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What is Social Medicine? An experiential course in Africa inspires and motivates two future physicians

Hi! We are Anita and Ione, and we’re writing today in the wake of our return from a four-week trip to Uganda and Rwanda where we participated in an experiential course about Social Medicine.

We first heard about this course nearly two years ago through the Global Health & Disparities Pathway of Excellence, of which we are both a part. At the time, we were in the midst of our core clerkship rotations, deep in the weeds learning about the presentations of various clinical pathologies and the process of disease diagnosis and management. The title of SocMed’s course, “Beyond the Biologic Basis of Disease: The Social and Economic Causation of Illness,” stood out as a chance to revisit and go deeper into the structural framework that shapes health outcomes. We both kept the course on our radar as we moved through the Branches phase of the medical school curriculum, and the stars aligned for both of us to enroll in the January 2020 course in Uganda and Rwanda, with the generous support of Global REACH.

On a village visit in Northern Uganda to learn about culture as it relates to health

Arriving in Uganda at the start of the course, we joined a diverse cohort of learners from a spectrum of nationalities, ethnicities, professions, and personal experiences for a truly global educational immersion. Approximately half of the course students were from African countries, and the other half were from Western countries. The structure of the lesson plans offered ample opportunities to share and learn about the similarities and differences of our different contexts. Thus, as students we were also each others’ teachers, and through this approach we learned from our fellow classmates in ways that would have been impossible to organize into any kind of syllabus.

The curriculum of the course ensured that we spent our days exploring the structural causes of disease and the response of health systems to these structural causes, not only through conventional techniques like classroom-based lecture, discussion, and group projects, but also through reflective writing, dramatic expression, and place-based site visits. These layered exercises in critical thinking and action (termed praxis) encouraged us to interrogate how and why health systems are structured, and the considerations that must be given to demand, resource availability, and resource distribution. Moreover, the course structure left space to discern the values that define these health systems, and what implications that has for health equity.

Anita and Ione at the peak of Mount Kalongo!

However, we didn’t stop at the level of health systems: we also investigated the role of social movements in addressing structural causes of disease, and implementing the principles of advocacy for change. We practiced engaging with these practices in an intrinsically personal way: by drawing upon our personal histories and situating those within the work we do, we can approach action, agency, and change from a place of authenticity and security. Moreover, we can give ourselves the space to reflect on how we, too, are a part of the structures we choose to critique, and how power dynamics and systems of oppression that we might learn about in an abstract sense unfold on deeply personal levels. After completion of this course, we both feel inspired and motivated to use our voices as future physicians to engage with our communities at a grassroots level, and organize to effect change at a structural level!

Studying Anatomy on a Yoga Mat

Studying Anatomy on a Yoga Mat

The first letters I ever had after my name were “RYT,” which stands for Registered Yoga Teacher. Before medical school, teaching yoga was a significant part of my life, with classes catered to groups ranging from third grade students to the football team at my university. After starting school at UMMS, I still found time for my personal practice and even teaching a weekly class at the CCRB through UM Recreational Sports, but my identities as a medical student and as a yoga teacher seemed to exist in two separate worlds.

Until the M1 Musculoskeletal (MSK) sequence, that is. As we dissected the muscles of the human body and discussed their attachments, actions, vasculature and innervations, I found myself returning to a familiar language from yoga teacher training and my subsequent studies as a Kinesiology major at Wayne State. When it came time to memorize this wealth of information for the exam and anatomy practical, a fellow yogi-classmate and I rolled out our yoga mats, cracked open a book on the key muscles of yoga (which, incidentally, was written by a UMMS alum!), and literally moved our way through the list of structures. Our yoga-based studying proved to be helpful (or at least wasn’t an impediment), and, beyond that, it was fun.

It made sense to me that movement-based education could supplement the traditional musculoskeletal anatomy curriculum, so I proposed the idea of an anatomy through yoga workshop to the MSK sequence directors, Dr. Hearn and Dr. Alsup. They were incredibly supportive. Over the following months I drew upon my knowledge and experience both as a yoga instructor and as a medical student to design the curriculum for a session that reviewed the key muscles of the upper and lower extremities along with their attachments and actions. The session goals, in my mind, were not only to create a structured space for review of important content, but also offer participants a new way of engaging with anatomy and a chance to bring wellness practices into the classroom.

During my M2 year in the Clinical Trunk, the M1 MSK sequence fortuitously fell in line with the Intensive week for clerkship students, giving me the availability to lead the MSK “Anatomy through Yoga” sessions multiple times. With the support of the MSK sequence directors and the Division of Anatomical Sciences, the sessions were well-advertised and attended by over half of the first-year class. I was even listed alongside the faculty lecturers as an “MSK course instructor”!

In the spirit of self-assessment, we administered a short, anonymous quiz before and after the session, as well as a post-session survey, to understand the value and impact of the workshop. The results demonstrated that the session significantly improved participants’ objective knowledge of the content and subjective comfort with the material. Students found the session valuable and overall left the class in a better mental state than when they arrived.

As an M3 in the Branches, I had the flexibility to ensure that I could offer these sessions to this year’s M1 class as well, and under the auspice of the Capstone for Impact program, I am working on developing this into a resource for the MSK anatomy curriculum that exists beyond my graduation. Exactly how that will happen? Still to be determined. But as I look forward to the next steps for this project, I am confident in its success largely because of the immense support from UMMS faculty and the extent of resources made available for students to turn their ideas into tangible impact.

Growing Thyme: A Reflection on Cultivation and Community

It takes a tomato seed about a week to germinate, seven weeks to be ready for transplant, and about two months after that to have harvestable fruit. By the metrics of the academic year’s calendar, that timeline would easily tally up to the completion of at least four sequences, a handful of weekly quizzes, and countless lecture hours. But with harvest season on the horizon and summer break at its peak, it feels fitting to count days by when we transplanted our seedlings as we wait for vines heavy with green tomatoes to ripen.

Anita Vasudevan, Jack Buchanan, and Charlie Katzman with the freshly planted garden

Before beginning medical school, a good amount of my time was spent in gardens, growing food. It is a space that requires patience and persistence, not to mention a willingness to go along with the occasional derailment of plans (maybe not so different from med school itself!). In becoming a part of the UM Medical Campus Garden, I was excited to embrace our single garden bed as a reprieve from the rigor and rhythm of curricular demands and a return to a cherished and familiar hobby.

This year, we’ve planted a variety of tomatoes, peppers, eggplant, basil, marjoram, sage, and chives. Our garden is tended to by student volunteers who water and weed daily, and we are eagerly anticipating our first big harvest at the beginning of August. But perhaps what carries even more weight than the pounds of produce we gather is the attention we garner from nearly every person who strolls by while one of us is at the garden.

Student volunteer Mikhail Ognenovski poses with the garden after his watering shift.

Though it may be small, the garden is a symbol of our medical community’s commitment to honoring where real food comes from, connecting with our planet, and sharing with one another. Our plot is situated along a well-treaded path between two hospitals and the UMMS admissions offices, which makes it very amenable to eliciting conversations with all passersby – patients, staff, physicians, and fellow students alike. These usually begin with a question and end with taking a small sampling of herbs home.

It is a small action, but one that I believe goes a long way in creating a sense of community and belonging. With much of all our lives defined by a nonstop agenda of places to be and things to do, the garden is a gentle reminder of the value that lies in pausing for a moment to marvel at a flower as it flourishes into fruit.

Waiting for tomatoes to ripen!