2018 - Healthcare as a way to address larger societal injustices: an interview with Nina Sreshta

August 29, 2018

Nina Sreshta is a Mario Pagenel Fellow in Global Health Delivery.

What is your current position?

I just started a job with Partners in Health/Inshuti Mu Buzima as their Mario Pagenel Fellow in Global Mental Health Delivery. The job of the Pagenel Fellow in Rwanda is to help the local team scale up the integration of mental health care in primary care. Primary care nurses are being trained in a couple of districts to deliver diagnostic and treatment interventions; this sort of task shifting is important in Rwanda but also in most of the world, because there is a shortage of mental health specialists.

How many years have you been working in healthcare?

I graduated from undergrad with a degree in cultural anthropology and subsequently went to medical school. I did my residency in adult psychiatry at Cambridge Health Alliance. In total I have spent 8 years in healthcare.

What brought you to the position you’re about to start?

I went to medical school because I view healthcare as a way of addressing larger societal injustices that play out in people’s ability or inability to live a life of agency and access to joy. In medical school, I realized that much of suffering involves a psychological component; physical pain and illness contribute to psychological suffering, and vice versa.  I also came to see that the burden of most diseases is disproportionately experienced by marginalized and vulnerable populations.

In residency, I worked with asylum seekers, conducting interviews and writing up psychological affidavits for use in their court hearings. The individuals I worked with were fleeing persecution in their country of origin due to a number of reasons; however, what was common is that each asylum seeker was experiencing significant psychological symptoms months and years later. I’d always wanted to work in global health, and conducting these asylum evaluations was a way of being involved in global mental health locally. The work has a lot of cross-cultural elements;  practitioners must understand a person’s context from a historical and socio-political perspective in order to understand what they’re going through in their current psychological state.

Dr. Bepi Raviola gave a talk on PIH’s approach and their current projects in Haiti and Rwanda at a conference I helped organize on social justice in psychiatry in the fall of last year. I learned about the Pagenel fellowship through Dr. Raviola’s talk.  I was fascinated by the fellowship’s use of the collaborative care model, which has proven to be effective in delivering mental health care to people who otherwise wouldn’t have access. I had already been interested in and had been working in this model, and I felt compelled to apply for the fellowship to learn more about improving access to mental health care in underserved areas globally.

What is something that you wish to accomplish in your career or any goals that you have?

As I look forward to my time working with PIH/IMB in Rwanda, I hope to be part of the wonderful efforts to improve access to mental health care. In doing so, I will be taking the lessons learned from the GHDI course: how one should always deeply consider context when performing any intervention, and monitor and evaluate the efficacy of the intervention. There are many ongoing projects that I will help support in Rwanda, but applying the approaches I have learned in the GHDI course is my short term goal. In the long term, I want to be part of the creative solutions to the issues around caregiver burnout and depression, whether that be medical providers or non-medical caregivers. I think the risk of medical and non-medical caregiver burnout may be even higher in places where there are fewer providers and resources, so being cognizant of this element and thinking about solutions is something I am generally interested in.  

What would be a challenge that you’ve faced so far?

I think the biggest barrier to addressing caregiver burnout is perspective. It is not enough to simply improve individual resiliency, there are systemic issues that contribute to this experience which would need to be addressed.

When you were applying to GHDI, what were you hoping to get out of this program?

When I’ve talked to previous fellows, they had such positive things to say about the GHDI experience. The leaders, instructors, and colleagues in this course are phenomenal. There is very careful attention paid the to the curriculum, the instructors bring the leading experts in global health to come speak to us in class, and my colleagues are exceedingly passionate and supportive. The people who attend this course come from a wide variety of backgrounds. Notably, there are individuals who have been working in their respective countries for decades, so they bring much practical experience to the classroom.

What impact do you think GHDI will have on your career?

I think GHDI has helped me get perspective and develop a framework for how to approach issues in healthcare and global health more specifically. The biggest takeaways for me were remembering to think about the context from a wide lens, taking into account sociopolitical and historical factors, considering what incentivizes individuals in making choices, and how one should consider such pressures when designing interventions. Being specific about what defines success when running a program and choosing outcome measures are key concepts I learned through the case studies, the lectures, and the vibrant classroom discussions.  

Also, and importantly, the network. The GHDI instructors and colleagues are committed and courageous. Each has worked in imperfect systems. I feel really luck to have gotten to know their work so intimately. I hope that we continue to stay in touch and work together in the future.

What are you most proud of in your career?

I did a lot of community building in residency—creating spaces for minority trainees, and creating spaces where residents and allied healthcare professionals could process and reflect on work, work-related stress, and personal stress. I’m really proud of that work because I felt like it helped build community in an intentional way and bolstered individual and group resiliency.
What advice would you give to someone just starting out in healthcare in your country?

This may be trite, but do what you love and be who you are. Develop both the skills that you want to cultivate and those that come naturally to you. Be the full expression of yourself because you can then help other people, and be an effective part of the movement through that. You’re probably going to be more passionate about the things that you want to do than something that you are forcing yourself to do. When you look at our GHDI cohort, we all have unique experiences and different personalities—that’s  great, because in the effort to provide more equitable health care globally, we need everyone.