No Teen Left Behind: One Fellow's Mission

Merrian J. Brooks, DO, MS Early in her training, Merrian J. Brooks, DO, MS, knew she wanted to be a health researcher to improve the health and lives of as many people as possible. During her fellowship in Adolescent Medicine, she found herself leaning more and more toward pursuing a second fellowship in Global Health. This fellowship would allow her to broaden her knowledge about different health systems, enable her to work with children of all ages, and enhance her research and teaching skills. All these were critical to her mission of improving the lives of as many children and their families as possible.

She discovered the David N. Pincus Global Health Fellowship at Children’s Hospital of Philadelphia (CHOP) would be the ideal program. It offered:

• A fully immersive in-country experience for two years (recently expanded to three years)
• Access to expert mentors from CHOP and the University of Pennsylvania
• Support from in-country clinicians in Botswana or the Dominican Republic depending on where her fellowship was located

If Dr. Brooks needed further proof that the CHOP program was the right fit for her interests, her interview experience further convinced her.

“During my interview with the CHOP partners in Botswana, it was clear to me that while they valued the adolescent medicine expertise I would bring, they were also genuinely interested in supporting my professional development,” says Dr. Brooks.

Clinical care and more

In July 2017, Dr. Brooks began her Global Health fellowship at Princess Marina Hospital in Gaborone, Botswana. After a month-long orientation, her regular schedule involved splitting her time between inpatient care, adolescent clinic consults, research, and teaching residents and medical students.

During her first few months in-country, Dr. Brooks developed a rapport and trust with both her colleagues and patients. Through her clinical work and conversations with the many people who care for and about adolescents in Botswana, she noticed an abundance of adolescent mental health needs.

She approached her mentors, Andrew Steenhoff, MBBCh, DCH, the David N. Pincus Global Health Fellowship Director; Elizabeth Lowenthal, MD, MSCE, CHOP Global Health Research Director; and Tonya Arscott-Mills, MD, MPH, Lead CHOP Pediatrician in Botswana. This team, together with faculty from the University of Botswana, supported Dr. Brooks’ as she developed her fellowship project.

Dr. Brooks' project focused on adapting and evaluating the effectiveness of a near-peer lay counselor intervention program to reduce depression and anxiety among adolescents living with HIV.

With her mentors’ support, she was able to secure pilot research funding for the project from the Penn Mental Health AIDS Research Center (PMHARC) and the Penn Center for AIDS Research (CFAR). The project helped Dr. Brooks better understand the specific mental health needs of adolescents living with HIV. She then screened youth living with HIV and those at-risk of developing depression/anxiety. While Dr. Brooks is still analyzing all the data, preliminary analysis shows symptoms of depression, anxiety, or problematic substance or alcohol use were seen in up to 30% of the youth in the two populations.

Lessons learned

Dr. Brooks recently completed her Global Health Fellowship and is now a clinical instructor at CHOP. Her new role enables her to spend nine months a year living and working in Botswana. She is also an Adjunct Lecturer at the University of Botswana School of Medicine.

The skills and expertise she gained during her CHOP fellowship remain relevant to her current work in Botswana. She feels fortunate to have gained an overarching understanding of health systems by practicing in a publicly funded health system that prioritizes public health, while continuing to interact with patients one-on-one.

Dr. Brooks says she also gained a deep appreciation of the challenges, limitations, flexibility, and creative thinking that is required when conducting global health research. Through her teaching experiences, she recognizes that cultural nuances must be considered if teaching and learning opportunities are to be effective. Dr. Brooks says she learned a lot about judiciously using resources ― lessons that are valuable and transferable to the United States as well.

As a cultural outsider, Dr. Brooks says she was able to continue learning herself and bring lessons in cultural humility to Botswana – lessons she honed as a student and physician working with racial and ethnic minority patients and families in the U.S.

Dr. Brooks is continuing her research to understand and develop evidence-based interventions to address the mental health needs of adolescents in low-resource settings at the community level, as well as the health systems level. To expand the impact of her work, Dr. Brooks is committed to teaching not only other physicians, but also social and mental health providers and parents about ways to engage with adolescents to improve their health and wellbeing. She  looks forward to working with colleagues around the world to “leave no teen behind” – by helping make the world a better place for all adolescents.

Encouraging future fellows

Now a graduate of the David N. Pincus Global Health Fellowship, Dr. Brooks urges other early-career pediatricians and subspecialists to consider becoming a fellow themselves. She says CHOP's program is ideal for individuals who:

• Want to be leaders in Global Health and within their respective subspecialties.
• Have a keen sense of how they would like to contribute to efforts to improve global child health. While a 3-year fellowship may seem long, the time goes by quickly in global health. Fellows who have an idea of what they want to accomplish through the program will help them maximize their time in the program.
• Are passionate and flexible – moving to a new country for 3 years is not easy, but the many benefits are hard to quantify!

How to become a Pincus Fellow

Early-career pediatricians and pediatric subspecialists interested in learning the skills to become a leader in pediatric global health should consider this fellowship. The program is an expertly mentored and fully-funded three-year experience in global health practice. Learn more about the David N. Pincus Global Health Fellowship, or request an application by emailing the CHOP Global Health Center at globalhealthcenter@email.chop.edu.