Introducing Sirinya

Sirinya advises students and alumni of Harvard College and GSAS who are interested in pursuing a career in medicine, dentistry, veterinary medicine, or another health profession. Prior to joining OCS, she spent five years as a Preceptor in chemistry and chemical biology at Harvard, teaching and managing two introductory courses: Physical Sciences 1 and Life and Physical Sciences A. Sirinya earned her bachelor's degrees in chemistry and biology from Cornell University, and her PhD in chemistry from Harvard University. In her doctorate work she performed organic synthesis of a small molecule library and screened it for biological activity. A few of her compounds have been studied for their effectiveness in combating the hepatitis C virus. During her graduate studies, Sirinya served as a resident tutor in Dunster House where she discovered her passion for advising undergraduate students and for preparing meals for large events. In her spare time, she enjoys cooking, traveling, digital photography, playing with her son, and walking her dog, Gaius, whom you may see occasionally in her office.

"Surgeons rock out in the operating room..." and more, by Omar Mesina'14

For the past month I have been shadowing Quirurgica, a private team of general surgeons in Barcelona, Spain. In the past few weeks I have had numerous experiences that have both informed and cemented my aspirations to pursue medical school and hopefully, surgery. Any undergraduate in the pre-medical track will attest to the fact that there is an overwhelming desire to partake in memorable medical or scientific research while in college. While I do believe that this sort of passion is what fuels discovery, I am also of the belief that simply observing, and taking in what the career you envision yourself in entails is as equally rewarding. I knew the importance of medical shadowing but it never revealed to me as an experience I would want to undertake for a whole summer.

Over the course of five weeks I have observed and scrubbed in to multiple surgeries: thyroidectomies, laparoscopic cholecystectomies, colectomies, various hernia repairs, and hemorrhoidectomies to mention a few. Aside from shadowing in the OR I also spend a significant portion of my week in clinic with the surgeons, sitting in on patient visits and have gotten to witness numerous cases from the very first visit to the post-operation appointment. Below are some of the reflections I have had over the past few weeks:

1. To the patient, this is a huge deal. No matter how many thyroidectomies or gallbladder removals the surgeon has done, the patient is experiencing one of the most significant and scariest events in their lives. In my seven weeks with the surgeons I have learned a lot about the symptoms, diagnostic tools, surgical procedures and post-operative treatment for many of the cases they treat. I have seen many patients come in with nodules on their thyroid that is easily treatable (albeit trough a very invasive way as it involves total extirpation of the gland). To the uninformed patient, the moment he or she hears “tumor” it is quickly associated with cancer. In order to provide care appropriately it is vital to see things from the patient’s perspective. It is easy to forget that what may seem like something insignificant to the doctor is really a big deal to a patient.

2. Surgeons rock out in the operating room. Yes, they listen to music---Queen, Beatles, even Taylor Swift. The first day in the OR, I expected to be in an intense place where all I would hear is the beeping noise of the anesthesia machine. Much to my surprise, as the surgeon began to make the first incision for a thyroidectomy he asked the rotation nurse to turn up to the music and “Don’t Stop Believing” came on---probably the most ubiquitous, overplayed song ever written. Of course, there are times during the procedure when the surgeon will ask to turn the music down, but generally music can make the procedure calmer for the surgeon---much like any student who may enjoy doing their problem sets to their favorite tune.

3. Operating rooms can be scary. Patients may arrive in surgery nervous and scared. Therefore, the time when they are wheeled into the operating room is a very sensitive time. Most of the time the duty of comforting the patient falls upon the anesthesiologist, who calms and soothes the patient into unconsciousness. If anything, anesthesiology is one of the most important fields in medicine. Historically, most of the life-saving procedures undergone today were not possible without the proper handling of anesthetics. Having the knowledge and skill set to comfort a patient and not have them feel a single thing while they’re being cut into must be fascinatingly rewarding.

4. Surgeons (and residents) don’t eat. Most days I shadow my mentor surgeons all day, sitting in during patient visits, going around hospital rounds, and scrubbing in to the OR. After a few days the realization came as a shock: an unbelievable hunger on most afternoons. To truly thrive in this setting you must be able to disregard your natural body necessities, and ignoring hunger is definitely one of them. Surgeons and residents and other hospital staff do not necessarily have a scheduled meal break and must find time to quickly do so. Most pre-medical students are aware of this fact but it’s a different story to experience how uncomfortable it is to be hungry almost all day. These past few weeks I’ve realized that this will be an inevitable part of pursuing medical school and that as obvious as it may seem it could definitely be a deterrent for anyone who is not expecting it.

5. Being a surgeon is like being a detective. A patient may arrive to the surgeon’s office with certain symptoms and diagnostic tests pointing to a certain pathology, but there may be a piece of their medical story that might not completely fit in. My favorite part of my summer experience is listening to the surgeons discuss their week’s most difficult cases in their weekly team meeting. Each surgeon presents his or her case, the procedure that was undertaken and asks for advice or suggestions on how to follow-up. Just this week my mentor surgeon had a case of a woman with medullary thyroid carcinoma (MTC), who had alarmingly normal calcitonin levels. Normally, the biochemical activity of MTC is increased production of calcitonin. Cases like these are extremely rare and there are very few published; the surgeons are hoping to publish this case in the near future. It was such a privilege to be present during this case and I’m continuously awed at how knowledgeable they are, which has personally served as an impetus to keep working hard towards medical school.

6. Surgeons thrive in seeing an immediate palpable positive outcome. My mentor surgeon has repeatedly told me that the reasons he enjoys his career so much is because he is able, within a span of a few weeks involving pre-operational, operation, and post-operational care, to improve a patient’s health. Luckily, I’ve been a witness of this account. During my time with him this summer I have journeyed with patients from their very first visit, to the OR, and finally to their post-operation appointment. A surgeon is able to bring an immediate improvement in the health of the patient through his or her own efforts.

My experience this summer has been truly amazing and I want anyone who is considering medical school to reach out and shadow physicians in fields you are interested in. I learned first-hand this summer how vital the shadowing experience is both to your own reflections on why you want to pursue medicine as well as to your medical school application.

Being Pre-med and Studying Abroad, by Meg Barrow'13

I hear it all the time: “Wow, you studied abroad? I would love to, but I’m pre-med.”

“Really?” I always respond. “I am too.”

Coming into college I wasn’t sure about many things, but studying abroad was something I knew I wanted to be part of my college experience. I had never actually left the United States, but ever since starting Spanish classes in middle school I was certain that I wanted the chance to live in and experience the culture I had learned about so often. On the other hand, being pre-med was something I wasn’t sure about at all. Science was always one of my strong points in high school, and I knew I wanted a career that involved working with children, but it wasn’t until I was accepted at Harvard that the idea of pursuing a career in medicine even crossed my mind. I decided that, while I wasn’t 100% sure medicine was where I wanted to end up, I should at least take the pre-requisites to keep it open as an option.

So, coming into freshman year I had a lot of stuff I wanted to cram into my four years here: concentrating in psychology, fulfilling pre-med requirements, studying abroad for a semester, and completing a secondary field in Spanish. I sat down the summer before coming to Harvard and came up with a plan of attack that proved to me that it was possible to do all of these things. Clearly I haven’t taken every single class I outlined in that plan and have adjusted along the way, but it certainly allowed me to be much more confident with my decisions knowing that it was indeed possible to fit everything in. One of those decisions was choosing to study abroad my sophomore spring in Alicante, Spain. Based on this plan I had made, sophomore spring was the best time for me to go abroad.

For me, the most important thing about figuring out a time to go abroad was being flexible with the semester and order in which I would take my pre-med classes. Many students think there is just one acceptable sequence in which to take pre-med requirements, but that is not the case at all. I’ve ended up taking LifeSci 1b my junior year after taking LifeSci 2 as a sophomore, and will take Organic Chemistry as a senior. When you actually look at the course listings, several of the pre-med classes can be taken out of what is seemingly a necessary order – you don’t have to take LS1b before LS2, for example, and I’m doing the entire Physical Science series before Organic Chemistry. Being flexible and creative with scheduling pre-med classes, combined with my plan of attack that gave me the confidence to pursue all of these paths, is what ultimately allowed me to find a way to fit study abroad into my schedule.

Studying abroad was by far one of the best decisions I have ever made. By the end of sophomore fall I was starting to get burnt out and began questioning my commitment to and motivation for being pre-med. I knew that I couldn’t keep justifying spending so much of my time on pre-med classes if I was only taking them to “keep the option open.” Studying abroad gave me the chance to remove myself from the pre-med culture at Harvard and really reflect on my personal goals and motivations for being pre-med. Having time away from science classes and a chance to explore other interests actually solidified and deepened my desire to pursue medicine. I came back junior fall refreshed and with a new sense of purpose, motivation, and determination to finish my pre-med requirements.

Studying abroad as a pre-med is completely possible. It may take some extra planning and flexibility on your part, but the experience and benefits of getting to immerse yourself in another culture make all of the tradeoffs well worth it. I challenge you to re-examine the role that study abroad could play in your college experience – as one of my friends put it, “You may always regret not going, but you’ll never regret going.”

Hands-On Medical Education in Rwanda, by Stephanie Novak

The Harvard School of Public Health now teaches the course "Global Health Delivery" in Rwanda. Also read about the new HSPH Masters in Medical Sciences and Global Health Delivery program: Hands-On Medical Education in Rwanda, published in The New York Times on May 13, 2012.

Alzheimer's Buddies featured in the Boston Globe

Click here to view the video "The Buddy System: Harvard Students Pair Up with Alzheimer's Patients, and Both are Enriched," featuring Ryan Christ'13 and Lauren Gabriel'14

Read the video's companion article Alzheimer’s program has special meaning for Harvard student

Tanzania's First Female Physician

Tanzania's First Female Physician

By: Sydney Green, 2013

Today I met the first female physician in all of Tanzania. She is the sweetest, most adorable, and small old lady I’ve ever met. And inspiring. Her story is beyond remarkable. How does one become a physician when there are no role models to look up to? And not just female role models, but males too. She informed us that there were only 12 physicians in the entire country before independence in 1961; she became a physician in 1969. Naturally, we were curious as to why she decided to become a physician. Her story began somewhat typical: her mother was very sick for a large part of her life and died while she was in secondary school. She always felt that if she knew what was wrong with her mother, her mother would not have died and others like her won’t have to die either. Yet, when she took the exam to get into the medical program, her scores were too low and she was instead referred to secretarial school. At this point many would have given up, and in a sense, she did. Her mother’s death left her and her siblings very poor, and she knew she had to go to school and work, so that is exactly what she did.

Upon graduating, she worked for a chief medical officer, who at the time was British (Tanzania was still occupied). She hated working there and her desire to be a doctor resurfaced. She told them about her dreams and they called it the joke of the century; she soon left, after less than a year. She transferred to a different department and again told them about her dreams. They too laughed. She left in three months. Basically, she was unhappy. This is where divine intervention comes in. Tanzania gained independence and the government wanted to send students to Russia to get additional schooling, sort of a way to develop the brightest students into leaders.

She decided that Russia was her chance to fulfill her dream to be a physician. For once, she was not faced with opposition; however, she was missing the basic science needed for entrance into a medical program. In order to enter the program, she would have to attend high school for two years. A grown woman would have to return to high school. Again, this would be the end of the road for many, but she held her head high, completed those years of high school and entered the medical program.

Today, she runs one of first private medical universities in Tanzania, after serving 20+ years at the national hospital. Everyone adores her. I wish you could all meet this phenomenal woman. And next time you think about giving up, remember this story and get back on your feet.

The HOWs and WHYs of Primary Care

We often think of primary care doctors as our hometown physicians - the pediatricians, internists and family practitioners that serve as the front line of patient care and treatment. For me, my first point of contact with the medical world entailed a visit with Dr. Kielar, the white-coated, bushy-bearded family medicine physician who served my small, 10,000 person town. Dr. Kielar ran his private practice on his own and was a recognizable figure about town; everyone at some point or another brought their colds, allergies, and school physical forms to Dr. Kielar.

This hometown doctor model of primary care is familiar to most, quaint and unexciting to others. Tuesday's discussion with several HMS affiliates dedicated to primary care, however, suggested that we should broaden our understanding of primary care beyond the one-physician operations that dole out our albuterol and vaccines. Instead, the speakers at Monday's event touched upon about new, medical team-based models, primary care physicians as important agents of driving down healthcare costs, and the increasing interest and value of incorporating lessons from public health and business into medical degrees. As the physician and two HMS students elaborated on, primary care provides an arena for important research on social determinants of health and the use of information technology in health, as well as a stage for social justice efforts. Most striking were the parallels Dr. Andrew Ellner drew between primary care and a field of increasing popularity amongst undergrads: "Global health is primary care." For medical students and doctors traveling abroad, taking on global health endeavors meant becoming that first line of medical response for those who otherwise would not have access to health care - and without the ample personnel, equipment, and resources typically available in American hospitals and clinics.

Whereas the Dr. Kielar model of primary care certainly still exists, the general theme that the speakers ultimately highlighted is that primary care is an advancing, changing field that will be crucial to tackling domestic and international health care concerns in the future. At Harvard, this change is taking place through the work of dedicated faculty and medical students - not just the white-bearded, small town doctors - and championed by groups like Primary Care Progress and the Center for Primary Care. Thanks to an anonymous $30 million donation granted to Harvard in the name of advancing primary care, these initiatives will become fixtures within Harvard culture as they attempt to make in an impact in a broader medical context.

Interested undergraduates can seek out learning experiences from groups such as those listed above as well as OCS.

-Emmett Kistler '11, Comparative Study of Religion, Eliot House

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What exactly is primary care and what should future physicians know about this ever-changing and dynamic field? This, among many other questions, was the focus last Tuesday when affiliates from the HMS Center for Primary Care came in to talk about their experiences thus far in primary care and to give advice to other aspiring physicians.

The event began with a brief primer on the state of primary care from Dr. Andrew Ellner, interim co-director of the Center for Primary Care. As a primary care physician (PCP) himself who has worked both domestically and abroad, he pointed out some of the flaws of the current U.S. health care system. The U.S. spends almost twice as much as any other country in the OECD, yet our outcomes are subpar for a multitude of indicators. The most frequently cited indicator: life expectancy. But what was more important were his views about why we actually see these trends for the United States. And the answer, as the data points out, is the behavioral aspect of how individuals interact with our medical system. It is fraught with ultra-specialization, where incentives revolve around emerging (and expensive) biomedical technologies and procedures rather than enhancing holistic medical care (e.g. the likes of family medicine, internal medicine, and pediatrics) that is more cost-efficient.

With these big-picture ideas in mind, students were able to ask more focused questions about the intricacies of primary care. This was an interesting discussion because in addition to Dr. Ellner’s thoughts, there were two HMS students, Deep Shah and Janine Knudsen, who were in the process of their own medical training. A lot of the students’ questions ran the gamut, from the stigma of going into primary care to the connections of global health and primary care to the benefits of taking a year (or more!) off.

One of thing that all panelists hoped to get across to students was that the necessary policy changes are being put in place to level the playing field among specialties, especially in the financial realm. As Deep put it, “There can be a lack of understanding of the health care system and how PCPs fit into it. Nevertheless, this perception of primary care is changing. But when it comes down to it, when you think about what being a doctor actually means to most individuals, primary care really fits this vision quite well.” Janine echoed these sentiments, talking about her experiences working with the Crimson Care Collaborative as well as her experiences helping a PCP improve the efficiency of his practice.

Throughout all of these questions and conversations, the panelists did a wonderful job of embodying what primary care is and how it is going to redefine the face of American health care in the coming years. At the end of the event, there was a concrete message for students: as broad-based policy reforms and funding initiatives take effect, the field of primary care will have opportunities for all of us to make the medical system a more interactive and user-friendly environment for patients.

-Vishal Arora '14, Economics, Pforzheimer House

"What freshman doesn’t think that she can do anything and everything?"

To be honest, I have a hard time remembering the specifics of the whirlwind that was freshman year: I have vague recollections of excitement, happiness, insecurity, and confusion. But the one thing I do remember is that by October, the once-majestic Sanders Theater was merely a Life Sci lecture hall seating a sea of freshmen and problem sets were already the bane of my existence. I remember my frustration with feeling that I had an obligation to prioritize my science classes over all else even though I found that reading for my Hebrew Bible class was the only schoolwork I really enjoyed doing. So despite my parents’ fears that I was abandoning my plans to become a doctor to instead become a priest or to join a cult, I reassured them that I could concentrate in the comparative study of religion while being pre-med. After all, what freshman doesn’t think that she can do anything and everything?

While trying to survive on a few hours of sleep and over-committing myself to various extracurricular activities proved to be unsustainable, it turned out that if anything, being a non-science pre-med was possible. Of course, I was fortunate enough to decide this rather early on in my Harvard career, as planning a four-year schedule that fulfilled all requirements for my concentration, secondary (in chemistry), med school, and cores was crucial in making it all happen. It would have been nice to have more room for electives, but I was already taking so many classes that I absolutely loved that I did not mind. Being a religion concentrator was rewarding in so many ways—the contrasting workload for my religion classes and science classes kept me from getting too bored of either, I loved the attention I received from the faculty, and the small department provided a close community as I developed relationships with the seven other religion concentrators of my year.

Most importantly, it constantly challenged my plans and desire to pursue medicine. Being passionate about another field of study made me question if medicine was really for me. Though doubt and uncertainty are not the most comfortable of feelings, I’m glad I experienced them. It pushed me to give myself some flexibility to consider other career paths and the possibility of study abroad. After some exploration in the food industry and an amazing semester abroad in Israel, when I came back to the pre-med track, I did so with conviction. It was only when I allowed myself to fully pursue my other academic interests but found myself a pre-med once again that I felt like I had made an active decision.

I want to encourage all students considering the pre-med track to feel empowered to and give themselves the opportunity to explore other interests without guilt. If anyone has the privilege of taking risks and stretching limits of comfort zones, it should be Harvard students.

—Paula Bu, '12

Introducing Paula

Hi, I’m currently a senior in Quincy House, concentrating in the comparative study of religion with a secondary in chemistry and I plan to apply to medical school next year after graduation. Throughout my time at Harvard, I’ve had the opportunity to explore my interests in science and health in a variety of ways: I’ve co-directed the Health Advocacy Program, an organization that aims to teach Boston middle school children about healthy eating habits, I’ve worked in the HEB Nutrition lab my sophomore summer, I’ve shadowed at MGH, and I’ve worked with Unite For Sight in Chennai, India. While these experiences were undeniably enriching for a person who was seriously considering the field of medicine, there is still a certain level of disconnect I feel with the label of being a “pre-med.”

I’ve also spent much of my Harvard career traveling, being involved in interfaith initiatives, and exploring my passion in food. Spending my junior spring semester abroad in Jerusalem, Israel, was singlehandedly the best decision I had ever made at Harvard and was an experience that critically informed my thesis for the study of religion, all the while solidifying my desire to become a doctor. I would love to talk about my experience as a non-science pre-med and as a student who has gone abroad. I am also currently working on my thesis (which is on Jews and sustainable eating), so if you are interested in any aspect of my experiences or have any questions, please don’t hesitate to contact me!