As part of our Tuesday story of self series, today we revisit the story Janine Knudsen shared on
Progress Notes as a first-year medical student in March 2011. Initially inspired to pursue primary care by an innovative physician she met on a high school trip to India, Janine is now PCP's Clinical Innovation Fellow.
By Janine Knudsen
My fortuitous introduction to primary care began with my family’s cross-country move from New York City to Seattle. We arrived in Seattle when I was starting high school and the city was experiencing the growth of the Bill & Melinda Gates Foundation, World Vision, and other non-governmental organizations that were transforming the field of global development. I was fascinated by their efforts and the disparities they sought to address. What factors were causing so many children to grow up in poverty and malnutrition, without adequate access to education? I wondered. How did this affect their health and well-being?
I was eager to learn more about these issues and about how I might contribute to efforts to alleviate them. When a high school trip to India brought me to the Nishta Health Clinic, nestled in the foothills of the Himalayas, I knew I had found the answer: primary care medicine. I spent my time there watching Dr. Nath-Wiser, the clinic’s physician and director, treat a patient population that included Indian farmers, Tibetan refugees, and Nepali migrants.
The story of one patient, a pregnant woman bedridden due to calcium deficiency, particularly stuck with me. Dr. Nath-Wiser had learned how costly milk was in this patient’s community. As we sat by her bed, the doctor used her knowledge of the local diet to prescribe an unusual but effective remedy that included calcium-rich egg shells. Recognizing that this patient’s story was not unique, she went on to develop a maternal nutrition program for the surrounding communities.
Dr. Nath-Wiser’s innovation in the face of her patients’ financial and social constraints did not stop there. She went on to create a women’s health class, a youth program, and a literacy initiative to address the needs she saw in her communities, with great success.
Inspired by Dr. Nath-Wiser’s work, I headed off to study public health as an undergraduate at Johns Hopkins. Through my courses, volunteering, and additional public health work abroad, I continued to explore innovative, population-wide solutions to health disparities. In every scenario that I saw, the essential role of the primary care physician stood out, just as it had in the Himalayas. Primary care physicians were tapped into the pulse of the community, its history, and its health determinants. They could interface with health departments, advocacy groups, and researchers to develop far-reaching programs for everything from disease control to health outreach. They also appeared perfectly situated to provide preventative care, a core value of public health.
Now, as a medical student, I have immersed myself in the primary care community and I find it more evident than ever that primary care stands at the junction of medicine and public health. In my future career as a physician, I am excited to use this to my advantage, since progress in confronting disease in the United States, from diabetes to lung cancer, requires addressing issues through population-based approaches. I know that as a primary care physician, I will be able to incorporate this perspective in my work.
Janine is a Harvard medical student passionate about improving health systems to provide high quality, equitable primary care. She co-leads the Harvard PCP chapter and is involved in expanding Harvard's primary care opportunities. She is currently pursuing a year of primary care innovation and research at the UCLA Health System with support from the Harvard Center for Primary Care. As PCP's Clinical Innovation Fellow, Janine works to develop the Clinical Innovation Network and organizes webinars that highlight innovations in care delivery and primary care education.
Read more stories of self here.