Learning the Ropes in Faraway Lands
words by eve jacobs / photograph provided by felecia jinwala
nkit Patel and Felecia Jinwala hike across a walkway suspended by ropes between seven trees in Kakum National Park in Ghana, more than 5,000 miles from their home-base in New Brunswick, NJ. This walk in the park is the kick-back part of their journey abroad, where they are learning about the practice of medicine on a faraway continent.
These 20-somethings just started their second year at UMDNJ-Robert Wood Johnson Medical School (RWJMS), so this past summer, their doctoring skills were not yet very advanced. They journeyed as ambassadors and as student-workers in the Unite for Sight program in Accra, and returned to school with a worldview that stretched leaps and bounds beyond New Jersey’s borders.
This is exactly what their associate dean and mentor had in mind when he created the Global Health Office at RWJMS. His name is Javier Escobar and he is a psychiatrist with a specialization in the mental health of Latino immigrants to the U.S. He was chair of the Department of Psychiatry at the medical school for more than a decade before taking on this new challenge, one that is near and dear to his heart. As an immigrant himself — albeit with an extraordinary fluency in the language — he understands how difficult it is to leave your native land, language and customs, and set up a new life in a faraway country. He’s sympathetic to the families whose medical care is dependent on finding their way through a complex system, often with minimal language skills, and he knows how particularly difficult it is to access mental health care when you lack the words to describe what you are feeling.
A native of Medellin, Colombia, Escobar earned his medical degree there from the University of Antioquia, moved on to Spain to study psychiatry, and immigrated to the U.S. in 1969, earning a master’s degree in psychiatry/medical genetics at the University of Minnesota in 1973. Subsequently, he held faculty positions at
several large universities, but it was six years later, as an associate professor at UCLA, that his research career took off when he became principal investigator for several studies focusing on the epidemiology of mental illness among Latino, and non-Latino, residents of California. He also became co-principal investigator in 1981 for a large, multi-year project — the Los Angeles section of the National Institute of Mental Health’s Epidemiologic Catchment Area Study — to collect data on the prevalence and incidence of mental disorders there, and on the use and need for services by the mentally ill.
In 1986, he relocated to the East Coast to serve as vice chair and then interim chair of the University of Connecticut School of Medicine’s Department of Psychiatry; and in 1994, became professor and chair of the Department of Psychiatry at RWJMS. Latino mental health has remained high on his list of research priorities.
What he enjoys most about his job is collaborating on research projects with colleagues around the globe. Their search for the gene for bipolar illness and hunt for schizophrenia genes through studies of large extended families living in remote areas of Colombia, Argentina and Costa Rica have cemented Escobar’s professional relationships in diverse locales. And his partnerships to collect data on the human, social and economic cost of illicit drugs in North, Central and South America, funded by the Organization of American States, helped him build an international network that supports and hosts the “journeying students” from RWJMS. The doors of the medical school’s Global Health Office officially opened about two years ago.
“First and foremost, our students must be safe,” says Escobar, who is personally involved every step of the way. He sits down with each student to map out their one- to three-month stay abroad, which he hopes will familiarize them with another healthcare system, introduce them to clinical cases they may not have the opportunity to see in the U.S., and give them a positive living-abroad experience — supervised by his office.
Spain, Peru, Argentina, Colombia, Ghana, Kenya, India, South Africa — all are places where RWJMS students worked, learned and explored this past summer. But Escobar labors diligently to expand this list, hosting medical delegations from many countries, among them Thailand, China and South Korea, to visit, observe and learn about new technologies and surgical techniques from the medical school faculty in New Brunswick, all the while planning for a reciprocal visit by his students in the future.
“It takes a long time to form relationships and get these student-exchange agreement signed,”explains Escobar, “but the benefits are immeasurable. Students learn about other cultures and languages, they gain an awareness of the health issues in other countries and how they deal with limited resources. Our students have early exposure to clinical cases and see how family support systems work. Best of all, they develop friendships in other countries and, I hope, will want to return there some day.”
While Escobar helps students stretch their personal boundaries, he never relinquishes his own commitment to alleviating the mental and physical stresses of immigrants living in the U.S. “Many immigrant patients are under severe stress and come to the emergency room with physical symptoms that are unexplained,” he says. “What they’re often suffering from is major depression or anxiety, or PTSD [post traumatic stress disorder] from exposure to traumatic experiences,” he says.
But interestingly, the psychiatrist’s research has shown that most new Latino immigrants are far less likely to suffer from major chronic diseases, such as hypertension, than immigrants who have become more Americanized. “Our society is competitive and individualized. We also tend to use more drugs — not just prescription drugs such as Oxycontin, but cocaine and marijuana. The family systems of new immigrants are stronger. But in the U.S., these family systems get decimated.”
“New immigrants are resilient and have fewer expectations. They’re happy not to be persecuted,” he continues. “But the next generation has greater expectations and this can be very frustrating.”
Escobar says that in New Brunswick, “70 percent of our patients are Spanish speakers.” His research shows that the psychiatry patients are primarily from nine Latin American countries, and that a large number are from Oaxaca, Mexico, where, he states, some students would like to go to learn more about life there so they can better understand their patients.
With so many irons in the fire, does Escobar have a vision for the future of the Global Health Office at RWJMS? The answer is yes. He would like every medical student to go abroad after their first year, and all internal medicine, psychiatry and family medicine residents to go to other countries for at least one or two months. He wants more students to take the medical Spanish course offered through his office so they will be more conversant abroad, but also more effective medical practitioners at home. And he is developing a global health curriculum beyond the first and third year electives offered now, as well as working to establish a Master’s degree in this field with UMDNJ’s School of Public Health.
“Just this past Saturday, three out of five consultations that I did in the hospital were with patients who had no English. From my personal experience, this is happening more and more,” he says. “Medical students who understand the importance of cultural differences and have greater cultural sensitivity will be far more effective physicians in their future practice.” Like Ankit Patel and Felicia Jinwala, they will have “learned the ropes” abroad and be better prepared to meet whatever challenges come their way down the long road ahead of them.