(Originally published in Interdisciplinary MPH Program Alumni and Student News, Spring 2011)
Rita Hamad MD, MS, MPH ’07 writes: “After more than two decades of school, I finally received my MD last year from UCSF. I’d completed the Interdisciplinary MPH in 2007 and I was ready to start changing the health care system, as I had envisioned since when I first applied to medical school.
“Sadly, the first year of residency is not a great time to embark on such a mission. Eighty hours of my week are devoted to patient care or the paperwork needed to satisfy insurance administrators and charting requirements. The rest of my week is spent satisfying my bodily needs, like eating and sleeping.
“Still, it’s an exciting time to be a member of the health profession. I am an intern in Family Medicine at Contra Costa Regional Medical Center based in Martinez, California, with my clinic located at the Richmond Health Center, a few miles north of Berkeley. As a public system that serves the uninsured and underinsured, we have seen no shortage of patients who have lost their health coverage in the recent economic meltdown.
“Our hospital and clinics have been overflowing with people desperate for medical attention, testing our ability to provide timely and effective care.
“Thankfully, our county is one of the beneficiaries of the recent health care reform legislation. Our dilapidated clinic in Richmond will soon be rebuilt to include more physical space and updated technology. Our hospital is installing an electronic medical record system, to be launched next year.
“Most days I am absorbed in trying to learn the dose of antibiotics that I should prescribe to treat an ear infection in a three year old. So I can barely follow, let alone be involved in, local policy initiatives. But I view my current indentured servitude as a stepping stone to making more meaningful change on a community level.
“At the end of each long week, I have miraculously found the time to continue the research that I began as a student in the Interdisciplinary MPH Program and the UCSF-UC Berkeley Joint Medical Program. In 2008, I gathered longitudinal data among 2,000 clients of a microcredit organization in Peru. This organization provides small loans to individuals who are too poor to access the traditional banking system, allowing them to invest in businesses and support their families. I collected reams of data in an effort to find out whether participation in this program was associated with improved health among clients and their families. I also explored whether supplementary education about infant health might act synergistically with the funds to improve children’s well-being.
“In my few spare hours each week, I have been able to chip away at these research questions and publish some of my results. The first analysis suggested that women who have participated in microcredit for longer amounts of time may have reduced rates of anemia¹. The second concluded that the supplementary educational intervention improved parents’ knowledge, but not child health status2. I have recruited one of Berkeley’s brilliant MPH students as a research assistant, and together we are assessing whether longer participation in microcredit is associated with improvements in child nutrition, since many clients claim they use their profits to invest in their children. My data also hold the potential to answer questions regarding effects on child education, mental health, and a variety of other variables….if I am ever allowed enough time outside of the hospital to work on them.
“A medical resident’s schedule is unforgiving. My few hours of research are a welcome escape, and I am reminded why I decided to enter the medical profession.
“As all of us in the Interdisciplinary Program are aware, healthcare is not just about face-to-face interactions with our patients, which are alternately brutally frustrating or intensely rewarding. Nor is healthcare simply designing perfectly controlled, sterile research studies that are divorced from the everyday experiences of practitioners on the ground.
“Rather, healthcare is about using all of these components to intelligently use our limited resources, and to best serve the public’s health — especially the most vulnerable among us.”
¹ Hamad R, Fernald LCH. Microcredit participation and nutrition outcomes among women in Peru. J Epidemiol Community Health. Nov 2010 [ePub ahead of print].
² Hamad R, Fernald LCH, Karlan DS. Health education for microcredit clients in Peru: a randomized controlled trial. BMC Public Health. Jan 2011;11(1):51.