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Amy B. Saltzman ’05

M.D.-Ph.D. Candidate, Social and Medical Anthropology, Harvard University

I learned about anthropology almost entirely by chance. As a fall-semester freshman, I knew I wanted to do everything I needed to do to become a doctor, but I did not know much else about what I wanted to study in college. I certainly did not know anything about anthropology—even simple things like what it is. Glancing through a Latin American studies brochure before a meeting with my freshman-year academic adviser during Freshman Week, I noticed the last course listed in the pamphlet, “Medical Anthropology.” Two days later on the first day of classes, I was the only freshman in the 90-student auditorium listening to Professor João Biehl explain the discipline: Medical anthropology is the study of people’s experiences of wellness, illness, and medical intervention aimed at understanding the complexities of suffering and considering the interventions designed to alleviate that suffering.

Until that day, I had assumed I would study molecular biology. Fascinated with science since about age six, I had worked in a genetics laboratory at the medical school in my home city since ninth grade and competed in national science fairs throughout middle and high school. As I enrolled in introductory molecular biology courses in my freshman year at Princeton, I planned to work toward completing all of the molecular biology course requirements (alongside the pre-med requirements) and start working in a Princeton lab as soon as possible. As I made and began to execute this plan, my studies of how history, culture, and political economy influence people’s experiences of illness began capturing my imagination and my focus. After taking “Medical Anthropology” and several other anthropology courses throughout my freshman and sophomore years, including “Cultures of Science and Biotechnology” and “Medicine, Power, and Politics,” I was sold on becoming an anthropologist.

Discovering new interests

Even as I continued to complete my pre-med requirements and take the electives that interested me in the molecular biology department (“Genetics,” “Biochemistry,” and “Diseases in Children: Causes, Costs, Choices”), I began working with several professors in the anthropology department—most closely with Professor Biehl, who had taught that “Medical Anthropology” course my freshman year. The anthropology department was enormously supportive and small (with lots of opportunities for personal attention and one-on-one advising), and the discipline’s flexibility allowed my classmates and me to study pretty much any topic through the lens of anthropological theory and methodology. As my current Ph.D. adviser in social and medical anthropology likes to say, anthropology ventures to ask the difficult questions of social and political complexity that other disciplines are not always willing to ask but then works with those other disciplines to try to answer them. Because of this characteristic, any subject can be explored using anthropology.

As I learned about anthropological methods during my junior year, I conducted original ethnographic research on experiences of postpartum depression among American mothers to inform my junior paper. I also got a job as a research assistant for a Harvard University physician-anthropologist during the summer between my sophomore and junior years, which allowed me to develop my interest in postpartum illness. With that professor’s support, I spent three months in Fiji between my junior and senior year conducting an ethnographic study of postpartum illness among indigenous Fijian women, many of whom experience a postpartum syndrome called na tadoka ni vasucu. My thesis emerged as an ethnography of motherhood and illness in Fiji based on my months of fieldwork. More importantly, however, the time I spent in the impoverished Fijian community in which I conducted my fieldwork taught me how political turmoil, ethnic conflict, geography, climate, and unequal global flows of resources shape epidemiology and illness experience. To me, that lesson is central to the canon of medical anthropology.

Still certain that I wanted to one day become a doctor and newly convinced that I also wanted to become an anthropologist, I applied to joint M.D.-Ph.D. programs in social and medical anthropology. As I waited to hear from these programs, I realized that a year away from academia would offer me a critical chance to think outside of the world of the Ivy League. Unsure of quite literally where to go next, I applied to several different fellowship programs but ended up deciding on an opportunity that would let me continue to learn about experiences of illness in the context of motherhood.

With the support of a Princeton in Africa fellowship, I moved to South Africa after graduation to work with a grassroots network of HIV-infected mothers dedicated to preventing mother-to-child transmission of HIV. Working in a rural, racially divided region with extremely under-resourced public health services, paralyzing stigma against HIV-infected people, and no antiretroviral treatment, I came to further understand how political, economic, and social forces limit health outcomes. I watched as severely limited resources in rural public health institutions combined with government refusal to provide antiretroviral treatment free of charge led to the AIDS-related deaths of seven of my friends and colleagues in just four months. Over the 15 months I spent working with these mothers, I witnessed how political economy and the legacy of apartheid dramatically restrict people’s life opportunities and access to work, health, land, and home. My experiences on the ground in South Africa reaffirmed my plans to study anthropology alongside clinical medicine.

Integrating diverse experiences

After returning from South Africa, I enrolled in Harvard’s M.D.-Ph.D. program in social and medical anthropology. I have now completed three years of clinical training and am currently in my final year of doctoral coursework in anthropology. In July 2011, I will begin a year of fieldwork between Cape Town and the rural former Transkei region of the Eastern Cape, South Africa, studying how HIV- and tuberculosis-infected labor migrants think about what kinds of health care are available to them (biomedical and nonbiomedical) and make decisions about accessing care in order to reconsider health system design in South Africa and better serve the health needs of the country’s large migrant population.

Through my ethnographic work, coursework, and clinical training over the past decade, I have come to realize that neither clinical medicine nor anthropology alone offers a complete perspective on the experience of illness. Only upon combining the two disciplines’ practical, methodological, and theoretical training can I craft an analysis that optimally informs public health practice. My dissertation research is a first step in developing such an interdisciplinary analysis to inform health systems' design and health service provision by considering the history, political economy, and social forces behind illness experience.

I have now spent a total of about 24 months in South Africa, working on a variety of clinical, public health, and ethnographic endeavors, and I am committed to continue working there long term. My career goal is to craft an integrated and balanced analysis combining the theories and methodologies of clinical medicine, anthropology, and public health. Working simultaneously as a clinical doctor, an ethnographer, and a public health practitioner, I will strive to more completely understand and theorize illness experiences, contributing both to the practice of clinical medicine and public health, as well as to the study of anthropology.

I still think back to that first “Medical Anthropology” course frequently; in fact, I refer to articles in the course’s Pequod packet pretty regularly these days as I work on my dissertation research proposal, and I am in close contact with Professor Biehl as I make various decisions about my research and my career path. I have no doubt that had I continued along the path to major in molecular biology, I would have also found a research project I felt passionate about and would still be on my way to becoming a physician-scientist. No matter the would-have-beens of that route, anthropology has certainly taken me in a different direction, one that fulfills me intellectually and personally as I travel back and forth between Boston and South Africa, clinical practice and research, and basic and social sciences.