David Flood's passport tells the story before he does. Page after page, the same stamp: Guatemala. Guatemala, fifty times over, across fifteen years.
Flood, a hospitalist and researcher at the University of Michigan, has spent the better part of his career working alongside Indigenous Mayan communities in Guatemala's highlands — first as a medical student supporting clinical outreach programs, then as a faculty researcher asking how the lessons learned in a small chronic disease clinic might be scaled up to reach the country's 500,000 people living with diabetes. The answer, he found, runs through the Ministry of Health.
His largest research projects are health system strengthening efforts: working with Guatemala's Ministry of Health to improve how hypertension and diabetes are managed at the national level, testing whether the practical, community-based approaches developed through years of on-the-ground work can be rigorously evaluated and scaled. One of those approaches — having nurses manage chronic disease patients using a simple one-page algorithm rather than a hundred-page clinical guideline — is both cheaper and, evidence increasingly suggests, better. Another concept of "polypills" that combine multiple medications into a single dose originated in the Global South and is only now gaining traction in places like the United States.
That bidirectional flow of knowledge is central to how Flood thinks about his work. "Some of the things we do in Guatemala," he says, "I think they just make a lot of sense." He's actively exploring how task-sharing models and simplified care protocols developed in low-resource settings might be applied closer to home — not as a curiosity, but as a genuine improvement on how American medicine manages chronic disease.
What grounds all of it, though, is something harder to put in a grant application. Flood and his wife — who also works in global health, and who he met while volunteering with Partners in Health in Peru — have built a life intertwined with Guatemala's. They've learned to speak Kaqchikel, a Mayan language spoken by about 500,000 indigenous Guatemalans. They know the researchers, the activists, the archaeologists. The Minister of Health is a mentor. When Flood visits, he stops to see friends, holds babies, and eats breakfast made by someone's mom. "The human connection," he says, "is what's kept me really motivated."
That depth of relationship, accumulated over fifteen years in a single place, isn't incidental to the research. It's the infrastructure the research runs on.
