travels

I’m not sure I’ll ever be able to describe the experiences I had when I was away. People talk about traveling, and the impact it has on your life, and you don’t believe them until you actually have that transformation yourself. You grow up in the comfort of your own country with people that mostly look like you and act like you. For my personal childhood, these people were pretty homogenous to me – in appearance and ideology. When I went to college I realized how much I appreciated learning from other cultures and from people that think differently than myself; I adored meeting those people and developed an appreciation for our differences. This December, I seriously sat down with my dad and asked if I could travel abroad for a Maymester. Going out of the country, admittedly, scared me. After some convincing and coercing, I was given blessings to go to Ireland and England. I would be studying public health of three countries and was ecstatic to learn of an area of healthcare I was less familiar with. The spring semester came with its challenges of exams, family life, a new research job, and college in general but before long I had finished my second year of college and was packing to travel across the pond. I can admit that I really had no idea what I was getting myself into – and that is part of the beauty of it all.

It is overwhelming to think of how to write about my experiences. I couldn’t possibly try to start from the beginning to the end, and I’m kicking myself for not keeping a journal going throughout my journey abroad. Truthfully though, I was going pretty much nonstop and would cherish the few hours of sleep I would get each night. I didn’t find time to write. When I think about what I learned on this trip, so much comes to mind. I’ve decided to just write of my experiences as I think of them – so my first one is below!

I feel very deeply that my experiences abroad will make me a better future doctor. Public health is concerned with the health of the masses – not the privileged, or the wealthy, or the exceptional, but of every man and every woman that is deserving of health. A public health perspective is not focused on individual treatment but on ensuring health opportunity for every person. This means that the woman in poverty with a newborn child is just as deserving of health as the wealthy businessman with a nice sportscar. On the first three days of our trip, I learned about the public health infrastructure in the United States, Tennessee, and Nashville. The Commissioner of Health for Tennessee spoke with passion about healthcare for all, not just in the states, but globally. He spoke of not just improving health but health equity. I learned of government programs that aim to improve the health of vulnerable populations – women with children, the impoverished, elderly people, people in rural populations. I observed with excitement the earnest desire that our public health professionals have to alleviate disease and illness and ensure health for all people. I walked the streets of Nashville with a nonprofit organization and talked to people living in homelessness – people I had often passed. I learned of how homeless people are even more susceptible to mental and physical disease than those that have a place to rest their heads. My heart became more compassionate, more understanding, and more heartbroken for the lack of systems we have to care for people that need it most. I thought of how homeless people were stigmatized and criminalized. What I realized most was my own attitude towards them. People – despite color, wealth, social status, illness, or any other factors – are just people at their core. They share the same anatomy, the same biochemistry happening inside their bodies, the same capacity for illness, the same emotional vulnerabilities. People are people, and sometimes as a society, we don’t treat them that way. People are stigmatized for mental illnesses, HIV/AIDS or other STIs, disabilities, and a menagerie of other diseases. In my own country, I noted these discrepancies. As I traveled overseas, I had lectures on public health in the UK and in Ireland. The same problems exist elsewhere, but I do feel these countries have developed more inclusive health systems. Without getting into the (complicated) details of the healthcare systems across the pond, the UK has a single-payer system that is funded through tax dollars and offers coverage to all citizens. The UK also ranks #1 among healthcare delivery, accessibility, quality, and timeliness; unfortunately, they rank second-to-last in health outcomes (second only to the United States). So, of course, the UK has its problems in improving the health of populations but at least has developed a sophisticated and inclusive (for the most part) healthcare system. Ireland has a much more convoluted healthcare system that has a public component where all citizens get a medical card they use to get public healthcare, and a private component where paying citizens can get private insurance and faster healthcare services. Interestingly, the public healthcare services are more desired than the private because of more extensive expertise in the public hospitals. Nonetheless, all of this healthcare talk is really exciting to me and something I want to be more involved in but probably boring for everyone else… The culmination of my experiences abroad lead me to realize that whether or not you believe healthcare is a right or a privilege – you have to believe that health is a right. Every person is entitled to living a healthy, happy life, free of disease and illness, free of disability, and free of pain. The unfortunate truth is that many people don’t live lives that way now and may never live that way. In my future practice as a doctor, I hope to work to ensure my patients have the best medical care with their optimized health always in my mind. I will value my patients as people with equality and integrity – no matter their race, background, income, homelessness, religious belief, or language barriers. I learned much more on my trip (like where the best pubs are in Ireland and where to get the best Americano in London) but of course this was the important, overarching theme that I wanted to write about first. I will forever be thankful for my travels abroad and hope to write of (perhaps more exciting?) experiences soon!

mentality

There’s an epidemic coursing through America, silently capturing the lives of many people. It leaves them internally harmed and demoralized. It is stigmatized, looked down upon, and often viewed as unacceptable. I am personally responsible for contributing to the growth of this problem. But sometimes, life has a way of exposing you to situations and people that will dramatically change your perspective. This happened to me, and I feel obliged to correct my previous ways by being a voice for those experiencing this silent killer.  We can treat it with awareness, compassion, and support. I boldly stand behind the notion that these illnesses are real problems that need real solutions. I want to be a part of a system and country that seeks to address awareness and answers. I refuse to continue being a part of the problem. There’s an epidemic coursing through America, and it’s called depression and anxiety.

As an aspiring physician, I hope to treat patients holistically and with a purely patient-centered focus one day. I am particularly interested in heart diseases. Who knows what type of physician I will become, but I find it fascinating the heart is uniquely connected to other body systems and plays a fundamental role in regulating normal functions. If a patient presented to me with symptoms of cardiovascular disease, I would certainly identify the origin of the problem and seek to address it with a canon of treatment options. It would be absurd to think that physicians would allow their patients to carry around undisclosed symptoms due to fear. If a patient came to me and failed to mention severe chest pain, it would greatly alter the course of treatment and would likely lead to poor outcomes for that patient. Why is it then, when a patient presents with a mental disorder they often feel restricted or discouraged to tell their family members and physicians? Like our hearts, kidneys, lungs, and immune system, alterations in the mind can lead to a “sick” mental state as well. These problems are real. I was someone who paid little attention to mental disorders before this summer. I don’t really know why there was a disconnect for me, but I do know that I wasn’t convinced that mental disorders were real. It gives me great shame to say that. We as individuals, communities, and a country must seek to understand the needs of patients with mental disorders and try to alleviate the deeply rooted stigmas these individuals are faced with.

From a humanistic standpoint, I previously thought anxiety and depression could be controlled and cured by an individual person. A lack of willpower, I suppose, would cause a person to suffer from chronic mental illness. I am revealing these very derogatory  ways of previously thinking to illustrate what I believe to be a common theme throughout American opinion; however, from a purely scientific standpoint, a chemical imbalance in the mind cannot be controlled by individuals. Chemicals, specifically these types called neurotransmitters, control so many of our regular processes in the mind and ultimately throughout the rest of our bodies. A deficiency or over-production of certain neurotransmitters can wreak havoc on a person’s homeostatic levels of these chemicals and can lead to subsequent pathway activation or inhibition. I am not a brain biochemist, and I’m certainly not claiming to be one, but I can at least attest to the fact that the brain is infinitely complex and chemical imbalance theory likely plays a significant role in depression and anxiety. This means that in combination with other factors, chemical imbalance is a problem that people cannot control. Neuroscientists across the United States and world are working tirelessly to understand the basic mechanisms of depression and anxiety to hopefully develop better treatments and cures (insert: future blog post on the necessity of basic scientists vs. clinical and translational researchers). Furthermore, we can do something as non-scientists and as friends, family members, and individuals that interact with people who have mental disorders on a daily basis.

I propose a few key points.

The first: Let’s stop stigmatizing people who struggle with chronic illnesses of the mind. My initial point was the synonymity between cardiac diseases and mental disorders. Maybe this is hard for some people to understand (as it once was for me), but these are both simply problems that happen to the human body. I had trouble even typing the words “mental disorder” because the word disorder has such strong negative connotations surrounding it. The main reason I chose to use that term, though, is that I would not hesitate to write heart disorder or kidney disorder. In order to eliminate the stigma associated with depression and anxiety, we must treat them as we would treat any other human illness: as just that. It is a disorder. One that we must fight to normalize and identify. Mental disorders happen, and they will continue to do so as long as our brains hold the ability to change (which they will continue to do so). So let’s work hard to make these individuals feel less like outcasts in the world and accept them for being just like we all are: highly imperfect and flawed.

The second: Anxiety and depression affect a combined 25.1 million people in the United States (Anxiety and Depression Association of America). That’s a lot of people. It is very likely that you will encounter someone who struggles with these illnesses at some point in your life, probably daily. I suppose that these people look as if they have no struggle, they likely speak positively, and may even deny any kind of illness. Instead of trying to identify every person with a mental disorder, let’s seek to create a welcoming environment for someone who may need to talk about their mental struggles. Let’s become a more openhearted community and country and invite these special people to share what they’re going through. Much like a person with the threat of a stroke should let their family and friends know, we must be able to accept the responsibility of trust from these people. I desire to be a comforting hand, listening ear, and unbiased friend to anyone who needs to talk about what is happening with their mind. We can all be these types of people.

The third, and the last: If you find yourself struggling with a mental disorder, please know that it is okay. Someone with heart disease would have their health compromised if they felt the need to hide it from others as well. The best way we are going to solve this problem is if we have people come forward to be ambassadors for change. Mental illnesses are real. We all experience them at some point in our lives, maybe temporarily or perhaps chronically. Know that what you are experiencing is okay and be open to reaching out and talking with someone. We can all spread awareness, and we can all push for ending the epidemic that harms so many lives each year.

As a future physician, I pledge to create a welcoming environment for my patients to tell me about these things. I will seek to treat a patient holistically, including issues of the mind. Until I am a doctor, I will be a friend to those who need me, pray for those who are struggling, and try to spread awareness of the highly stigmatized illnesses of depression and anxiety. Our friends, brothers, sisters, mothers, fathers, pastors, professors, aunts, colleagues, and the world need us to band together and fight to end this epidemic.