um, they're going to take, you know, many careers, but some problems in lower income countries are fixable. Much less time, money and people. And so, you know, I felt like these are problems that we could definitely fix, and I find that's true across many different countries.

[00:14:57] Dr. Rob Murphy: Tell me a little bit about your project in Guinea Con Creek. I have a particular interest in West Africa. I've been to Guinea Conakry. We tried to do a project together with them but I've been in Burkin, Faso, and Mali, Senegal, Nigeria, Ghana. Tell me a little bit more about your project there.

[00:15:13] Dr. Farrah Mateen: So, I've been to Guinea now probably more than 20 times, and so I started working there in 2017. And the most common question I get besides where is Guinea, so it's in, as you said, west Africa is, why did I start going there? And so I started working originally in Asia, in Bhutan, doing work on epilepsy and smartphone, EEG and epilepsy outcomes. And then a Guinean neurologist who was on a fellowship in Belgium named Aba Foday Sii, And he said, would you come to Guinea and try to do the project with me in Guinea? And I said Sure, you know, I will come and try it and let's meet and see what happens. And I got there. I was very impressed both by the huge demand of patients and also the opportunity to help, but also the culture and the organization of a boss who's a great collaborator and the warmth of West Africa, which I'm sure you can relate to. And the need and just trying to think about how we can help deliver epilepsy care. So originally I came thinking we're going to help diagnose with EEGs and the demand. We were trying to enroll, I think 150 people, and people started lining up at midnight. To be the first patient at 8:00 AM because there just wasn't much neurology, there wasn't very much access to care. And by the time I got there you know, they were already, you know, sleeping at the door and we couldn't even see all the people. I can tell you the most number of patients with epilepsy I've seen in a day of 73, but I was way too many. And so, there are thousands and thousands of untreated people with epilepsy in Guinea, and it is humbling.

To think about, we can offer our services to a very small fraction and comment on a small fraction. Over time, we've done more work with traditional healers who are the first point of care for people with neurological disorders. Similar to the polio days when uh, polio became eradicated. Many countries through the collaboration with traditional healers.

Guinea is a very strong network of traditional healers who've been there for thousands of years, and I always remember Neurology's been around for about 200 years. Five neurologists. So we have to be sort of humble in this approach.

[00:17:18] Dr. Rob Murphy: Before coming to Northwestern last year, you spent 12 years on the faculty at Massachusetts General Hospital, also called MGH and which is part of the Harvard Medical School system.

You were building the Global Neurology Research Group. Looking back, what were the most important lessons from that chapter of your career?

[00:17:37] Dr. Farrah Mateen: Yeah, no. First of all, my most important listen was that it matters where you try to build your research team. And that's particularly true in the US even more so. So I was lucky to be hired by Mari Kovich, who was the chair. She was a new chair, and at the time she went to the department and said, what do we not have that we want? And thank God the residents and fellows said, we want global neurology. Otherwise I probably wouldn't have a job at Mass General and she was willing to take a risk on it and me. And so having the support of your chair in my case, or if you're a resident, your program director, and you know, replace that position no matter where you are in your training or career, is really important because there are, as you know, well, peaks and valleys and global health funding and what you're able to do, what the sentiment is. Where are the cash flows and just thinking about whether you need to sustain a career across all those peaks and valleys. So that was my first lesson. The second lesson was the importance of students and trainees and their excellence and their passion really keeps me going. And, you know, I'm never impressed by, you know, the quality of work coming out of the students that I had at MGH. There's some really important young people who wanna take on this task of global neurology. And there were more than I could take on as a mentor. So one of the things I learned over time is you can't mentor everybody, unfortunately, particularly in a very narrow intersection. So there aren't a lot of global neurologists you might imagine. There's like a handful of us um, who really do this with their careers and particularly who do research. And so, having really important trainees is essential to a really thriving research program in my opinion.

[00:19:15] Dr. Rob Murphy: Your experience is very similar to the overall global health experience at Northwestern and many other institutions. The interest really came from the students. Students and residents wanted a global experience. We had over 50% of our medical students doing some kind of international elective. Very little infrastructure or oversight or anything. And it just highlighted the need in the education program. And that's the primary reason why we had a Center for Global Health. And now we have the Institute for Global Health.

[00:19:49] Dr. Farrah Mateen: No, I would agree with that because students know what they want to do with their career and they want high quality experiences, right? So they want to be mentored to do important projects, not just projects. And also, I think the institution has a responsibility to think about the host countries and make sure that they're. Benefiting from having these exchanges. And so, one of the tasks as a faculty member was to make sure that Guinea, in this case and Bhutan before them, was also getting something out of the work and the projects and that their own human capacity was being built in the hospital or in the field.

[00:20:25] Dr. Rob Murphy: Here at Northwestern, you're chief of the Multiple Sclerosis and Neuroimmunology division and director of the New Center for Global Neurology at the Habe Institute. What excites you most about leading these centers?

[00:20:38] Dr. Farrah Mateen: First of all, I'm thrilled to be here and I've loved my time. I started in September and it's been under a year, but I'm just, I'm having a great time and never felt more supported among a group of really enthusiastic colleagues. So, the first I'd say multiple sclerosis known neurology goes way back to my early days growing up in Saskatchewan. So many people know that MS has a latitudinal gradient for reasons that are partly known and partly unknown, but the north around the poles has more multiple sclerosis. So when I was a medical student, I was very inspired by diagnostic fields. Importantly neurology. And to be the sort of division head of multiple sclerosis in our immunology allows me to have more influence in this field, which is what inspired me into neurology. In global neurology, which I think now intersects with ms. When I started both of these, they were parallel in trust, parallel careers, even competing interests and careers. And now the world is changing enough that you can do point of care diagnostics for neuroimmunology or you can do. Portable brain imaging, or you can do guidelines for MS or even clinical trials for treatments and related disorders. So, um. This is a really great time to be in neuroimmunology, which is a very emerging field. We have, you know, 30 treatments in our field and also in global neurology where there is a need for those treatments and that expertise. So it took a long time for people to get sort of on board that these could intersect. But I think it's happening now to be able to be a global neurologist. To sort of organize that for the whole department across all the different specialties is really special. And it is probably worth mentioning that neurological disorders are a leading cause of death and disability across all age groups and are overall neglected compared to their burden. And so we have across the department, stroke, epilepsy, brain tumors, meningitis, traumas. There's so much to be done and just to put it together and start to figure out how we're gonna organize and prioritize is the next step.

[00:22:33] Dr. Rob Murphy: you've just mentioned this, Global neurology center projects. Range, as you said, epilepsy care in Guinea stroke research in Nigeria neuroimmunology and neuro infectious diseases, including long COVID. What's the common thread that connects all these efforts?

[00:22:50] Dr. Farrah Mateen: There are points of intervention there. Definitely capacity to be built. So some of the projects you mentioned have a primary capacity building goal to educate and to train people on diseases that have traditionally been considered more high income or more sophisticated diseases. The other side is that we have new technologies to identify how to treat these diseases or, or measure these diseases better. So for example, the cerebral malaria project is. You know, we're talking about new biomarkers for diseases that have been around for centuries, and so thinking about the advances in the medical field and applying them to brain disorders is the most important. But a lot of this is based on new technologies, new biomarkers, new measurements.

[00:23:33] Dr. Rob Murphy: I have one final question for you today, Dr. Matine. I ask every one of the guests of the show, what advice do you have for young people who are now just embarking or wanting to embark on a career in global health?

[00:23:46] Dr. Farrah Mateen: be flexible and also have a backup plan, to be honest with you. So, um, it's probably not the most optimistic, but I think there are times in your career when global health is going to thrive and soar and they're gonna be times when it's gonna be very hard. And so, the people who really have a major passion, who are willing to roll with all the punches, I think you will succeed. But it is a very difficult career in neurology and global health, and you have to really be able to be diversified in what you are studying and to be willing to be flexible. So, for example, some of my projects are, you know, pediatric epilepsy. I'm, I never mentioned, an epileptologist and I'm not a pediatrician. But there's certain things that are important to the field that you may not be. The biggest expert in the US but you might actually be the biggest expert in global health and thinking about how you can contribute. And the other side of this is also to respond to the needs of the country that you're working in or the location that you're working in, and not just to go in with your own agenda. And so, my best example is originally I wanted to do my PhD in public health and. Meningitis and I were going to do it in Bangladesh, and there were 12 cases of meningitis in the registry that we were looking at, and there were 1,250 cases of stroke. And I thought, well, what is the need for the population? It was a stroke at that time and like I could go in with my interest and not that meningitis is not important. It really is. But I could go with my interest and try to. You know, make that their priority or I could go in with their priority and make that my research. And I ended up with the latter trying to meet people where they were in terms of what they needed done and what could help them. And I think that was an important lesson early on that I might find something really strategic and important. But if the population itself doesn't, or if the people there are telling me there's a different need to also be responsive and interested in that.

[00:25:36] Dr. Rob Murphy: Farrah Mateen, thank you very much for joining me today on this podcast. And thank you for your wonderful advice and telling us all about your exciting history and how you got where you are today. Thank you very much.

[00:25:49] Dr. Farrah Mateen: It's an honor, Rob. Thank you so much.

[00:25:51] Dr. Rob Murphy: Follow us on Apple Podcasts or wherever you listen to podcasts, to hear the latest episodes and join our community that is dedicated to making a lasting positive impact on global health.