Spotlight on Dan Schwarz

Dan Schwarz MD'12, MPH

 

Med Student Brings Healthcare to Rural Nepal

Dan Schwarz is currently an MD candidate at the Alpert School of Medicine at Brown University (2012) and holds an MPH from the Harvard School of Public Health (Management and Policy Department, 2010).  Dan's interests lie in the strengthening of public sector primary care health systems in developing nations. In that regard, Dan has been working for the past several years with Partners In Health Rwanda (Inshuti mu Buzima) and Nyaya Health in Nepal, where he is the Executive Director of Bayalpata Hospital. Prior to this, Dan spent several years working in non-profit primary care initiatives in Zimbabwe, Botswana, and Mexico.

Domestically, Dan has been very involved in the community health center network in Rhode Island, and has served as student director of two free-care community health centers. Dan has also been working as a harm reduction counselor in Providence, focusing on HIV/STI prevention and substance abuse counseling, primarily among men who have sex with men in the Providence bathhouses. In that vein, Dan has been involved in a significant amount of public policy work, and has testified on several occasions in front of the Rhode Island State Legislature sub-committees and to the general committee on Health and Human Services.

Following the completion of his MPH in May, 2010, Dan has been working full-time in Nepal with Nyaya Health. He has subsequently return to Brown to complete the final year of his MD, before moving on to a Medicine-Pediatrics residency, with a focus on primary care in underserved areas and developing nations. 

What is your current status at Brown?

I am currently on Fellow status, and will to return to complete my fourth year of medical school during the 2011-2012 academic year. After having finished my third year of medical school in 2009, I spent one year completing a Master’s Degree in Health Systems Management at Harvard School of Public Health, and am now working full-time for Nyaya Health in rural Nepal

 How did you first get interested in global health?

In 2003, while in undergrad at Vassar College, I had the privilege to spend several months working at a public hospital in Botswana. This experience, in tandem with my political science studies (at Vassar) led me to start thinking of medicine as a vocational tool by which we can approach social justice in a truly meaningful way. After college, I spent time working for Partners In Health, and then several years working with a rural hospital in Zimbabwe before and during my time at Brown. All of these experiences highlighted for me the ways in which medicine can be used as an entrance into communities that have wide-spread problems of entrenched poverty, structural violence, and underdevelopment. By beginning with a disease management focus, broad-based development of public service infrastructure can then be approached with strong community support and buy-in.

 For me, my interest in “global health” began as a much broader interest in finding a way for myself to contribute most effectively to the much broader understanding of “health” from a community standpoint. While TB and HIV treatment regimens are obviously incredibly valuable to a community, sending a “healthy” patient home from clinic to a community that lacks food, water, and schools seems to be a rather myopic and limited understanding of “health” on the truly “global” scale. Clinical and physiological health is a good starting point, but is not good enough – necessary and important, but definitely not sufficient.

 How did you become involved with your current project?

Several of my friends at Yale had started working in rural Nepal in 2006, and had formed a non-profit organization called Nyaya Health (“Nyaya” means “justice” in Nepali). While I was very devoted to the community I had been working with in Zimbabwe, I was also interested in expanding my scope of experience, and in particular, working with a program more focused on community-based preventative medicine and infrastructure development. I began working with with Nyaya while in school at Brown, and over time, decided to shift my energies from Zimbabwe to Nepal. For me, Nyaya was more in line with my future goals and understanding of health system development than the rather “band-aid medicine” model of my work in Zimbabwe under the Mugabe dictatorship (which is certainly not to detract from the incredible importance of this type of work). Currently, I am serving as the Executive Director of Nyaya Health International and volunteering full-time in a managerial role at our first full-service hospital here in Achham, Nepal.

What is most difficult about your global health work? Most rewarding?

Paul Farmer, paraphrasing an old African proverb, challenges us: “How does an ant eat an elephant? … One bite at a time.”

There are quite a few days on which the challenges of our work can truly feel overwhelming. Days in which the enormity of the problems in front of us and the daily circumstances that often seem Sisyphean in their scope, can really just beat you down. But I think that it is those very days, and the degree to which they challenge us, that makes our work as rewarding as it is.

In the face of such massive problems, I try to think of what mentors such as Paul have taught me, and slowly but surely, keep on taking bites out of the monstrosity in front of me. I do often feel like an ant trying to eat an elephant, but my own frustrations are far outweighed by the inconceivable struggles that our communities face on a daily basis. Each bite is a mountain that can often seem insurmountable, but with each bite that each one of us takes, we all learn more, and soon, one bite will become many bites. We may only bite the elephant’s foot at first, achieving local change, but with time, we will chew on his leg and his belly, moving towards truly changing the system as a whole.  

How does your global health work fit in with your career plans?

I plan to be here in Achham for the duration of this year, and then, following the completion of my fourth year of med school, begin a Med-Peds residency. Thereafter, I hope to be able to work full-time in the NGO and public-sectors of developing nations, working to build health system infrastructure. I hope that I will be able to use my background in both medicine and health systems management to ameliorate some of the injustices in our world. 

What has your experience been with global health at Brown (Framework, GHI, etc.)?

Since I first came to Brown in 2006, I have often been struck by how fortunate I am.  Speaking to friends at other medical schools, it is humbling to realize the difficulties that many of my colleagues face at their own institutions while trying to get their global health work approved, much less funded, as has so often been my experience over the past several years.

As a member of the initial class of the Global Health Scholarly Concentration, I have been able to watch as Brown has scaled-up its efforts to support global health work over the past several years. I remember, during my first year here, being pleasantly surprised to find out that I was able to get my plane tickets to Zimbabwe paid for by the Foreign Studies Fellowship, and that there were other University grants that were able to help pay for my research and living expenses. Since then, with the Fogarty-funded Framework in Global Health and Brown’s own Global Health Initiative, I have found myself with even more institutional support and an academic home which I can continue to rely upon in the future.

To be understated, I consider myself extremely privileged to continue to benefit from such support. Without the impressive amount of financial assistance, and more importantly, the academic backing and guidance of my faculty mentors, my work would simply not be possible.