Icahn School of Medicine at Mount Sinai, New York, NY
For the past nine weeks, I have had the privilege of interning for Dr. Cappy Collins, who works in the Pediatric Environmental Health Specialty Unit (PEHSU) at Mount Sinai. This summer experience was creatively named a “Communitology” internship, as I had the opportunity to learn about community health from several complementary angles. These perspectives included classroom style lectures, PEHSU board meetings, workshops with pediatric environmental health specialists, and a public health summer bicycling program for children from East Harlem.
My childhood fascination with the mysterious complexity of science eventually evolved into a passion for medicine, as, through life experiences, I discovered the rewarding fulfillment generated by helping and forming connections with other human beings. Last summer, I was fortunate enough to intern with the Kigezi Healthcare Foundation in Kabale, Uganda. One aspect of this experience involved day trips to provide health services to rural communities. Through these community visits, I learned to critically analyze the realities of health access, the social determinants of health, and how our fundamental beliefs determine our approaches to and interpretations of health decisions. The impossibility of treating each person in Kabale was strikingly apparent, so we worked on several projects aimed at prevention and education. Additionally, during Williams’ Global Medical Training Break-Out Trips, I observed patient care in mobile clinics in the Dominican Republic and Nicaragua. These experiences also elucidated the limitations of traditional medicine as a single approach to overall health, particularly in impoverished communities, and increased my interest in pursuing public health.
All of these experiences in global health solidified the unfortunate truth of the shortage of doctors to treat every individual in need. While my interest in attending medical school is unwavering because of the paramount value I place on one-on-one patient interaction, I became passionate about the promise of also incorporating public health into my career to affect the level of the community. I pursued this opportunity at the PEHSU to gain exposure to the main health challenges faced by people in East Harlem, a community right here in the United States. Dr. Collins served as an ideal mentor because he is both a pediatrician and the founder of a public health summer program for East Harlem youth.
During the first two weeks of the summer, Dr. Collins focused on teaching his interns the framework concepts necessary to improve health at the level of the population. I learned that the term “environmental health” is actually somewhat synonymous with community health in that it involves taking into account all of the factors that could impact one’s wellbeing. These include physical health, mental health, one’s occupation, socioeconomic status, family structure, responsibilities, neighborhood, and home environment. Past incredible, empathetic mentors taught me the importance of acquiring all of this information when taking a patient’s history, but I was unaware it could be concisely referred to as environmental health. Dr. Collins emphasized two main topics this summer: upstream vs. downstream interventions and the Frieden public health pyramid. We discussed the United States’ healthcare spending and specifically how 97% of the money spent is on downstream clinical approaches instead of preventative public health measures. The Frieden pyramid describes the five levels of health intervention, including education, clinical, long-lasting interventions, change in the context or societal expectation, and transforming root causes such as poverty and resource allocation. The model states that the efficacy of one’s efforts increases further down the pyramid toward root causes, while the burden on the individual is highest at the top with unreliable educational and clinical interventions.
Dr. Collins specifically focuses on how early childhood adversity severely affects neurodevelopment and thus contributes to disease later in life. In attempting to put theory to action, he designed a summer bicycling program for kids in East Harlem that aims to boost resilience to chronic stress through positive youth development and a curriculum centered on civic engagement. I spent four days a week with this group of 10-15 riders, many of whom had little biking experience before the start of the summer. Over the course of seven weeks, they covered about 180 miles around all five boroughs of New York City, exploring destinations such as Inwood Hill Park, the Bronx River, Governor’s Island, The Met Cloisters, and the Palisades. Not only did they accomplish physical feats like crossing the Queensboro Bridge or biking 10 miles on a muddy trail, but they expanded their sense of community by gaining confidence in how many different parts of the city are accessible by bicycle. On non-ride days, the Cyclopedia riders participated in an intensive STEM curriculum and had the opportunity to meet with activists in East Harlem, including the founder of Cafeteria Culture and Councilwoman Diana Ayala. It was extremely motivating to track the progress of the students, as I saw a notable change in their self-confidence, determination, and positivity. The riders complete time trials and stress surveys at the beginning and end of the program, and the overall data for the past several years has shown that students improve their biking speed and report lower overall stress by the end of the summer.
Aside from this summer public health program, Dr. Collins is also highly involved in Mount Sinai’s PEHSU. This specialty unit’s mission is “to provide clinical consultation and education to families, health care professionals, public health officials, and community organizations who have concerns regarding environmental exposures in children and pregnant women.” Every week, I met with a resident to review that week’s most prominent cases before attending the PEHSU board meeting. This is where I heard these cases discussed and debated from a wide range of physicians, environmental health scholars, toxicologists, and industrial hygienists. The group constantly highlighted the limitations of toxicant testing from commercial labs, as these tests have no reliable diagnostic value because of the often arbitrary reference intervals. Many of the cases involved lead or mold, exposures that have been well researched, yet messaging to the parents was consistently and simply to remove the source and ventilate. By the end of the internship I understood that, from a public health standpoint, the best response to a parent is one that reduces anxiety and provides the parent with a sense of agency. In addition to these PEHSU case discussions, I attended several lectures, a workshop on designing message maps to respond to media inquiries, and a tour of a groundbreaking lab that maps baby teeth to find biological markers that signal disease. These experiences working with physicians and public health specialists within the confines of Mount Sinai complimented my work with Cyclopedia and further expanded my view of environmental health.
I was so fortunate to intern under a physician who successfully combines clinical and public health work in his career, and I am deeply influenced by the unwavering dedication of these doctors to addressing the root cause of their patients’ health decline, whether it be elevated mercury levels or chronic stress due to the patients’ home environment. I am sincerely grateful to the ’68 Center for Career Exploration, as well as the Class of 1972, for the support of my summer internship.
Megamenu Social