Often, and necessarily so, medical training is highly focused, with relatively few apparent avenues to explore applications beyond clinical practice or academic research. But for several doctors, the AAAS Science & Technology Policy Fellowship (STPF) enabled them to not only branch out, but to bring their medical expertise to bear on human health issues on a global scale.
For Kathleen Fenton, whose determination to become a physician never wavered from a young age—“I never had a plan B,” she quipped—the fellowship came on the heels of more than a decade in Nicaragua working as a pediatric heart surgeon. She is currently serving as a second-year fellow at the National Heart, Lung and Blood Institute (NHLBI) at the National Institutes of Health (NIH).
In Nicaragua, Fenton not only practiced surgery, but also mentored local pediatric heart surgeons to bolster their knowledge and expertise. Often, she said, the lack of experienced surgeons, as well as a lack of medical supplies that hospitals were forced to ask families to pay for, determined which, if any, surgery a child could receive.
She said her NIH placement allows her to work at the intersection of her interests in ethics and policy—specifically, how resource allocation affects healthcare at local, national and international levels. Currently, she is working on a project related to rheumatic heart disease, which causes damage to heart valves following one or more bouts with strep throat that result in rheumatic fever. Children and young adults in developing areas of the world are disproportionately affected—yet a simple course of antibiotics treats the underlying cause.
“It’s almost completely preventable,” Fenton said. “The problem is putting that into practice. We’re trying to figure out how to get people to do what we already know works.”
Amit Chandra also found himself working as a physician abroad, in Botswana, following the conclusion of his medical training. But even throughout his undergraduate studies, with an interest in science for public good and economics, he’d been thinking about ways to join the two seemingly disparate disciplines.
The Millennium Challenge Corporation (MCC), where Chandra served as an STPF 2015-17 Executive Branch Fellow, turned out to be a perfect fit. A relatively new US aid agency, the MCC focuses on projects with partner countries that promote economic growth to reduce poverty. At MCC, Chandra worked on a project in Indonesia to reduce childhood stunting in rural villages through nutrition education and feeding practices, training for local healthcare workers, and community-led sanitation programs. In addition to helping prepare guidelines and training materials for the Indonesian Ministry of Health, Chandra was able to conduct site visits and work directly with local healthcare providers.
Able to pick up shifts as an emergency physician throughout his fellowship and even through to today, Chandra said he sees a great many lessons from abroad that can be applied at home.
“The same issues these countries are dealing with – related to improving healthcare efficiency, quality and equity – are also issues here in the U.S.,” Chandra said. “And there are a lot of innovations coming from countries traditionally thought of as lower- or middle-income, like the use of technology and different approaches to delivering healthcare.”
Anila Jacob also continued her internal medicine practice on the side, as a shift hospitalist, during her time as an STPF fellow at USAID from 2010-12—and she has never stopped practicing. Within USAID’s Office of Forestry and Biodiversity (FAB), Jacob built on interests she developed while pursuing degrees in medicine and public health at Emory University: global environmental change, and the impacts of degraded environments on human health.
“As global ecosystem degradation takes place, people feel the impacts,” Jacob said. “Watersheds are being destroyed, soil quality is declining. Unless we show how important the environment is, we can’t get the broad base of support we need for ecosystem protection.”
While at FAB, Jacob developed a methodology for combining environmental and human health datasets that had never before been cross-referenced—a tactic that is now common in conservation and international healthcare research. Jacob looked at how loss of forest cover in Malawi impacted childhood health and diet (less forest cover equated to negative impacts on diet); and in the Philippines, how proximity to marine protected areas (MPAs) affected children’s diets (those who live closer to protected areas had better diets).
Those two pilot studies led to many more studies looking at linkages between human health and biodiversity, Jacob said. Her medical and public health experience allowed her to introduce the idea of using human health datasets to an environmental audience that wasn’t as familiar with it, she said.
Jacob also credits her time as a fellow with being able to pursue a passion that, initially, seemed destined to be tangential to medicine.
“In this field, we’re told how to go into academia or private practice, but there’s not much exposure for physicians who want to do something related to policy,” Jacob said. “The fellowship is a fabulous way for doctors to pursue passions and interests that there may not otherwise be a direct path for.”