Adeola Oni-Orisan. Image: Aaron Washington
This essay was written for the 2017-2018 HMS Dean's Report in answer to the question "What is the promise of medicine to me?"
This fall I will be applying to residency in family medicine, which to me, embodies all that the promise of medicine offers. Upon starting at Harvard eight years ago, this choice was not immediately clear to me. Having spent my undergraduate years focused on neurobiology research, I was excited to see what promise there was for translating my basic science skills into clinical care. On the other hand, I was becoming increasingly interested in women’s health, global health and the structural processes that hinder progress in both of these areas.
HMS afforded me the opportunity to explore this new set of interests with activities that included testing and counseling people with HIV at the Dimock Center, a community health organization, and helping to start HMS’s first student-faculty practice, the Crimson Care Collaborative, as well as a summer of research on postpartum hemorrhage in Zambia. These experiences reinforced my desire to become a physician but also made apparent the complex social factors that contribute to the production of disease.
I hope to always think about the person who sits in front of me, their families, and their environment. This will motivate me to continue fighting the structures, whether they be bacterial or institutional, genetic or socioeconomic, that stand in the way of a person’s health.
By the time I started my third year in medical school, it became clear to me that my medical education would not be complete without in-depth training in critical analysis of the social processes that impact health. After finishing my clinical year, I took a leave of absence from HMS to do just this. I started a PhD in the joint medical anthropology program at the University of California, San Francisco, and the University of California, Berkeley. My dissertation explores the causes of maternal mortality in Nigeria as they relate to social, political, economic and religious processes that were set in place as far back as British colonization.
I believe it is important that we understand how postcolonial dynamics continue to impact health in many countries despite the hundreds of millions of dollars being invested into lowering maternal mortality. I learned there is no quick fix to maternal mortality. It will take a longer-term, sustained commitment to women and the communities in which they live. This realization is what brought me to family medicine.
Back at HMS for my fourth year, I am excited about the prospect of close longitudinal relationships with my patients as I accompany them over the course of every stage in their lives. I look forward to taking care of individuals, families and communities. The philosophy of family medicine exemplifies the promise of medicine in many ways but especially because of its commitment to social justice.
Yes, the promise of medicine means caring for patients, standing by them through their various stages of health and illness, and offering cutting-edge treatment supported by rigorous research. But, in my opinion, it also means calling senators and advocating to keep health care accessible for all. It means marching in the streets on behalf of each victim of police violence. It means going to Standing Rock to stand with the Sioux Tribe against the Dakota Access Pipeline. It means speaking out against polluted water in Flint, Michigan. It means writing a letter to a utility company to prevent them from shutting off a patient’s utilities. It means contributing to bail funds and speaking out against the prison-industrial complex. It means mentoring disadvantaged high school students. It means community organizing. It means campaigning for candidates who support public health as a right.
It also means calling a patient to check in after a particularly emotional office visit or starting food banks or offering mindfulness classes in clinics. It means acknowledging racial, sexual and other forms of trauma that a patient may bring with them into the office. It means not only acknowledging that implicit bias affects our medical decision-making, but putting in place institutional policies that can minimize its effect. It means both community-driven research and community-led intervention.
Of course, none of this can be accomplished alone, so it also means working with multi-disciplinary teams that include social workers, physicians, nurses, researchers, public health workers, psychologists and community leaders.
This is the promise of medicine that I hope to carry throughout my career. I hope to always think about the person who sits in front of me, their families, and their environment. This will motivate me to continue fighting the structures, whether they be bacterial or institutional, genetic or socioeconomic, that stand in the way of a person’s health.
