The Dr. Mario Pagenel Fellowship in Global Mental Health Delivery provides an opportunity for post-graduate psychiatrists to collaborate with mental health colleagues in global health settings, enhancing service delivery while also exploring opportunities for academic research. This year’s fellows are working at Partners In Health’s (PIH) sites in Liberia and Rwanda to accompany local healthcare workers and mental health program teams, collaboratively devising plans to strengthen the quality of mental health care, share their clinical expertise, and develop an area of academic focus in research or education related to global mental health delivery. This week, we hear from Dr. Mary Yang, the current Pagenel Fellow working in Liberia.
Since October 2019, Mary has been working with PIH in Harper in Maryland County, a rural setting Liberia far outside of the capital city. PIH chose to begin work in this area, specifically, in order to bring care to those in rural settings, upholding a mission to provide those who are poor with access to care and preferential options for treatment. In Harper, Mary’s work is focused on improving mental health service delivery in the county. The day-to-day focus of her work is clinical accompaniment and she spends time with clinicians in clinic, the community, and hospital ward seeing patients together.
Mary attended McMaster’s Arts and Science Programme for her undergraduate degree and she completed her medical training and psychiatry residency at the University of Toronto. In her residency, Mary participated in outreach trips to communities in Ontario, Nunavut, and had the privilege of participating in the Toronto Addis-Ababa Psychiatry Project, which established the first psychiatry residency program in Ethiopia. In the future, Mary hopes to continue to work in areas that improves service and care for the most marginalized around the world.
Q&A with Dr. Mary Yang
Louisa Hudson Question: What lead you to choose to a career in global mental health?
Dr. Mary Yang Answer: I have been interested in global health since my undergraduate studies, and discovered psychiatry later in medical school. I was not sure how the two would intersect until later in my residency. My experience with the Toronto Addis-Ababa Psychiatry Project was formative in providing an opportunity to work alongside Ethiopian colleagues to provide one-on-one clinical teaching and supervision. The residents’ dedication to their patients in a very challenging environment was utterly inspiring and I would say this was the biggest motivation for me in entering the field.
| Dr. Mary Yang working at JJ Dossen Hospital, in Harper City, Maryland County, Liberia |
Q: Why did you choose psychiatry over other service delivery methods?
A: I love the field of psychiatry and tremendously enjoy the day-to-day work of seeing patients. Our work is profoundly human, challenging, and always different. There is much we don’t understand about the brain and the mind, so there is much to be humble about, yet there are many things we can do to improve quality of life. Psychiatry is also less dependent on technology than some other specialties, and high quality clinical assessments are central.
Q: Can you share some of the struggles you have faced in your career and what inspired you to continue in this field?
A: I struggled for some time in my psychiatry residency with how to combine my interest in global health with my clinical interests. Global mental health is still a relatively new field, and I was not sure of what opportunities actually look like on the ground. I was interested in opportunities to participate in capacity building, education, and research that makes a difference to the lives of patients – hence, I was very glad to have found the Pagenel Fellowship! I think seeking out mentorship in people whose sensibilities I admired, and actively seeking opportunities were key.
Q: What goals did you have when you were preparing to leave for Liberia? And how have these adjusted since you have been there?
A: I did not have many specific goals in preparing to leave for Liberia. My fellowship director and team in Boston oriented me to the key task of building relationships, above all. This was so tremendously true – I was, and am in still in many ways, a guest to the team, and building relationships with mutual trust and security is essential before people can really hear what you might have to say. Since I have been here, I would say the goal for the next few months of my fellowship is being even more observant and aware of how things work. Understanding the work of the team, culture, local context is definitely a recursive process, and it’s easy to think you know something confidently only to find out how much you might have overlooked or misunderstood.
Q: How are you finding the experience of providing care in a culture and country that is not your own?
A: I don’t provide care directly, and so my experiences are filtered through the lens of the local providers with whom I work. While there are many cultural differences, I would say that most things are universal: the need to be heard and understood, the need for connection, acceptance and community.
Q: Are you finding stigma around mental health to be an issue in your work in Liberia? And how does this compare to other countries you have worked in?
A: Stigma around mental health is a major issue in most places around the world. The team I work with in Liberia has done tremendous work against stigma in the local community. I believe the most convincing anti-stigma work has been providing effective treatments.
Q: What has been the highlight of your experience in Liberia to date?
A: Liberian culture is extremely extroverted, loud, and funny. Liberians have a great sense of humor!
Q: Any additional comments?
A: Many patients I have met in Liberia have expressed how much they want more interventions to address disorders that are often overlooked (e.g. common mental disorders such as post-traumatic stress disorder, depression, etc). While I have always believed that it is a human right to have access to high quality medical treatment, it has been even more humbling to listen to patients expressing desire and need for interventions that alleviate suffering.
Global mental health is an amazing field. We need more psychiatrists interested in this work, and in accompanying our colleagues in the low middle-income countries who are doing this incredible, challenging work.
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Written by Louisa Hudson, Research Assistant, Department of Global Health and Social Medicine, Harvard Medical School
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