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Every Tuesday, Beyond Boulders runs a five-question interview with either a first-year Schweitzer Fellow or a Schweitzer Fellow for Life (ie, a Fellow whose initial year with ASF has been completed, but whose commitment to lifelong service continues).

Why seven questions instead of five? Because today, we have a Beyond Boulders first: an interview with someone who has served as both a U.S. Schweitzer Fellow and a Lambaréné Schweitzer Fellow. That someone is Meredith Dixon, who returned from Lambaréné in April.

As a 2006-07 Pittsburgh Schweitzer Fellow, Dixon worked with a juvenile detention center to bring troubled youth into contact with community role models and encourage them to creatively express themselves through writing, film, music, and art. In Lambaréné, Dixon worked with HIV-infected youth as both a medical Fellow and a Maternal and Child Health Fellow. Now, Dixon is a 4th-year medical student at University of Pittsburgh School of Medicine who is pursuing a pediatrics residency.

Why did you develop your particular Pittsburgh project?

A fellow medical student and I were doing HIV/AIDS education in a juvenile detention center, where we encountered many children who had entered the detention system through their reactions to less than optimal living conditions. Their lives were impacted by various forms of abuse, poor parenting, lack of support from family and/or school, violence, substance abuse and mental illness. Many of these adolescents had no outlet through which to voice their experiences, and acted out by engaging in harmful behaviors. The idea was born that an expressive writing program could promote a more positive manner in which to express one’s negative life experiences, as well as help participants see that other young people have experienced similar traumas.

What was the lasting impact of your Pittsburgh project on the community it served?

I’m not sure exactly how to answer this question. The truth is that as we were wrapping up our project, a lot of changes were happening within the organization. The founder of the organization died, which sparked various political pushes for control within the organization. Our key community site coordinator resigned from the organization. Our project just stopped and we as medical students became engrossed in our clinical activities. I think the combination of those things made it difficult to maintain something long-term.

However, on the positive side, several of the girls with whom we interacted really took to writing and journaling as a stress reliever. One particular girl said that she used to get angry very quickly and lash out at others. However, since beginning a journal several days a week through which she turned her anger into words, she was able to reduce the number of negative interactions that she had with people in her life. This isn’t scientific. It’s not data-driven. That said, if you can make a positive impact on the life of one person, isn’t that a great thing?

Why did you decide you wanted to apply to become a Lambarene Fellow?

While I had previously traveled outside of the US, my time as a Peace Corps volunteer [in 2001] illuminated global health disparities of which I had previously been only tangentially aware. I was astounded at the utter dearth of medical resources available to the community in which I lived in Cameroon. The only staff at my village’s health clinic was a part-time nurse with an unpredictable schedule. The clinic had a desk, 2 chairs, an infant scale, a fridge, a birthing bed with no mattress and that was essentially it. The electricity was as intermittent as the nurse. There was no waste disposal area. There were no gloves. There was no running water. There were no medications stored there.

Peace Corps was an eye opening experience which strengthened my desire to become a physician and work in developing countries. And it was during my time as a Peace Corps volunteer that I learned to speak French, as my village was Francophone. When I learned of the Lambarene [Schweitzer] Fellowship, I saw an opportunity to use both my language and newly-formed medical skills to learn more about the challenges of healthcare delivery in a similar resource-poor area. Plus, I think through experiencing and living in other cultures, you learn more about yourself and become more adaptive and flexible in how you view things.

What was a typical day like for you in Lambarene, and was it what you expected? 

During my first three months [as a medical Fellow] in Lambarene, I was up by 7 am every morning for breakfast at the refectoire with other hospital visitors. At 7:30 I was in the pediatrics ward, and rounded on inpatients. Around 10-11 am, I started seeing outpatients and/or performed newborn exams, depending on how busy the pediatrics ward was.

Once the morning outpatient visits were over, I had lunch and was free ‘til 3 pm. In that stretch, I read about patients, checked email, and visited with other visitors or hospital staff. From 3 to 7 pm, I saw more outpatients.

However, if it was a community health team day, I joined that group at 8:30 am, traveled to a distant village by truck, and vaccinated, performed growth surveillance, and performed outpatient services for children in local villages ‘til whenever the work was done. Sometimes that wasn’t until 4 or 5 pm.

During my time as a Maternal and Child Health Fellow, my day was whatever I made of it, and was pretty unstructured. I had lots of people to talk with so would travel the hospital wards ‘til one of the nurses or doctors had time to talk with me about what the hospital needed to start a pediatric HIV treatment program. Often this involved a lot of waiting around! I would read. I would email people with questions. I contacted NGOs.

What was the most surprising element of your experience as a Pittsburgh Schweitzer Fellow?

The most surprising element of my experience as a Pittsburgh Schweitzer Fellow was the level of natural connectedness that I felt with other fellows and staff. It was refreshing to find a group of people who shared very similar values, who were compelled to work with underserved populations and whose approaches to people to whom life hadn’t been kind was open, encouraging and honest. I hadn’t expected these bonds but this connection has buoyed me during the difficult times in medical school.

As a Lambarene Schweitzer Fellow?

That patients are patients, no matter where on earth you live. In the US and in Gabon, patients run the gamut intellectually, educationally, economically. There are people here and there who give a great deal of respect and power to physicians, who stand up when the doctor enters the room, who will do whatever the doctor says, who are too nervous to ask questions, who won’t admit that they don’t understand something.

There are patients who can’t afford the treatments you prescribe, or who have some other barrier that prevents them from following medical advice. There are patients who feel a sense of entitlement, who demand antibiotics despite their not being indicated or who, because of their position in life, expect to be treated in a certain fashion. All said, despite the vast differences in culture and resources, looking back, I see more similarities between patients in the two places than differences.

What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed? 

I think that health, and healthcare, is too often viewed as a privilege, and not a right. This mentality is embraced by governments who don’t want to put the money into their own citizens. Further, this perspective forms the basis for opposition to healthcare reform in our own country. The people who I most frequently see and hear objecting to healthcare reform are those who already easily access healthcare services.

What does Albert Schweitzer’s legacy mean to you, and how will you carry it with you now that your Lambarene Fellowship has drawn to a close?

When I think of Dr. Schweitzer, I think of someone who made health services available to people who didn’t previously have many choices in that part of their lives.

What originally drew me to the Schweitzer programs was this emphasis on working with and improving healthcare for those overlooked populations, wherever they may be, whatever their background, whichever reason they have for being underserved.

My Schweitzer experiences have strengthened my resolve to work with such groups, and to lend my voice and position when that is desired. Wherever I go for residency training, I know that I want to work with marginalized groups.

There will always be people with power getting what is best for them, but what prompted me to go into medicine is the chance to help less powerful people who aren’t getting the treatment that they need.

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