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Challenging Preconceptions: Forging an Authentic Professional Identity
I woke up around six o’clock in the morning in anticipation of a busy day. My colleague and I were heading to a health center on the outskirts of Karnataka, a state in Southern India, to shadow primary care providers and see firsthand the challenges of caring for the community’s growing population. As an undergraduate pre-med student at Allegheny College, I was halfway through a summer internship at an Indian grassroots nongovernmental organization (NGO) dedicated to public policy research and advocacy.
The NGO had been tasked with drafting a quality assurance proposal for the Ministry of Health in Karnataka in response to health system adequacy concerns. While primary health centers in the region were free for community members, residents overwhelmingly perceived the care as suboptimal. Even when they faced financial hardships, residents often used private facilities. The government’s goal, and the NGO’s mission, was to identify best practices that had been enacted at primary health centers and incorporate them into statewide policies. Our specific project was to collaborate with the organization’s policy experts to research evidence-based strategies that had been found to be effective in improving quality of care across a range of providers and increasing community members’ use of government-funded facilities. Site visits and informational interviews with health care workers were intended to provide context for our work.
After a long drive through the jungle and over dirt roads, I jumped out of the van, eager to learn from the providers. I was shocked to see that the health center was a small, three-room facility with a patched roof. Immediately, I realized the fault in my expectations. I had assumed that these centers would match an archetype in my mind, reaffirmed countless times during my own visits to the doctor. While I had imagined that an Indian health center would differ from those of my childhood, I was still surprised.
Joined by a translator, my colleague and I met with the doctor during his scheduled break to discuss his role and the challenges he faced on a daily basis. He estimated that he would see roughly two hundred patients that day, affording only a few minutes for each visit. This particular primary health center was the only facility of its kind for more than twenty thousand people. Because the majority of community members chose to pay for private care or not to seek out any care, the doctor suggested increasing the number of community health workers who could dispel rumors about the public health care system and refer patients to the health centers. What struck me most after our conversation with the doctor and two other staff was their ingenuity and resourcefulness in providing quality care for their community in light of the very apparent, severe challenges, such as overcrowding and an array of patient health conditions. I left that day with a greater appreciation for the Indian primary health care workforce. This much-needed dose of reality influenced the rest of my interactions with local experts, as well as my contributions to the proposal.
This global health experience represented only a small portion of my time in India, but it inspired me to change my career goal from becoming a clinical practitioner to addressing population health. I began to understand that although this highly skilled physician showed tremendous dedication in caring for hundreds of patients a day, systemic factors that affected the health of the community would remain in place unless policy could influence funding levels (to provide resources for existing or additional primary care centers and investments in workforce training); behavioral change (like increasing frequency of preventive care visits and screenings); or environmental factors (such as improving access to clean water and reducing air pollution).
When I made this realization upon my return to the United States, I focused on epidemiology as a tool to reveal significant health impacts, researching connections between underlying risk factors and health outcomes. For example, I designed my senior thesis to study the indirect effects of gun violence. I found that there were significant differences in the birth weight of babies born to mothers who were pregnant during, and lived in the same communities as, mass shootings, compared with mothers living elsewhere. As in my internship in India, I recognized that social context greatly influences health and well-being.
Upon graduation, I enrolled in a Master of Public Health program where I made the leap from epidemiology to health policy, focusing on evaluating current policies and implementing new ones to improve population health. For me, it felt like a natural evolution. My current job, developing health policy for the legislative branch of the US federal government, certainly parallels my work in India. While my career path was by no means straightforward, I appreciate how my experiences in India defied my expectations, challenged my biases, and helped forge my professional identity.
Garrett Devenney has a BS in Biology and Global Health Studies from Allegheny College (2016) and a Master of Public Health, Health Management and Policy, from Drexel University (2018).