Simple, but Powerful Medicines: Patience, Listening and Trust

By the end of my time at Davidson, I had become so accustomed to immediate results. After a long evening session in the library, elegant graphs, lengthy Spanish sentences, and even chapters of my thesis would appear before my eyes. It was so satisfying to see my ideas and efforts rapidly crystallize into a tangible product (a metaphor for my organic chemistry professor, Dr. Stevens).

Thus, when I first began my fellowship at Mountain Area Health Education Center (MAHEC), I myopically assumed that I would instantly see “results” in all of my projects. I thought to myself, “I am going to make a radical impact, immediately”. How idealistic of me! My sense of time was completely skewed. It can be very difficult to change an individual, a community, a culture or a system. Difficult, but still possible. Through both my research and clinical roles at MAHEC, I have learned to embrace my work with a new sense of patience.

As a research fellow, I am involved in two projects. One project is a community education program for long-acting birth control, which aims to reduce unintended pregnancies in two surrounding rural counties in western North Carolina. Since the topic of birth control can be controversial, we recruited 15 local community members to help us design a culturally-sensitive birth control message and figure out appropriate ways to spread it. Although designing our own campaign is much more time-intensive than distributing existing posters from an established birth control campaign, our thoughtful approach will hopefully have a long-term impact because we are developing a culturally-specific message that will actually resonate with the people in our target communities. This project has shown me the vital importance of patience. My other main research project is a study on childhood trauma and the social determinants of health. I appreciate this research project because it has enhanced my understanding of the psychosocial factors and human behaviors that affect health.

As a community health worker, I get to apply what I’ve learned in my research and address some of these psychosocial factors and behaviors with actual patients. In essence, I help patients follow their treatment plans and engage in behaviors that positively impact their health. Helping patients adopt a healthy behavior, such as eating a more nutritious diet or quitting smoking, usually entails changing a deeply ingrained unhealthy habit. This aspect of my work has tested my patience in a new way. It may be one of the most challenging things I’ve ever done, given that humans are creatures of habit. During the first few months of my fellowship, I felt frustrated. I kept asking myself: “Why am I not seeing results? How do I motivate my patients to change their behaviors? Where does motivation even come from?”  I contemplated this last question for a while. When I asked Cathy, my wonderful boss and mentor, for advice, she encouraged me to take time to learn more about my patients’ interests, activities, goals and dreams. So, I started listening.

I learned about my patients’ lives. I listened to their stories. I learned what brings them joy and meaning. Although listening seems like a simple task, I have found it to be one of the most crucial clinical skills. After learning what things are important to to my patients, I am more effective in helping them adopt healthier behaviors because I can encourage and motivate them in a personalized way. This approach requires more time and patience, but it’s worth it. Additionally, I have observed a powerful side effect of listening — it builds trust; it demonstrates to patients that I am invested in their stories, instead of merely being interested in their medical progress.

I am especially grateful for my impact fellowship because it has enabled me to understand these lessons before I enter medical school and begin my career as a physician. In my medical school personal statement, I wrote the following sentence: “I grasped the power of listening and the importance of making patients feel heard.” From my work at MAHEC, I have learned that it is so crucial to not only listen, but also to make patients feel heard, recognized and validated; to bring compassion and to be really present with patients in the midst of their vulnerability, pain and illness. That is how a lot of the healing happens. Listening, trust and compassion are some of the most powerful medicines I’ve seen.

Adversity Against Adversity

When I walked through the doors of the Education building at MAHEC, I wasn’t sure what to expect. I had never done an employee orientation of any kind before. ‘It’ll just be an extended series of PowerPoint presentations… right?’ Well, little did I know that said presentations would have such a great impact on my future goals. The very first presentation focused on the mission, values, and structure of MAHEC and began with one phrase – Your Doctor. Your Teacher. Your Advocate. Contemplating these words over a matter of weeks struck me sufficiently enough to lead me to shred my first medical school personal statement and write something entirely new – a piece largely influenced by this simple statement. Yes, really… the root of my motivation to go to school for yet another 4 years had transformed by observing the essence of this statement first-hand every day.

My very first day of actual work began with a 2-hour discussion with Dr. Letson, my supervisor, and former Davidson Impact Fellow/new MAHEC employee, Cate Hendren. We went from Medicaid expansion to neonatal abstinence syndrome, then to the unique academic life at Davidson, off to ‘best-practice’ pun delivery techniques, back to Dr. Rishi Manchanda and upstream medicine… and back again. Needless to say, it was a relaxed and friendly conversation on the surface. But I’m sure my new colleagues could see the whirlwind behind my eyes, as though I was literally screaming, “There is so much to be done! Where could I possibly begin?!?!” Even now – three months in – narrowing my focus has not helped much in the complexity of these important problems. What has helped is meeting people who have dedicated their lifelong careers to trying. How do we end sexual assault for good? Completely eradicate the rampant spread of HIV in the Southern U.S.? Find a sustainable and effective way to close the health outcome gap between races and ethnicities? Well. You simply start by trying.

In my opinion, I am meeting the most extraordinary people this nation has to offer. A woman who goes to work to raise money for Planned Parenthood, knowing she will likely be met by an adamant pro-life protestor. A man living with HIV who leads community engagement to ensure access to medicine and frequent rapid testing to stop the cycle of transmission. A health system innovator who says that her work is informed by her deepest personal values. Almost every day, I meet a new person who inspires me to consider the breadth of what I could do as a Davidson Impact Fellow and (fingers crossed) as a future primary care physician. Instead of simply being a doctor, why not be a doctor AND teacher AND advocate each time I enter an exam room? Holding the responsibility of charting symptoms and advising treatments was never my dream job – it has always been more than that. I want to make people healthier and sustain healthy states, not merely cover-up symptoms. Most will need medications. Others will require knowledge on how to manage their chronic illness. And every patient deserves an advocate who will stand in their place in front of the legislator, the landlord, or the peer physician when their voice is being silenced.

I am exciting about my current projects and initiatives here at MAHEC and beyond as an advocate for women’s and children’s health and well-being. And I could not be more grateful that this opportunity has directly informed my future as a primary care physician.

Matching Idealism with Pragmatism: Working towards a Healthier Tanzania

Over 7,000 miles away from Tanzania’s Lake Zone is a different sort of jungle—New York City. While Touch’s in-country team executes and manages our projects in East Africa, I support the development, implementation, and evaluation of the organization’s communication plan from Touch’s New York office. Established in 2004, the Touch Foundation works to improve Tanzania’s quality and quantity of healthcare workers, optimize their deployment and retention, and enhance the healthcare delivery mechanisms in which they work.

I worked with a lot of nonprofits during my four years at Davidson. What drew me to Touch was its commitment to sustainable impact and emphasis on local collaboration and ownership. Our projects are designed from careful needs-based analyses and executed with the expectation that Touch will eventually transition them to Tanzanian management, empowering our Tanzanian partners and ensuring the vitality of Touch’s work. Touch embodies a sense of idealism matched with a pragmatism that channeled the many Exit 30 discussions had on effective service and international development. This isn’t entirely coincidental as a fellow Wildcat, Lowell L. Bryan ‘68, founded and leads Touch as its president. This now a warrants a shout-out to Dr. Steve Justus ‘78, Touch’s Chief Medical Officer and Senior Vice President and Hannah English ’12, Touch’s Development Manager. Adjusting to post-grad/city life wasn’t too bad as you can now see.

Working from New York has also enabled me to obtain a greater grasp at nonprofit development, i.e., the fundraising elements of nonprofits. It certainly spans far beyond throwing annual galas and generating appeals. Development is a giant undertaking an an integral component of a nonprofit organization. It encompasses donor management to ensuring funds are raised, responsibly spent, tracked, and reported. What repeatedly overwhelms me most about the process is learning how many organizations there are working on healthcare in Africa. What makes Touch worthy of donor contributions among the tens of dozens of organizations doing great work?

But then I step back. I think about our approach. It’s a single country focus and while not as “sexy” as rolling out a map with project dots emblazoned across four continents, it’s what makes Touch effective. International development takes time. There are relationships to build and success is contingent upon a community’s specific dynamics and institutions in place. We’re here for the long-term and when we leave it’s because Tanzania is ready for us to leave. Such realizations make me even more proud to be part of such a dedicated and reflective team.

I know this will increasingly be the case when I experience and contribute to our on-the-ground work firsthand–and it looks like this will happen sooner than later. Vaccination appointments set and flights are booked! Just in time to escape New York’s painfully cold weather too.