Arcita Hanjani Pramudita. Image: Gretchen Ertl
For Arcita Hanjani Pramudita, life is never about a single moment. It’s about the connections between experiences, woven together to form a strong, intricately patterned fabric.
Her own diverse experiences have formed the tapestry of who she is as a physician, researcher, student, educator, and entrepreneur who is about to graduate from Harvard Medical School with a master’s degree in clinical investigation.
One of the recurring patterns in the tapestry of her own life is the belief that the key to excellence in medicine is understanding all the different aspects of a patient’s life. These colorful threads appear in her approach to health care whether she’s working on clinical research in oncology, the ethics of palliative care, or a new, culturally sensitive, patient-centered approach to women’s health in Indonesia.
“Looking at the stops I’ve taken on my journey, or even all the things I’m working on right now, sometimes I wonder what the universe is trying to tell me,” Pramudita said. “But if I step back and think about all the pieces as parts of a whole, it starts to make sense.
“I believe that a physician’s most important job is to meet their patients wherever they are in life, to try to understand the whole patient, and to help them meet their own goals for health and wellness.”
Life and death with dignity and caring
The fibers of life and death are spun together in one of the strongest threads of Pramudita’s life. This thread ties together experiences like watching two close family members die of cancer and then seeing her mother struggle to find closure in her mourning following those deaths.
She felt the pull of that same thread again when she began her own medical education and found herself wondering why students weren’t taught how to help patients or their families manage the difficult stages at the end of life. That tug carried on through her work as an MD in Indonesia, where she is from, trying her best to help the people she served meet their own struggles with dignity.
From 2020 to 2021, Pramudita completed HMS' Global Clinical Scholars Research Training program, which inspired her to continue her focus on clinical research by enrolling in the master’s degree program, which she began in June 2022 with the support of the Indonesia Endowment Fund for Education.
Pramudita chose a research project that would attempt to measure how various social factors affect cancer patients’ likelihood of surviving treatments such as bone marrow transplants. Understanding how much impact these social forces have on a patient’s wellness can point out the need for additional social supports for vulnerable patients or help clinicians decide which patients would benefit most from a given treatment.
In 2023 Pramudita’s decision to attend a session on the bioethics of clinical oncology at the American Society of Clinical Oncology conference by chance led to her being invited to co-author a commentary for an ASCO publication about the ethical aspects of palliative care in Indonesian medical education.
Her co-authors included Lintang Sagoro, a current student in the HMS master’s program in global health delivery; Ardita Pramudani, Pramudita’s sister and master’s candidate in the HMS bioethics program, who has been chosen as one of the student speakers at the bioethics program’s hooding ceremony; and Polo Camacho, the ethics program manager at ASCO.
While it is well understood that factors like race, income, geography, and social support structures can make a big difference in outcomes for cancer, Pramudita said she was surprised by how little the topic has been studied and how difficult it was to gather the data she needed for her research.
“We know that patients aren’t just a collection of symptoms and vital signs,” she said. “Cancer is not just about biology.”
Unfortunately, Pramudita noted, the medical system is not designed to capture the data researchers need to understand which social and cultural forces have the greatest impact on patient outcomes and to allow oncologists to help patients better prepare for the challenges of facing cancer.
Her project mentors — Roman Shapiro, HMS instructor in medicine at Dana-Farber Cancer Institute, and Robert Soiffer, the Worthington and Margaret Collette Professor of Medicine in the Field of Hematologic Oncology at Dana-Farber — supported her project and encouraged her to do as much as possible within the limited amount of time, Pramudita said.
“It takes a great mentor to believe in and challenge you to become best version of yourself,” Pramudita said.
She narrowed in on people who were diagnosed with one of two bone marrow disorders, myelodysplastic syndromes and acute myeloid leukemia, and underwent bone marrow transplants. Since there was no database that matched medical records with information about the patients’ status for any of the known social determinants, she had to manually read and tabulate social workers’ notes from 587 patients.
Although Pramudita is still completing her analysis and preparing the study for publication. She says the preliminary results show an association between a patient dying within three years of follow-up on the bone marrow transplant of something other than a return or a worsening of their cancer and the patient having lived alone or without a caregiver before the transplant.
The study is just a small sample of the important clinical insights that can be gained by listening to the stories of patients’ lives and understanding how the details of a person’s home life and social status can influence their chances for healthy treatment outcomes, Pramudita said.
A new thread: Women’s health in Indonesia
Pramudita has started weaving a new thread into the fabric of her work. For her latest project, she is working with two other Indonesian women — Windy Natriavi, a master's candidate in the MIT Sloan Fellows MBA program and Melina Subastian, a master’s candidate in the Harvard Graduate School of Education — to create Indonesia's first virtual primary care platform for women's health. They are calling it Empati, using the Indonesian word for empathy.
Pramudita is looking forward to weaving her growing understanding of the importance of treating all patients as whole people, with their own autonomy but also with intimate connections to their family and culture. At first, she said, she was surprised to find herself shifting to work on women’s health after her initial focus on cancer, but is excited to apply her philosophy to this new focus.
She also noted that this new work is an extension of another thread in the fabric of her life. After medical school, she cofounded Arc & Co. Research, an online study community to help Indonesian health care students and professionals learn about biostatistics, clinical research, and public health.
The Empati project was chosen as one of 12 ventures in 2024 to be supported by MITdesignX, a program that empowers students, faculty, and researchers to develop forward-thinking solutions that address challenges facing the future of cities and the human environment.
After her graduation from HMS this spring, Pramudita plans to return to Indonesia with her co-founders to build Empati in Jakarta, the nation’s capital.
Pramudita said that during her time at HMS she came to appreciate the many opportunities to learn, build friendships, and collaborate with people from so many different backgrounds, both at Harvard and around the greater Boston biomedical and innovation communities.
Working here with people involved in different aspects of cancer care, global health, social medicine, bioethics, entrepreneurship, and design encouraged her to tap into the diversity and innovative spirit of Jakarta, the largest metropolis in southeast Asia.
Pramudita said that it was important to remember that there are many common threads that all people share, whether they are doctors or patients, men or women, in the prime of their life or near the end. The secret, she said, is to focus on the common threads woven across all people’s lives, to acknowledge the connections and similarities between us all, while also appreciating each individual’s specific needs and to give them the help and support that they need, whoever they are and wherever they are in the course of their life.
“The universe gives everybody different experiences, and it gives us the ability to find the shared humanity and understanding that connects us all,” Pramudita said.
Personal Journeys, Common Purpose
Celebrating the accomplishments of the Class of 2024
