On the ground: Why global health matters to Sojung Yi ‘12

Thursday, Oct 19, 2017
by Erin Wispelwey

In this spotlight, we talk with Sojung Yi about her experiences abroad, what has inspired her outlook, how she finds motivation in medical school, and why global health begins with local health.
 

Erin: How were you involved in the Global Health Program as an undergrad?


Sojung: I had been interested in global health even before college, so once I got to Princeton, I knew I was going to apply for GHP [Global Health Program]. It has a solid core curriculum with inspiring lecturers who constantly challenge you to hone a more nuanced understanding of “global health.” After taking a GHP course with Professor Biehl, I committed to majoring in anthropology and worked with him on my junior and senior theses. I also relied on GHP resources for immersive opportunities in the field every summer to dive into subjects that had intrigued me from lectures on campus.

Erin: What did you value most—or what was most unique about the GHP experience?


Sojung: GHP champions a comprehensive approach to health and health care. It brings in diverse perspectives, which is reflected in not only how our classes were cross-listed across multiple departments, but also how those lecturers were well-known voices in their respective fields. For example, I took seminars with Professor Adel Mahmoud who is a molecular biologist and the former president of Merck Vaccines, and of course with Professor João Biehl who is an expert in his area of medical anthropology. The rich backgrounds of our professors, the innovative collaboration between them, and the respectful dialogues they fostered all demonstrated the importance of being able to think across traditional disciplinary lines. In practice, the medical field and global health landscape are often quite siloed, so building this reverence for multidisciplinary work through GHP has been fundamental to my growth. Ultimately, studying these complex health milieus with our diverse peers and faculty empowers us to think that we can address these multifaceted health challenges—in small or grand scales.


To this day, I refer back to my GHP texts and syllabi when I write applications for global health-related opportunities, because what I gained through GHP at Princeton is so central to my values. These courses and experiences provided the language and frameworks that I needed to be able to approach global health-related questions—it taught me the way to speak about the problems that I want to help solve.

 

Erin: What texts do you tend to go back to?


Sojung: I still use concepts from Pathologies of Power by Paul Farmer (link is external). I’ve kept up mostly with anthropology texts, because I enjoy the ethnographic sensibility for understanding global health, so while these newer books were not assigned in class back then, they are very much in line with the curriculum: Improvising Medicine (link is external), A Heart for the Work (link is external), and Scrambling for Africa (link is external).
 

Sojung Yi

Sojung attended the Rwanda Surgical Society's Annual Scientific Conference in Kigali, Rwanda, where she is seen here listening to anesthiologist Dr. Paulin Banguti during discussions about National Surgical, Obstetric and Anesthesia Planning, an iterative process through which physician-leaders and Ministry of Health officials focus on expanding surgical capacity and health access.
 

 

Erin: You mentioned that you knew you wanted to study global health before college, was there a specific moment that you realized you were interested in global health?


Sojung: Yes! It was while eating steamed broccoli in high school [Lakeside School (link is external)]! I know it’s a bit of a cliche, but I had the opportunity to meet Dr. Paul Farmer and Ophelia Dahl over lunch, and I remember listening to their Partners in Health (link is external) story and deciding, “I’m going to do global health, and I’m going to do it this way—through anthropology and medicine.” I was and continue to be incredibly lucky. My high school was focused on global citizenship and had a very internationally aware curriculum.


Another more personal reason for being drawn to this kind of work is my hyphenated identity as a Korean-American. I grew up between two distinct cultures, and anthropology provided me with the intellectual space and tools for exploring and translating  between these two sides. I have always wanted to use this in-between experience to help with immigrant or minority health and social justice issues in the US, which fits in with my larger vision for health equity worldwide.  

 

Erin: You mentioned that you went abroad every summer, can you tell me more about where you went and what you did?
 

Sojung: The first summer I did a global seminar through IIP [Office of International Programs (link is external)] entitled, “Sustainable Design: Creating New Solution in Global Development,” and went to Ghana with Professor Soboyejo (link is external)from the MAE [Mechanical and Aerospace Engineering] Department. We learned a practical framework for integrating culture, development, and design to tackle problems such as transportation, affordable housing, alternative energy, and health. It was exciting to finally see things on the ground that I had read about.
 

The second summer, I developed a Health Grand Challenges internship through the Princeton Environmental Institute (link is external) with GHP support. I was interested in HIV and nutrition, so I went to work with an NGO that focused on women’s and children’s health education in South Africa. I wanted to understand how this tiny NGO managed to navigate the larger international NGO scene to carve out its niche and gain funding. Religion played a significant part of this organization’s identity and strategies for negotiating financial support, so I ended up writing about religion for my Junior Paper, which was unexpected but responsive to my experience.
 

The following year, I studied abroad with the EEB (link is external)[Ecology and Evolutionary Biology] Department. I’m not sure if they’d ever taken an anthropology student before. I wanted to go to Kenya and it was a unique opportunity to see ecology and biology in action. I learned what EEB measures when they examine climate change or water scarcity, and how these variables in turn affect health care and migration. As an anthropology major in this EEB program, I gained new appreciation for how biologists and engineers approached health through biostatistics and other quantitative analyses, and learned to bridge some of these insights with anthropology and its qualitative advantages.
 

For senior year, I did my independent thesis research in Rio de Janeiro, Brazil, with the help of GHP and the Adel Mahmoud Global Health Scholarship (link is external). At the time I was in Rio, the city was undertaking massive primary care system reform.  I hung out in the favelas and tried to understand challenges to implementing this primary care expansion process. I followed Community Health Workers to visit patient homes and also worked with public health officials in their offices. What I discovered was fascinating—despite increased access to healthcare on the maps, people living close to clinics still couldn’t access care. Local criminal and drug trafficking boundaries often did not align with the government’s designation for the clinic service areas. The thesis findings culminated into a proposal to facilitate communication channels between the community and municipal levels during this health care reform process. This experience emphasized to me the importance of community-based research in forming policy that has the potential to shape health systems and even medical practice.

 

Erin: What have you been up to since graduation?
 

Sojung: After I graduated, I did a P55 [Alumnicorps (link is external)] Fellowship in health policy. I spent so much time abroad as an undergrad and I wanted to understand the US health system in which I would be training and practicing. This was 2012, so it seemed logical to explore implementation efforts of the Affordable Care Act (ACA). I helped draft recommendations on how to implement different components of the ACA and presented them to various industry and legislative representatives. During this fellowship, I saw firsthand the importance of integrating care quality metrics that are relevant but also flexible and responsive to local practices. It was important to contextualize aggregate statistics from policy initiatives with physician’s experience at a local, day-to-day level.
 

After my fellowship, I started medical school at George Washington University in Washington D.C. Most recently, I took a year off and went back abroad through the Paul Farmer Global Surgery Fellowship (link is external) (PGSSC) at Harvard Medical School. There are many one-off opportunities in medical school to go abroad through health mission trips, but it was important to me that any program or experience I chose was something that had continuity and was thoughtful about its long-term impact for the communities it intended to reach. The PGSSC consists of an impressive group of surgeons who think across disciplines to develop sustainable health systems.

 

Erin: Where did you go and what sort of things did you learn and do as a PGSSC Fellow?
 

Sojung: I lived and worked in Rwanda for most of the year and went to Brazil for the final few months.

After learning about trauma systems in the US, and innovative care quality metrics in trauma through a surgeon mentor at GW, I of course wanted to learn about the problem from an international perspective. The global burden of disease addressable through surgical intervention is significant and growing. Road traffic injuries, for example, are rising swiftly in low- and middle-income countries. Simple, curative surgical procedures can avert disability and premature death from life-threatening emergencies. I was drawn to how strengthening surgical care required thinking about non-operative aspects of care, such as management, financing, and infrastructure.

 

Erin: What was it like going abroad in medical school compared to the experiences you had abroad at Princeton—how has this experience helped you decide where to focus in medicine?


Sojung: There are a couple aspects to my PGSSC research year that were pivotal. First, my main responsibility as a research associate was to strengthen the research capacity there and to develop my own research skills. In addition to those activities, being in the hospital’s ED [emergency department] as a medical student really shifted how I understood the state of clinical care, health systems development, and medical education in Rwanda. Day-after-day, I was confronted with real challenges of providing medical care in contexts with variable resources: from the higher-level, inevitable ethical conundrums, to the individual medical decisionmaking limited by the realities of poverty. The acuity and intensity of those patient experiences in the ED captivated me. I think GHP had prepared me well with a moral and ethical framework to approaching global health, but it was important to see medicine in action, from the frontlines, as a future provider. After a couple years of memorizing and studying facts in the library, I needed to remember why I had chosen to go to medical school. Having this re-ignition in Rwanda and Brazil was essential. Living and working abroad helped energize me, and to draw inspiration again from the rapidly changing global health field.
 

Sojung Yi
The first class of emergency medicine residents to graduate from University of Rwanda teach Sojung how to use an ultrasound machine to assess for lung injury. The ultrasound is advantageous in limited-resource settings for its low-cost, low-maintenance, transportable, durable, and clinically versatile technology.

 

Erin: What factors went into your decision to choose a career in medicine and global health instead of a career in public health and global health?
 

Sojung: I wanted to be able to care for patients with a clinical skill set, which naturally drew me to medicine. The ultimate goal is that the insights I gain from my clinical training and practice help inform how I can contribute to the global health field. Of course, there are so many ways to enter global health, and what’s so exciting about being a part of this community is that it needs to be interdisciplinary. Just to bring it back to GHP, a key strength of the program is that we all have our own majors, and then decide to add on the GHP certificate, which means that we can approach these health challenges from multiple angles. In that process, we learn different thought processes and tools for solving problems.
 

Rwanda was the first time I was in a more clinical setting abroad and could add a nascent clinical lens to the public health dialogue. The role of a provider brings a whole host of clinical and ethical questions that I may have been able to access as a non-clinician, but perhaps not feel as intimately as when I imagined being responsible for medical decisions. For example, during my first morning rounds, there were five babies needing a ventilator, but only two were available that day. We discussed who would get the ventilators, how to make that kind of clinical decision. Imagine being the person that calls those shots! Importantly, my American attending reminded me that her Rwandan colleagues make these decisions every day, all day, and still got up the next day and came back to work. It was a good reminder that providing health care in this complex web of variable resources is simultaneously very personal and much bigger than us.
 

Seeing the global, changing health care landscape this year has reminded me that the world is full of a staggering array of opportunities, and we simply cannot know what we don’t know. The choice of how to enter global health is a personal decision, because no one can determine what your priorities are and will be.
 

Erin: What do you love about your work now? Is there anything you don’t like as much about what you do?
 

Sojung: I love that I’m constantly challenged to think and grow. I will always be a person between disciplines, moving between fields and spaces. Global health is a dynamic field—it can sometimes feels glacial but every step forward impacts someone, some community.
 

Medical training can be physically and emotionally exhausting, but holding onto those moments of remembering why I’m doing it is the most nourishing. I learn how to treat patients in resource-rich, academic centres while I’m in medical school, but I always try to translate what that care would look like if I were to meet this patient in the DRC [Democratic Republic of the Congo], the Amazons, and so on.
 

Erin: Any thoughts, advice, words of wisdom for current GHP students?
 

Sojung: It's been important for me to think about how these global health lessons are applicable at a local and community level too. For example, I helped start the GW Human Rights Clinic in DC which helps refugees undergo medical exams as part of their application to seek asylum in the US. Especially now, with this particular political atmosphere, getting engaged and fighting for the social equity issues that affect health in the US is essential. I find my roots in my local community, wherever that may be.