Each week, Beyond Boulders delivers a new installment of “Five Questions for a Fellow” – an interview series with Schweitzer Fellows across the country and in Gabon, Africa who are leading the movement to eliminate health disparities. For an archive of previous “Five Questions for a Fellow” interviews, click here.
Earlier this week, the Obama administration unveiled its new national strategy for addressing HIV/AIDS—a strategy that emphasizes prevention, urges coordination between agencies, and aims to reduce new infections by 25%.
Revathi Jyothindran and Joshua Liao, two Schweitzer Fellows in Houston, TX, are tackling the issue of HIV/AIDS at the local level. With Ben Taub General Hospital’s Emergency Center as their setting, these Baylor College of Medicine students are working to establish a program that links newly-diagnosed HIV+ patients to follow-up and long-term care, and amplifies their voices through stories that will be published for hospital system distribution. Ultimately, Jyothindran and Liao’s Schweitzer project supports a larger goal of helping HIV+ patients live longer, healthier lives through awareness and continuity of care.
Why did you decide to develop your particular project?
Jyothindran: Both of us became quickly involved with the clinical practice of medicine early on in our first year of medical school. The emergency rooms at the county hospital here fascinated us, not only because of the exposure we got to the management of illnesses, but also because the largely indigent patient population there moved us.
We have both always had an interest in public health, and the Ben Taub Emergency Center (BT EC) seemed like fertile ground for our ideas. [Click here, here, and here to read about two of last year’s Schweitzer Fellows, who established a lifesaving patient education program in the BT EC last year.] In the EC, we saw HIV patients run the natural course of their disease, when in this day and age HIV is a disease to die with, not to die from.
Finally, we wanted to work with this population because spending time and energy to improve the system for HIV linkage will not only improve the quality of our patients’ lives, but also teach us how to more effectively use resources and address the many other important issues in HIV care.
What do you hope will be the lasting impact of your project on the community it serves?
Jyothindran: Because such a large proportion of our county’s HIV+ population is diagnosed in the BT EC, and because we currently have little insight into why the linkage rates are so dismal under the current system, our project hopes to provide the community enduring value by laying the initial groundwork that will hopefully improve the quality of life and give the BT EC and community clinics more insight into how to conduct future implementations and projects.
Additionally, it will give the patients affected by these linkage issues an avenue to express their voices through stories and lives that resonate much more deeply and inspire much more powerfully than any data, number, or rate.
Moreover, we believe these several benefits will create even more lasting value as the attention and efforts given to various aspects of HIV care in our community only increase in the coming months and years.
What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?
Liao: This might sound biased given our project and somewhat artificial given the connected nature of the healthcare climate, but I really believe HIV is probably the most pressing medical issue of our time.
While there are other conditions that are important in terms of cost and number of people affected – obesity, cancer, diabetes, heart disease, to name a few – HIV/AIDS seems most “pressing” and unparalleled in view of the social stigma and range of morbidity and mortality associated with it, its impact on issues like healthcare access, and the way it has gone from obscure disease to treatable chronic condition in a matter of 30 years.
HIV/AIDS is a huge issue, and I don’t presume to even begin knowing how to address it fully (our project is hopefully a small effort in that direction). But one thing is clear: with regular, consistent treatment and follow-up, patients can drastically decrease HIV-associated morbidity and mortality. They can live better and longer, and their condition doesn’t have to be the “death sentence” it was once viewed as.
With that in view, it seems that one of the most urgent steps in addressing HIV/AIDS should be strengthening long-term continuity care through issues like pharmacy, access, and patient awareness/education. Because up to this point, much of the emphasis and progress in HIV care has been related to diagnostic and therapeutic advances, while the reality is that the potential for those advancements will never be fully realized without ensuring that patients to link to, and maintain, the care available to them.
What’s encouraging is that many groups and communities with HIV prevalence understand this and are working to strengthen that aspect of patient care.
What has been the most surprising element of your experience as a Schweitzer Fellow so far?
Liao: So far, we’ve probably been most surprised by the amount of outside interest and commitment to improving continuity of care for HIV patients in our community. Obviously HIV has been a major health issue for some time now, but we didn’t realize how much time, interest and resources are being invested in some of the things we are trying to learn through our project.
As we realized which aspects of care and ideas for improving it were most important to us, we also discovered that many others in the county district had similar ideas, passions, and desires. And though it certainly takes great cooperation and understanding to work with so many different groups, the encouragement and support that they provide will be invaluable to our project.
So far, our project has really been example of how when you start specifically looking for things, they begin showing up everywhere, including places you wouldn’t ever have expected to find them. In this case, what we’ve been noticing is the support and encouragement that can’t really be over-emphasized. We’re confident that they will be crucial as we try tackling a small aspect of this important, pressing health issue.
What does being a Schweitzer Fellow mean to you?
Liao: For me, the Fellowship is at once an affirmation, encouragement, and challenge. It is an affirmation of my belief that no matter what stage or arm of health care I’m in, I can and should think creatively and work diligently to address important health care issues. As obvious as that might sound, it’s often far too easy to forget amid heavy work schedules, endless amounts of information, and complex clinical situations.
With that in view, the Fellowship serves as an reminder that I have not been misguided or foolish to put my energy and hope into what (admittedly) small projects can do. It is an affirmation that service is transformative and crucial to my personal growth, even as I try to help those around me.
The Fellowship is also an encouragement, especially as I meet with the other Houston/Galveston Fellows, and as I learn more about what U.S. and international fellows are doing. It encourages me that I’m not alone in my effort, and reminds me that I don’t have to (and assuredly can’t) rely only on my own effort in view of such passionate peers.
Finally, it is a challenge because while the goal is not to live up to the legacy of Albert Schweitzer or other fellows, I am spurred on to bigger, greater things by their examples. They push me to aspire and reach for bigger and greater things than I would’ve otherwise.
Jyothindran: Being a Schweitzer Fellow means that I have been fortunate enough to be granted a set of resources – mental, emotional and financial – which I can use to implement the vision I’ve had for our public health project.
Certainly, one of the most striking features of our cohort is that our passion is contagious. Already I have had some great interactions with my cohort and it seems like there is no end to the number of ideas that our group can come up with, given a certain problem. Most importantly though, being a Schweitzer Fellow is an honor and a privilege that symbolizes that I have miles to go to achieve that ideal that I have been striving for.
Revathi Jyothindran and Joshua Liao are Schweitzer Fellows in Houston, TX. Click here to read more about The Houston-Galveston Schweitzer Fellows Program and the Fellows like Jyothindran and Liao it supports in creating and carrying out yearlong direct service projects. To make a gift to The Albert Schweitzer Fellowship in honor of Jyothindran and Liao’s efforts to improve continuity of care for newly diagnosed HIV+ individuals, click here.