A strong love of the outdoors, and a childhood rooted in exploring the woods and mountains of the Pacific Northwest, influenced Kristen Delwiche’s decision to attend Geisel School of Medicine. “What better place to attend medical school than here, in close proximity to nature, where I can find balance and be happy. I feel a strong sense of community here too—and I like that,” says the first-year medical student.
Delwiche studied biochemistry in college and during her junior year she participated in a wildlife conservation and political ecology study abroad program in Tanzania—an experience that piqued her interest in the intersection between environment and population health.
“It wasn’t specifically health focused, but there was an independent study aspect to the program that gave each of us one month to pursue an area of interest,” she says. With thoughts of becoming a doctor lurking in the back of her mind mixing with her mother’s use of herbal medicine to treat the family’s aches and pains, Delwiche set out to learn how women living in a rainforest village with limited access to healthcare thought about illness and used plants to heal.
“I thought I’d be learning about native plants with powerful medicinal properties. Instead, I discovered spiritual healing involving charms made of animal parts and herbs were perhaps an even more valued aspect of the traditional healing process,” she recalls.
I was accustomed to thinking about health from a molecular level up, but my research in Tanzania pushed me to think about health from the community level down.”
- Kristen Delwiche '19
Initially, Delwiche found this practice horrifying—she saw elderly people with massive scars on their backs and chests from having burned herbs placed inside cuts made on their already frail bodies. Traditional healers were expensive, but with limited access to Western medicine they provided accessible medical care to the villagers. As she began to understand the substantial role traditional healers play in caring for a population, it reminded her to be non-judgmental toward their practices when treating those patients.
This experience was pivotal because it changed the way Delwiche thought about healing.
“I was accustomed to thinking about health from a molecular level up, but my research in Tanzania pushed me to think about health from the community level down,” she says. It became obvious to her that access to quality medical care was only a small contributor to overall health and she began thinking about a career in public health rather than direct medical care. “It can be overwhelming, but I like thinking about how the whole system fits together,” she adds. “There are a lot of problems that can be solved by scaling existing technologies, and there is a lot of money flowing into global health as well—the key is to make sure it’s channeled to the right places.”
As she sees it, one of the issues in the field of global health is a lack of high quality information about population health and health system function to inform both policy decisions and well-intentioned donors.
Delwiche’s next step was a three-year global health fellowship at the Institute for Health Metrics and Evaluation, where she worked on collating information on the prevalence and relative global impact of health risks. “It’s useful to know how many people are dying or suffering from specific disease,” she says. “But from a prevention perspective, what we want to know is what’s really driving disease —what are the biggest contributors.”
Her research delved into quantifying the impact of risk factors such as drug use, intimate partner violence, childhood sexual abuse and physical inactivity on death and disability from associated health outcomes. “If we have information on the prevalence of intimate partner violence, in combination with information on the magnitude of excess risk for say major depression associated with violence exposure,” Delwiche says, “then we can estimate the relative contribution of intimate partner violence to the overall burden of depression in any given country.”
In places like sub-Saharan Africa for example, intimate partner violence is highly prevalent especially among women of childbearing age—and she thinks it’s important to expose these issues on a global scale because they aren’t getting attention. “I like working with risk factors we don’t typically think of being immediately related to health issues, and thinking about how we can build capacity around prevention by looking at things that are strong predictors of health—education, violence, and access to good nutrition,” she adds.
The fellowship armed Delwiche with extensive data analysis experience and taught her the importance of using data to guide decisions. But staring at a computer screen everyday and thinking about people in terms of mere numbers took its toll. “It was really hard on me losing sight of those individual stories,” Delwiche says. “Ultimately human connections are what energize me and really ground my sense of purpose. I chose a career in medicine because I wanted both the depth of understanding and the flexibility to heal on an individual and population level.”
Population health is important because it keeps you in touch with health on a larger scale—and I’m trying to figure out how to incorporate that into a medical career.”
- Kristen Delwiche '19
When asked about future global health works, Delwiche says she is not enthusiastic about isolated mission work. “What does excite me,” she says, “are programs that build capacity by training professionals on the ground and have a long term bilateral plan—like the DarDar program in Tanzania and Dartmouth’s ongoing partnership with Kosovo, where I’ll be going this summer.”
Although Delwiche loves traveling and acknowledges there is a lot of work to be done globally, she ultimately sees herself practicing medicine in the United States. “I’m not yet sure what medical field I see myself in, but I do know I’d ultimately like to have a leadership component to my work,” she says. “Population health is important because it keeps you in touch with health on a larger scale—and I’m trying to figure out how to incorporate that into a medical career. It’s really those individual patient experiences that highlight problems and provide the context and insight that can fuel innovative solutions with the potential to impact many people.”