*This was originally published in the first Mabelle Arole Fellowship Alumni Newsletter
Sixteen years ago, an MIT graduate, Max Fischer, asked me where he might spend a gap year prior to entering medical school. I put him in touch with Raj Arole and he ended up spending nine months in Jamkhed with the Comprehensive Health Project — Arole’s nonprofit organization aimed at improving primary health care services in rural India. Upon his return to the U.S., Max reported that the time he spent in Jamkhed was a “life-changing experience.”
Max’s story motivated me to start a fellowship as a way to contribute to the development of the next generation of international community health experts. It seemed natural to name the Fellowship after Mabelle Arole who, together with Raj, contributed so much not just to Jamkhed, but also to the field of community health—demonstrating how to empower disenfranchised villagers in developing sustainable, community-based primary healthcare.
“The poorest of the poor did not come to us. They had no money to pay for transportation to the hospital, and no one to take care of their children at home. Most did not feel the need to come since they had never heard of prenatal care. Maternal mortality was high. Women and babies with tetanus were admitted. All this could be prevented. We had the knowledge to prevent so much morbidity and mortality among women and children, but by staying in the narrow confines of curative care, were we not doing a disservice to those very people we had vowed to help?” –Dr. Mabelle Arole
The results that Jamkhed has achieved are impressive and represent what we want and need to replicate around the globe. I believe that it is important to provide aspiring health professionals an opportunity to see and experience what I consider the gold standard of community health projects prior to entering medical school, to provide a conceptual framework to which to refer.
No matter where they end up practicing or in what field, the Jamkhed approach will hopefully influence the mindsets of young medical students and their dedication to the underserved.
I reached out to some of the former fellows recently; the following are their stories.
“This year marks the tenth anniversary of my time as a Mabelle Arole Fellow, and to date, I feel extremely fortunate to have received this opportunity at such a formative time in my life. The Jamkhed connection has been an energizing force through these long and challenging years of training, allowing me to keep my head above the proverbial waters of the U.S. healthcare system. Despite the distance, the wisdom flowing from the people of Jamkhed always seems to resonate loud and clear in my pursuit of academic, research, and clinical practice opportunities.
I can still close my eyes and recall all the treasured moments spent with Dr. Raj Arole in deep discussion of topics such as India’s healthcare system, the history and underpinnings of caste discrimination, and poverty, as well as the essence of people’s empowerment as only the Aroles could have materialized it. Spending hours with Shobha in the operating room and in the outpatient department was also a great introduction to the humane, competent, and professional approach of bringing medical care to some of the most disadvantaged members of society. I believe that experience has influenced me very positively in my work with underserved groups here in the US.
In my current role, after recently completing a surgical obstetrics fellowship, I have joined the faculty of the University of North Carolina-Chapel Hill as assistant professor of family medicine. In daily practice I work closely with students and residents while providing comprehensive care to a diverse mix of patients from cradle to grave, including obstetrics. I couldn’t be happier with my decision to pursue family medicine as a specialization, and I thank Shobha for helping me down that path. I only hope that in my tiny way, I can likewise plant a seed in the minds of students to realize the value of primary care and the compassion and rewards that come from a lifetime of service to the disadvantaged and marginalized members of our global society.”
-Alex Kaysin, MPH, 2005-2006 Mabelle Arole Fellow
Assistant Professor, Family Medicine, UNC School of Medicine
“Medical school at Hopkins is great! I love the clinical years, and am finishing up my third year now with lots of time to take electives and finish up my core rotations. I am 100 percent planning on going into a primary care field, through either a family medicine or medicine-pediatrics residency. CRHP and Jamkhed have truly been life-changing for me – I’ve loved primary care ever since! I’m constantly reflecting the cost-effective and all-inclusive health the village health workers provided to the community, and how applicable the Jamkhed mode is in the United Sates.”
– Aparna Krishnan, 2012-2013 Mabelle Arole Fellow,
MD Candidate, Johns Hopkins University School of Medicine
“One memory that has stuck with me over the years: I helped deliver a baby early on in my year working with CRHP. The birth was uncomplicated and the baby was healthy, and I got to know the mother over the next few days as she convalesced in the hospital.
A few months later, while out in a project village with the mobile health team I happened upon this mother and her baby, who was growing and thriving. The image of this mother and baby at home helps remind me of how the interventions we do in the hospital setting be it deliveries, surgeries, or treatment of illness—play only a small role in our patients’ health.
While a safe, healthy birth gave him a good start, ‘non-medical’ factors such as the family’s knowledge about healthy nutrition, financial security, and access to clean drinking water played a much larger role in his current good health. These concepts highlight why CRHP has been so successful by addressing all aspects of health both in and out of the hospital. Throughout my career, this model also helps me to maintain perspective on my role as a physician in the overall health of my patients.”
– Amy Romer, MD, 2006-2007 Mabelle Arole Fellow
Critical Care, Pediatrics UCSF School of Medicine
“For me, the CRHP experience absolutely solidified a path towards studying public and global health. It informed the idealism I previously had about working and living abroad, and it developed in me a commitment for working in low-resource settings. Since India, I’ve had the opportunity to work on separate public health projects in Guyana, Nicaragua, and the Dominican Republic. Without the CRHP experience, I’m not sure I would have sustained an interest in the beautiful fields of primary care and community development, as some medical schools have a way of influencing students towards the tertiary is primary approach. The hegemonic, curative only view of healthcare in the West is not the typical way I see healthcare, thanks in large part to CRHP. Understanding the logic behind primary healthcare is something I will always treasure. CRHP also provided me a context for a handful of public health skills I went on to formally learn during the MPH, from program evaluation to disease surveillance to community adoption of new healthcare practices. I have so many valuable memories from the villages, village health workers, mobile health team, and CRHP hospital.”
-Conor McWade 2011-2012 Mabelle Arole Fellow
MD/MPH Candidate Vanderbilt University School of Medicine