As a field of study, global health didn't exist when Lisa V. Adams, MD '90, was a Dartmouth medical student in the late 1980s. Nor were there programs available to help shape the experiences of students like Adams who were interested in working with medically underserved international communities—students were left to their own devices.
Lack of formal programs did not stop Adams from finding her own path, and Adams is now using her more than 20 years of global health experience to help students coordinate international service-learning experiences through Geisel School of Medicine's Center for Health Equity.
A third-generation Albanian-American, Adams went to Albania during her third year of residency. With neither the resources nor the support of a formal program, she took advantage of connections through family and friends to arrange a six-week elective working in the cardiology unit of a hospital in Tirana.
"There was something so profound about that experience that when I came back, I didn't want to change my wristwatch back to American time because I still wanted to be there," Adams recalls.
Working in Albania changed the trajectory of her career. "It was my life-altering experience," she says. "The cross-cultural aspect of care, together with the dire needs, were compelling to me—it was an experience that I'll never forget."
Adams knew she would continue working abroad, and after completing her residency she headed to Kosovo, where she spent several years as a tuberculosis (TB) medical director with Doctors of the World, USA. After a stint in a community health center in Boston, she joined the International Rescue Committee to provide care to Burundian refugees in Tanzania. She returned to the U.S. in the late 1990s to work for the New York City Department of Health's TB Control Program as director of surveillance.
At that time, Geisel was entering a partnership with the Pristina University Medical School in Kosovo to help them rebuild their medical education and health-care systems. And it was through that partnership that Adams was reconnected with her alma mater. Given her background in the region, she was consulted for informal advice, and she recognized the growth in international programs underway at Geisel.
While there wasn't an opportunity for Adams with the Kosovo project, she quickly singled out Ford von Reyn, MD, a professor of medicine at Geisel who, along with his research team, had been working to eradicate HIV-associated TB in Tanzania. On a leap of faith she left her job in New York and relocated her young family to New Hampshire's Upper Valley.
"It was a perfect fit and I was able to start on a very small scale," she says of her work with von Reyn, which allowed her to travel back and forth to Tanzania. Von Reyn would eventually become her most important mentor.
Interest in global health work among American medical students had increased exponentially since Adams made her first overseas trip. Further growth was catalyzed by the publication in 2003 of Tracy Kidder's widely read biography of physician and anthropologist Paul Farmer. The book, Mountains Beyond Mountains, inspired legions of college and medical students to pursue international humanitarian experiences.
To accommodate Dartmouth students' demand for those experiences, in 2009 the college's John Sloan Dickey Center for International Understanding collaborated with the Geisel School of Medicine to launch the Dartmouth Global Health Initiative, dedicated to providing opportunities for undergraduate students interested in global health. Naturally, Adams participated in the planning process and then became the initiative's part-time director
As the initiative grew in popularity, and overwhelming student demand began outstripping the ability to create opportunities, a group of enterprising medical students decided they needed something solely dedicated their interests.
Working with Adams, and others at Geisel, they laid the groundwork for a new initiative, presented it to Chip Souba, dean of the medical school, and in spring 2013, the Center for Health Equity became a locus for Geisel's global and domestic health activities focusing on care for underserved populations.
"We're putting our money, people, and time where our values are," notes Adams, now director of both the Global Health Initiative and the Center for Health Equity, and associate dean for global health. "It's about saying that this is central to our mission and to our core values—promoting health equity for populations across the globe."
Adams's plan is to have health equity more deeply embedded in Geisel's core curriculum, rather than on the fringe of it as is now the case.
To that end, she created a faculty advisory steering committee to develop learning objectives for service-learning experiences, and she is collaborating with Greg Ogrinc, MD, associate professor of community and family medicine, to determine what a global health concentration in the revised curriculum might entail.
With the long and continuing history of doctors providing medical relief work alongside those providing humanitarian aid, Adams is convinced that educational programs are increasingly necessary for preparing students to do this work well and to do it right—to take a deeper look at and to critically examine the issues around global health and their ramifications.
On par with the firmly established Urban and Rural Health Scholars programs, Adams created the Global Health Scholars program under the auspices of the Center for Health Equity to address the needs of students who are specifically interested in international health issues. This year, the 14 scholars organized speaker sessions and a journal club to discuss topics of interest, and they have created a website that is in a beta testing phase. They are also evaluating existing service-learning programs for sustainability and seeking new project partners.
The Geisel School of Medicine maintains strong partnerships in Haiti, Kosovo, Peru, Tanzania, and Rwanda, along with the Indian Health Service in the U.S. In 2012, Adams helped launch Rwanda's Human Resources for Health Program—a consortium of medical schools convened by the Clinton Health Access Initiative to build a high quality and sustainable medical education and health-care system in that country.
"I do think that Geisel is well positioned to help address some of the world's most pressing problems because we do a few simple things very well," Adams says. "We are excellent partners, we value personal relationships, and we honor our word, which is important. Honoring your word is something we try to ingrain in our students."
Adams says that she would love to be able to satisfy all of the qualified students who want to get out there and do something domestically or internationally, and to help Geisel's partner sites grow and incorporate more reciprocal opportunities.
"And," she continues, "I'd really love for there to be a health equity progression so that students can figure out what makes sense for their lives and their career trajectories."