Introduction:

Dr. Jonathan Wortham graduated from Washington and Lee University in 2004 and from the Baylor College of Medicine in 2008.  He currently works with the Division of Tuberculosis Elimination at the Center for Disease Control in Atlanta, Georgia.  Jonathan’s penetrating essay below eloquently describes how the combination of poverty-related coursework and an internship at the Atlanta Mission, a homeless shelter offering comprehensive services, has informed his education, his career, and his daily work as a physician. For an account of Jonathan’s recent trip to West Africa to understand better how to address the threat of the Ebola outbreak, see the story that Washington and Lee published about Jonathan on its website.

Essay:

My Shepherd Summer Internship was one of the most valuable experiences I had during college. Before the internship, I took the Introduction to Poverty Class; I learned about poverty in America and around the world. I became knowledgeable about the history of poverty, relevant poverty-related statistics, and policy initiatives for alleviating poverty. Subsequent to the 101 class, seeking an understanding of poverty and related issues in the context of the healthcare professions, I took a class focused on the healthcare system in America, which broadened my knowledge of poverty-related health problems. While I learned so much from both of these classes, the internship added invaluable perspective and unique practical experience that changed the direction of my career. During those six weeks, the people I met and the stories they told me transformed my perspective on homelessness, poverty, and health.

Dr. Wortham in Sierra Leone.

Dr. Wortham in Sierra Leone.

During the summer of 2003, I lived and worked at the Atlanta Union Mission in Atlanta, Georgia. The Mission met physical needs while providing counseling services and a transition to stable housing as men changed their lives.  I had the opportunity to meet and befriend many men who were living there. I will never forget the stories they told me. Most men I met at the Mission had held steady jobs; many had college degrees and a few had advanced or professional degrees. But, for one reason or another, they had become homeless and enrolled in the Mission’s programs to overcome personal issues that were stopping them from being the men they wanted to be.

Health is often conceptualized as the absence of physical disease. Before my experience at Atlanta Union Mission, I probably would have agreed with this definition. But, I was wrong. I realized, that to become the physician advocate for health that I wanted to be, I needed think about health and a different way. Health isn’t just the absence of disease. For example, Dorland’s medical dictionary defines health as “a state of optimal physical, mental and social well-being, not merely the absence of disease.” In addition to meeting physical needs, the Mission was meeting mental and social needs and providing a form of complete healthcare to the men who lived there. In addition to meeting physical needs, the Mission provided counseling services to attend to mental healthcare needs. The Mission also provided a community for men to restore social connections with like-minded people who understood the struggles from which they came and could encourage them to be the best version of themselves. I got to witness how this organization cares for the ‘whole person’ during the internship.

My conversations with men who had triumphed over their personal struggles taught me so much. During the introductory course, my classmates and I realized that poverty was more than the lack of monetary or material resources. But the stories of the men solidified that concept in my mind. “If I had money [from a new job],” one of the men told me, “I would have used it for destructive purposes. Now, I use my money to take care of myself and my family.” This exemplifies the relationship between poverty and the lack of an individual’s capability to control his own destiny to achieve his life’s goal. He went on to tell me that he likely would have remained homeless if he had not addressed his mental health needs. Through hearing his story and others like it, I learned how homelessness, mental health, and substance abuse are interconnected. Every day, physical, mental, and social issues prevent people from realizing their desires. Without addressing these underlying issues, homelessness and poverty will continue to be societal problems. If we address these issues, we will mobilize so much talent that is currently bound by physical, mental, or social issues and unavailable. Because of this internship, I now realize that the reason my profession exists is to use science and advocacy to remove these barriers from peoples’ lives to help them control their own destinies. By doing this, the medical profession can improves individual lives, communities, and society.

After my internship, during medical school and pediatric residency, I learned the science and art of medicine. We also learned that there are socioeconomic disparities in many infectious and non-infectious diseases. I wondered why and how to address these social disparities. During an international trip where we saw and treated many patients with diarrhea, rather than addressing the proximal cause of the outbreak, unclean water, I again questioned my role as an advocate for health. I reflected on my internship and the concepts of health, poverty, and capability, as I decided what to do after my clinical training. I applied to the Epidemic Intelligence Service (EIS) program at the Centers for Disease Control and Prevention (CDC) because I wanted specific training in how to practice applied epidemiology – studying disease at the population level to inform and measure effective interventions to improve health for populations – to complement my clinical training. As an EIS Officer, I got practical experience and training to develop these skills as well as how to provide scientific data to inform health-related policy decisions.

I currently work at CDC in the Division of Tuberculosis Elimination on the Outbreak Investigations Team. I also practice clinical medicine one day per week. When I entered college, my goal was to find a way to use my affinity for science to make peoples’ lives better. Now, I am very fortunate to be able to realize this goal through direct patient care as well as through fighting disease at the population level. Without the experiences the Shepherd Internship provided, I would not have had such a robust perspective of health and poverty that informed my decision to seek this career and informs my decision-making every single day.

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