#FellowsFriday: Ameena Razzaque '21

The Eric Eichler ’57 Fellowship for Health Care Leaders is a one-year fellowship that includes one-on-one mentorship with senior faculty and researchers at The Dartmouth Institute to guide your exploration of research, policy or health outcomes improvement work.

#FellowsFriday individually features each of the ten Eichler Fellows and the projects they are working on with their mentors.

Ameena Razzaque,
Eichler Fellow

My name is Ameena Razzaque, I am a ’21 (junior) from San Antonio, TX. My special major is titled “Women’s Health in the MENASA (Middle East North Africa South Asia) Region” and I am minoring in Middle Eastern Studies. I don’t know what my future holds, but I do know that I want my career to be flexible. I want to have a balance between global/public health and clinical work and I want to serve international communities. I want to aid Muslim women in the regions I have chosen to focus my major on, and work closely with non-profits, NGOs, and Doctors Without Borders.

I loved attending the Foundations session with musician doctors and learning about how they balanced both of their passions and how important improvisation and spontaneity is in healthcare. I also loved seeing a close-knit community come together to enjoy the last closing picnic and felt like I belonged with this group of amazing individuals.

Carol Stamatakis, Executive Director of Senior Solutions and mentor to Eichler Fellow, Ameena Razzaque

My project is in partnership with Senior Solutions and Carol Stamatakis. Senior Solutions is a non-profit community organization that “provides social services to Vermonters 60 years and older, their caregivers, and their families.” As my project evolves, it will most likely be about aiding non-citizen female survivors and other survivors of domestic and sexual violence, thus working closely with WISE as well. WISE aims to “end gender-based violence through survivor-centered advocacy, prevention, education and mobilization for social change.”

Foundations Alumna Spotlight: Eryka Molino

Eryka Molino, Foundations ’19

The Dartmouth Health Care Foundations was a once in a lifetime experience that I will carry near and dear to my heart. Of the many moments of inspirational truth touched on throughout the week, I believe the most powerful is the idea that health care is not a political issue, but a human one. The program has shown me the different ways to think of health care as more than a clinical practice, but as a human opportunity to better others. The reimagining of health care as a person to person effort was the ultimate goal of the interdisciplinary approach.

My favorite part of the week was meeting with Dr. Agnes Binagwaho, the Vice Chancellor of the University of Global Health Equity. Learning the ways in which she improved Rwandan healthcare after a genocide was so moving and captivating. It truly lit a fire within me to push for a better healthcare system. Her speech brought to a head how we need to push for the agenda of the vulnerable.

As an aspiring doctor, I have always believed in One love, and the interdisciplinary approaches Dr. Manish K. Mishra and Dr. Elizabeth Carpenter-Song took towards healthcare has changed my views of the system forever.

#FellowsFriday: Jessica Kobsa '20

The Eric Eichler ’57 Fellowship for Health Care Leaders is a one-year fellowship that includes one-on-one mentorship with senior faculty and researchers at The Dartmouth Institute to guide your exploration of research, policy or health outcomes improvement work.

#FellowsFriday individually features each of the ten Eichler Fellows and the projects they are working on with their mentors.

Jessica Kobsa, Eichler Fellow

My name is Jessica Kobsa, and I am a ’20 from Wilton, Connecticut. I am a Psychology major and Biology minor. I am also a Senior Fellow conducting research on an intervention to reduce problematic eating behaviors in adolescents. I tend to be drawn to issues that I feel are too often overlooked, such as care for the elderly, end-of-life decisions, women’s health, and the intersection of mental health with physical health. I feel very passionately that I want to be a clinician applying the knowledge and tools of medicine to positively impact people’s lives.

                  Clinically, I am especially interested in difficult yet hugely important conversations involving decisions about end-of-life care and palliative care. As a psychology major, I am also interested in how the mind affects our physical health and vice versa. I would argue that principles of psychology can be used to improve just about every human experience there is, including the experience of being a patient and the experience of being a doctor in today’s burnout-breeding environment. My goals pertaining to healthcare are to first understand the needs and perspectives of as many stakeholders as I can and then to use that knowledge to help make structural changes in today’s healthcare system that improve people’s experiences.

Dr. Robert Santulli, geriatric psychiatrist and mentor to Eichler Fellow, Jessica Kobsa

I am working with Dr. Robert Santulli, geriatric psychiatrist, on the Dartmouth Dementia Directive Video Project. In this project, we promote the Dartmouth Dementia Directive, an advance directive that allows people to describe their wishes for their medical care specifically at three different stages of dementia. Additionally, we provide interested individuals an opportunity to video record their directive, as evidence suggests that video advance directives are more likely to be followed and are valuable to family members and physicians involved in an individual’s care.

Foundations instilled in me incredible passion to make a difference and ignited my curiosity to learn as much as I can about the needs of the players in today’s healthcare system. I believe that with the right mindset, the willingness to compromise, creativity, and resilience, we can solve some of these problems. I am incredibly grateful for the opportunity to be an Eichler Fellow, and I look forward immensely to this step in my journey.

“Imprecision Medicine: Health Without History” with Dr. Rick W.A. Smith

November Seminar with Dr. Rick W.A. Smith, MA, MS, PhD

Dr. Rick Smith speaking with the Eichler fellows and greater Dartmouth community.

This talk titled “Imprecision Medicine: Health without History” given by Dr. Rick W.A. Smith of the Dartmouth Anthropology department targeted the intersection of Anthropology and genomic advancements. The Eichler fellows were joined by their classmates and colleagues as Dr. Smith shared his insights on his research interspersed with the information he would’ve wanted to hear as a pre-medical student. 

We are all familiar with the recent boom in genetic tests commercialized to uncover our family lineage and ancestry; these consumerized genetic test kits are what Dr. Smith refers to as “the unfulfilled promise of precision medicine”. Following the advancements in genetic medicine, we were promised a revolution in health, but what we got were take-home ancestry kits. In this talk, we were encouraged to think about all the greater possibilities and untapped potential in genetic testing. 

Dr. Smith’s research focuses on the ways that social and political power structures shape human biology in both ancient and contemporary societies. Not only does colonialism leave marks on the physical locations of civilization, but also on the bodies of the native civilians. Violence and trauma can be traced through genetic and epigenetic data. However, it has been only scientists deciding that “pure” blood qualifies a person as indigenous; genetic scientists have been studying indigenous populations without acknowledging the social experiences, trauma, and sexual violence that these populations have experienced. This manner of genetic data collection erases the history of white violence on indigenous bodies that indigenous women have faced.

How are scientists, removed from a historical and cultural context of what they are studying, the ones making decisions regarding indigenous people? Not only has this resulted in the erasure of alterations in genetic variation of indigenous people following colonialism, but also raises an ethical problem of how scientific literature determines both who is getting studied and what the implications mean without a full understanding of the social context.

This seminar topic and the work of Dr. Smith are a robust examples of interdisciplinary study. Dr. Smith’s multidisciplinary approach to his work is one that the Dartmouth Health Care Foundations program hopes to continue inspiring in pre-medical students. We must not only examine the most pressing issues in medicine as a biomedical problem – but additionally, how to approach these issues from a sociological/anthropological, psychological, social perspective. In doing so, we – as future medical leaders – will be able to better represent the people and phenomena we are studying. 

#dartmouthfoundations

For more information on the Dartmouth Health Care Foundations program, visit the site here.

Foundations alumna, Katie Wee, novice adult and golf warrior

Katherine “Katie” Wee

Dartmouth College ’19

Dartmouth Health Care Foundations ’18

Eric Eichler ’57 Fellow ’19

I first met Katie when she came to the Dartmouth Health Care Foundations week in July 2018. Her warmth and compassion, combined with a desire to make a positive impact in the world, made her an excellent candidate for The Eric Eichler ’57 Fellowship for Health Care Leaders, a year long-fellowship for future leaders in healthcare. She recently wrote to me, and the influence of Foundations and the Fellowship are alive and well in her as can be seen by her thriving as a novice outside of school, taking on new challenges without fear, and taking time to be thoughtful about her next steps to ensure she arrives at her destination with her whole self intact. Here is what Katie wrote:

hello!

The transition from college to “adulting” can be a very sudden transition. For me, I don’t know if the classes I’ve taken or the seminars I’ve attended necessarily prepared me for the real world, like managing finances/investments or cooking nutritious meals (the college dining hall is a blessing!). To be honest, it was a daunting thought during senior spring to imagine how I could navigate these unfamiliarities, but at least the tuition paid at Dartmouth didn’t go to waste! Day by day, I’ve been realizing that college has taught me skills that I’m finding very helpful: how to utilize my curiosity and hunger to learn, the concept of passion over perfection (of course you want to achieve both!), resiliency, and much more.

I’m still figuring out my life, and I’ve learned to be okay with that. I’d prefer to take the non-traditional path that satisfies/fulfills my soul than to feel pressured by a more traditional route that inhibits my creativity and joy. I’m not saying that one is generally better than the other, but I’m trying to make sure that I dictate the direction of my life rather than be strung along by societal or cultural influences.

My current post-graduate life first involves studying for the MCAT. I do dream of becoming a doctor, but I hope to spend this gap year to wrestle this dream – addressing the big WHY question. In the meantime, I wanted to lead an active life, so I decided to start studying for the MCAT ahead of time. This way, I can re-establish my science foundations over the summer and have the time to process some personal things after the whirlwind of college. Thankfully, studying the MCAT has been pretty manageable, and yes… sometimes I do wonder why certain topics are appealing now! I do wish I pushed myself to focus on my pre-med classes, but at the end of the day, I can’t change history and I have to move on!

With summer at hand, I decided to challenge myself to learn something new. My personality is one where I develop passions/interests quickly, but often find myself lacking the discipline to follow some things through. And so, I find myself in retirement mode – learning how to play golf, and wow! I forgot how difficult learning something new can be! All the patience and perseverance… Through this journey, I’ve learned how I enjoy doing things I’m best at because confidence was a major motivation. I’m also learning to push my limits and keep working hard at something that can be discouraging and makes me feel like a total novice.

Speaking of patience, LA traffic is a nightmare. To drive ~20 miles, it takes about an hour. In Hanover, that would’ve been a different story! This drive takes place a couple times a week because I’ve been shadowing at a teaching hospital focused on reaching the medically underserved community. So far, the experience has been incredible. I’ve been in the NICU, Pediatric Hematology/Oncology, and Pediatric Cardiology units. Surprisingly, all the doctors (attending, fellows, residents, MS students, nurses, technicians, etc.) have been willing to take the time to teach and advise/counsel me. One attending has even gone the extra mile to provide career counseling for 2 hours!! This experience has made me more motivated to become a doctor, even if my statistics make it seem impossible. Life is short, so I think I’ll give it a shot.

In the midst of all these moving parts, I’m in the process of exploring and establishing my identity. My self-concept and self-identity has gone on an intense roller-coaster ride, and I’m looking for some grounding. It is a lifelong journey, but I think it’s time that I spend time to reflect and know myself. What are my values, dreams, passions, and experiences? How did I become the person I am today? Questions like these help me learn more about myself.

Community has always been an important component of my life. While I do have family immediately by my side now, I would be lying if I didn’t say I was struggling to find community. Building relationships and friendships take time, and thankfully I have been fortunate to have been actively “pursued” by the young adults ministry at church. It was nice to see that there were people out there who genuinely wanted to get to know me and would try to include me into their circles. We are an eclectic group from all backgrounds and stages of life, and for an extrovert like me, it energizes and makes my week even brighter.

What are the next steps of my career? As of October, I will have job as an EMT at a 9-1-1 ambulance company. I’m super excited to be able to start working and training at this company. During the interview process, they made it clear that they value their employees and really invest all their resources and time. This can be seen in how their employees respect the company and how the public perceives this emergency organization. Once I start working, I will share more details, but for now, this is all I have.

Book recommendations

  1. Just Mercy: A Story of Justice and Redemption by Bryan Stevenson
  2. When the Air Hits Your Brain: Tales from Neurosurgery by Frank Vertosick Jr., MD

Lectures:

  • Richard Kogan MD on Music and Medicine: Chopin and the Power of Resilience
  • I would highly recommend listening/reading one of his works! I was first introduced to him during research for my thesis, but now I will get the opportunity to meet him in person when he gives his talk this Thursday!

Harnessing “Good” Stress and Minimizing “Bad” Stress to Promote Health and Well-Being

Today, we welcomed Firdaus S. Dhabhar, PhD, D’90, who shared innovative knowledge of stress mechanisms, both the well-known harmful as well as beneficial ways, to transform medical practice and health care.

Dr. Dhabhar came to us from the Department of Psychiatry & Behavioral Sciences, and the Sylvester Comprehensive Cancer Center,  at the University of Miami Miller School of Medicine. He was the first to discover mechanisms by which short-term stress physiology enhances the body’s immune defenses to increase protection during a fight-or-flight response.

He is interested in developing practical and sustainable interventions to minimize the effects of “bad” stress and maximize the effects of “good” stress. His interests extend from stress-related molecular and cellular mechanisms to their holistic physiological function in individuals, to practical and sustainable implications for public policy and societal well-being.

This month’s seminar had the best turnout yet!  Dr. Dhabhar drew a crowd of professors, collages, and students from so many areas here on Dartmouth’s Geisel School of Medicine campus. His intriguing topic generated a swirl of questions and comments from the audience, and conversations continued long after the seminar came to a close.

These are things that struck me (as an utter layman to the topic and associated terms—except for the word ‘stress’…that one I get!) as I listened to Dr. Dhabhar:

Quoting Hippocrates, Dr. Dhabhar said, “It’s far more important to know the person who has the disease than it is to know the disease.” His work is showing people how to maximize mind-body health through hard science psycho-neuro immunology shows us how stress impacts the nervous system, endocrine system, immune system, and overall health, and feeds back to brain creating a loop.

He asked us to consider two things:

1) while “stress is a loaded gun”, has some truth to it, it’s not always.

 2) mother nature gave us the stress response to help us survive, not die.  

Sometimes we even get stressed on purpose: we go to Halloween haunted houses to get stressed—to get a thrill.

The definition of stress is a constellation of events that begins with a stimulus that precipitates a reaction in the brain that subsequently results in the activation of fight/flight systems in the body.  Without the biological stress response, it doesn’t matter; there is no stress.

Short-term stress can last minutes to hours. Chronic stress is weeks to months to years. 

Stress affects the heart rate, adrenaline, noradrenaline, cortisol, cytokines—All increase. Some common everyday activities such as exercise and kissing (intimate) also activate this response.

Most research is focused on long-term chronic stress. It is important to investigate and HARNESS the protective effects of short-term stress which affects psychological states, heart rate, blood pressure, hormones, immune cells and factors, functional and health outcomes.

What happens to blood immune cell numbers during short term stress, as some of those events mentioned above, jumping out of an airplane, surgery, and medical procedures? T cells increase just before the surgery begins, decreases during surgery, and everything returns to baseline after surgery.  After psychological stressors, things return to baseline 3-4 hours after.

Immune cells are body’s soldiers, when a stress response begins, 1-3 minutes they leave the spleen and enter the blood vessels, resulting in increased lymphocytes and monocytes that enter skin to potential battlefields—they go everywhere (In case a lion bites you!—you know, harkening back to mother natures intended reason for stress: to save your life!) The immune cells are also better able to defend you.  But this also means they go to sites of ongoing inflammation, like cardiovascular lesions, which may be a reason for “events.”

What are the factors the distinguish patients who show high vs. low immune cell redistribution during surgery stress: 1. level of chronic stress leading up to surgery. 2. Gender. Women are less able to show adaptive stress and recovery is not as good.

Effects of short-term stress: Mice exposed to UV have lower tumor burden than mice not exposed to stress, especially during the early phases of tumor development, but the effects don’t last forever. If the tumor is already on board, and you pulse the system with stress, you can regress the tumors, until the late stages of tumor.

It’s good for babies to get poked and stressed when injected for immunizations because it stimulates the immune response.  In many clinic sites, we want to HARNESS endogenous immune-enhancing mechanisms to augment protective immunity.  In patients with inflammatory or autoimmune disease, we need to turn OFF endogenous immunology enhancement to prevent exacerbation of pathological immune reactions. This is one path that stress could exasperate unwanted immune responses.

Chronic stress reduces protective immunity, disrupts day-night biological rhythms & sleep, accelerates aging, and accelerates telomere shortening in response to life stress.  In my words: it turns the immune system from protector to killer

Sources of stress (just in case you were wondering):  job insecurity, high cost of living, economic uncertainty, relationship conflicts, loneliness, manipulation, and deceit. 

Yoda said:  Fear is the path to the dark side. Fear leads to anger. Anger leads to hate. Hate leads to suffering. The Dalai Lama basically repeated this message. Chronic stress can drive harmful, feed-forward cycles. What can we do about harmful stress?

How do we break that cycle? By optimizing the stress spectrum. This means minimize or eliminate bad stress. Maximize low or no stress times and events, optimize good stress and shut down the cycle as soon as possible.  To stay on the good side of stress, there are things to focus on. Have a good mix of all of the following:  LIFESTYLE: sleep, exercise, nutrition. PSYCHO-SOCIAL: coping, social support, authenticity, gratitude, compassion. ACTIVITIES: meditation, yoga, mindfulness, natures, walks, dance, music, art, gardening, fishing, breathing.  The activities affect the parasympathetic system by strengthening the calming response, regulating circadian rhythms, biological aging can be slowed down, and the probability dis-regulated responses are decreased. 

After his formal presentation, Geisel MED students, and TDI’s MPH and Eichler Fellows students stayed behind for the opportunity to delve deeper and ask Dr. Dhabhar questions over dinner.

tdi.dartmouth.edu/foundations

#DartmouthFoundations

Check out photos from the evening here: https://flic.kr/s/aHsmHqRXDM

Kicking off the 2019 Eichler Seminar Series with Contemplative Studies

We launched our 2019 Eric Eichler ’57 Foundations in Medicine and Humanities Seminar Series with guest speakers Dr. Harold Roth and a current Brown Medical Student, Chloe Zimmerman, a current Brown Medical Student,

both hosted by Professor Sienna Craig of the Anthropology department.

Dr. Harold Roth is the Director of Contemplative Studies at Brown University and leads students in meditation activities in the “Med Lab”. His academic path has taken him from pre-medical studies, to psychology, to Chinese philosophy. Both Chloe and Professor Craig have been students of Dr. Roth and have carried their experiences in contemplative studies onward in their own careers. 

In this session, Dr. Roth led the Eichler Fellows in a guided meditation that explored the four dimensions of our bodies: depth, width, height, and time. He encouraged fellows to “stop, drop, and return” if incessant thoughts or stressors invaded the contemplative space. Following the meditation session, Dr. Roth opened the space up for discussion. Fellows shared what went well for them and what challenges they encountered in this practice. Additionally, important topics arose such as:

How are we to think of meditation removed from its origins in religion? And how are we to maintain this practice in stressful and fast-paced atmospheres, like in the medical field?

Dr. Roth and Chloe shared their insights regarding meditation practice and how, like a muscle, with increased use comes an increased sense of ease. Mindfulness can be practiced in the guided form or as simple as noting every time you touch a doorknob to check-in with your body. Following this session, participants walked away feeling refreshed and ready to share this practice with their own communities. 

tdi.dartmouth.edu/foundations

#DartmouthFoundations